Chief Residents

[Adcadet]

just curious about Chief Residents. Who are they? Why are they doing an extra year? Is a Chief Residency almost required to go into academic medicine? How does doing one play into doing a fellowship?

Thanks!
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[Kalel]

Chief residents are PGY-4's who were selected among faculty and sometimes other residents to do a chief year. It's considered an honor to be a chief resident, and it does help with fellowship applications if you find out that you were selected prior to applying (for most people, this would mean defering fellowship by at least one year post residency). It is not required for academic medicine, but it does help you advance in academic medicine by having a chief year under your belt because so much of their time is spent doing administrative duties and teaching residents. Salary varies from program to program, some chief's get paid the same as junior faculty (60-80K), while others get paid as PGY-4 (50K), all chiefs have the ability to supplement their income by moonlighting.

 

[Adcadet]

Thanks for the info Kalel.

Couple more questions:
are most Chiefs probably headed towards fellowship?

are most Chiefs being fast tracked into a faculty position?

do any Chiefs end up in private practice or is this pretty rare?

 

[Kalel]

The majority of chiefs are probably headed towards fellowship positions, but I have met chiefs who were going into primary care or private practice the following year (Chief's of primary care tracks of course, but categorical as well). Doing a chief year supposedly helps your CV in the private sector as well because it shows that you have administrative training. It's not so much that they are "fast tracked" into a faculty position as it is just having something extra on the CV. It's like saying that you published a paper on an important research topic, it just looks nice.

 

[frank the tank]

I've noticed that some Chiefs at certain hospitals have done their residency at different institutions; I'm assuming these people weren't offered a chief year by their program but were still interested in doing one (or maybe they just needed a change of scenery). How often do programs seek outsiders to be their chiefs, and how do residents find out about these opportunities if you wanted to do a chief year but weren't selected at your home program? Does this carry the same prestige and help the same amount when applying for fellowships? Is the selection timeframe the same or a bit delayed?

 

[frank the tank]

Also, a lot of the chiefs I've met on the interview trail mentioned that they had never expressed interest in becoming one of the Chiefs, they were simply asked some time in their second year and then accepted it. Is it wise/beneficial to express your interest in becoming a Chief early on to the program directors, perhaps some time during your intern year? Or will they just make their own judgments based on their observation of the interns throughout that year, regardless of intern preferences?

 

[lurkerboy]

It depends on how the program does it, but basically the residency leadership will have a pretty good idea of who they want as chief. Some programs have the residents vote for who they want with approval by the PD.

 

[Apollyon]

And take a second look at places that have a chief that was a resident elsewheres: that means either none of their graduates wanted the job, or the administration didn't think any of their grads were good enough. Either way, that should be a minor alarm bell.

Also, anecdotally, someone who has been a resident elsewheres may not advocate well for the residents, and may instead be much more of an administrative pawn.

 

[lurkerboy]

Does anyone have a take on places that have chiefs that have already completed part or all of their fellowships? My sense is that this is a good thing but that the further out you get, the less you can connect with the residents.

 

[Fermi]

I was wondering about the salary of chief residents, seeing that you are giving up a year of "real" salary to do it. It seems some programs just pay chiefs at a PGY-4 level, maybe with a small supplement. But one community program I came across said that their chiefs are appointed as faculty and paid $130,000! If that were the case, I would certainly love to do a chief year, but I wonder if this is pretty rare.

 

[14022]

And take a second look at places that have a chief that was a resident elsewheres: that means either none of their graduates wanted the job, or the administration didn't think any of their grads were good enough. Either way, that should be a minor alarm bell.

Also, anecdotally, someone who has been a resident elsewheres may not advocate well for the residents, and may instead be much more of an administrative pawn.

Do not be so quick to jump to this conclusion. It may mean that all of their top residents were accepted into fellowship immediately after their third year, which is a good thing. Who would want to do a cheif year if you may get paid as a PGY-4 and have the opportunity to do your fellowship right away or get a job the next year for three times the salary. F the CV. I just want to get paid!

 

[pretzel]

My understanding is that chief residents at some hospitals are PGY4s, while at other hospitals, they have already done a fellowship, and then they become chief. In the latter case, they are technically the same as specialty attendings, but they choose to do a chief year. It helps if you want to go into academic medicine or teaching, and even if you don't, it's an honor. Chiefs essentially run the medicine teaching service.

There seems to be large variability in pay for chiefs, depending on the program or hospital -- some are paid like attendings, some are paid like PGY4s -- it depends on tradition of that particular place.

 

[peyronie]

I am currently working on my contract for next year's chief position at my institution. I was asked to be the chief in my 2nd year after the program found out I was waiting another year to figure out which of 2 different fellowships to apply to and would have a year to kill. I still haven't decided and may be a hospitalist but that doesn't matter... Our chief year is a PGY-4 for about twice the 3rd year salary. The rule of the salary generally is the more money you are paid the more attending months you have to do on the wards. For my salary I will have 1-2 attending months at most with ample time to moonlight. Our chief residents are about 50/50 fellowship to practicing internists.

 

[alhkim]

And take a second look at places that have a chief that was a resident elsewheres: that means either none of their graduates wanted the job, or the administration didn't think any of their grads were good enough. Either way, that should be a minor alarm bell.

Also, anecdotally, someone who has been a resident elsewheres may not advocate well for the residents, and may instead be much more of an administrative pawn.

I have to agree to disagree with this statement also--for example, at NYP Cornell, the chiefs are actually done with their fellowships before coming back for a chief year. At BIDMC, the chiefs are finished with their first year of fellowship before starting their chief year. I don't know why these places do this, but they do...

 

[lurkerboy]

I have to agree to disagree with this statement also--for example, at NYP Cornell, the chiefs are actually done with their fellowships before coming back for a chief year. At BIDMC, the chiefs are finished with their first year of fellowship before starting their chief year. I don't know why these places do this, but they do...

actually at BI, there are a mix of both, pgy4's and pgy5's, +/- fellowship. One practiced in primary care for a year, two are pgy4 and 1 did a year of cards. Being a little further out gives them a little added perspective for the teaching aspect of their jobs without being too far away from residency.