Chiefs and Former Chiefs…was it worth it?

[thetoddJR]

Offered chief position. Contemplating if it’s worth the extra time/stress with little extra pay. Undecided about academics vs. Private practice. Not doing fellowship. For those in either PP or academics, was it worth it? Why?

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[NICMAN]

Do it for the team.

 

[anaesthetic]

I’m in PP. The chief year gave me an edge when I joined this practice since we have very competitive pay in a desirable city. The year forces you to learn how to navigate the “system” as a whole, and you’ll learn how to deal with truly difficult personalities (only gets worse once you’re out in practice). It was worth it for me, and I’ll probably always have a spot back at my training program if I need a change.

“I wouldn’t do it twice, but I wouldn’t not do it once.”

 

[Shimmy8]

Yes. Valuable experience if you think you’d like to be in any sort of leadership position. Have to learn to navigate some of the admin BS no matter the career path you choose.

 

[thinkorswim]

There’s only two things that in my mind that make being a chief resident worth it:

1. The position comes with significant perks in addition to the nominal pay increase, such as frequent non-clinical administrative days, free trips to conferences, earlier relief, etc.

2. There’s a highly coveted private practice group you’d like to join that only hires chief residents from your program.

That’s it, I wouldn’t do it for many other reasons. The money alone is certainly not worth the stress and vilification you will be forced to endure.

 

[Morzh]

It wasn't easy but it was worth it. If I had not been selected it would not have negatively impacted my career, but in retrospect I learned an immeasurable amount of people / management skills that had been lacking in my education. I don't know if it necessarily opened any doors for me that would have otherwise been shut, but it probably opened already open doors a little wider.

Sometimes it was pretty cool to get to see the behind-the-scenes stuff (GME admin stuff, interview / rank list process, etc.), and it was at times genuinely rewarding to creatively solve various dilemmas that arose in ways that generally satisfied everyone. Our program leadership gave me and my co-chief a lot of leeway to solve issues on our own. We weren't micromanaged, and we definitely weren't the department's lap dogs. But sometimes it really sucked. Sometimes there is no good solution to a problem, and somebody is going to have to get screwed. A lot of times that meant falling on my own sword and being the one to pick up the extra call or whatever just to keep the peace and avoid the slightest appearance of abuse of power.

I also learned that some people just refuse to be happy. Even when you spend an inordinate amount of time hand-crafting their schedule to make it as fair and generous as possible, you'll still get emails and texts complaining about the dumbest things. It's disheartening. I normally am a pretty laid back, happy-go-lucky guy. During my chief year I had to get comfortable being the "bad guy" sometimes and learn how to deal with conflict head-on... when my default nature is to generally avoid conflict altogether. On the other hand you learn who the reliable "go-to" residents are.

Also consider that if you don't accept the position, it will go to someone else... consider who that may be and how you would feel about them.

 

[kidthor]

Offered chief position. Contemplating if it’s worth the extra time/stress with little extra pay. Undecided about academics vs. Private practice. Not doing fellowship. For those in either PP or academics, was it worth it? Why?

I'd do it if you're interested in it, and don't if you're not! Certainly not "worth" the headache unless you're into such things...

 

[agolden1]

I had an attending who was also a chief who explained it best and definitively encapsulated my chief experience:

Chief year is no wo/mans land. You’re no longer a standard resident. Your coresidents all expect something from you (scheduling, help with things where they feel slighted that you have no control over) and will vilify you when you can’t help them. This will be worst from your own class. Some people who are super checked out will ignore pretty much everything you say.

Similarly, you aren’t an attending yet either. Your attendings expect you to keep the residents in line and question what you’re doing if things go wrong.

I don’t think it helped that much with fellowship or the job search.

 

[D P356]

I had an attending who was also a chief who explained it best and definitively encapsulated my chief experience:

Chief year is no wo/mans land. You’re no longer a standard resident. Your coresidents all expect something from you (scheduling, help with things where they feel slighted that you have no control over) and will vilify you when you can’t help them. This will be worst from your own class. Some people who are super checked out will ignore pretty much everything you say.

Similarly, you aren’t an attending yet either. Your attendings expect you to keep the residents in line and question what you’re doing if things go wrong.

I don’t think it helped that much with fellowship or the job search.

Great summary.
I had no to desire to be chief resident. No mans land is a good description. I had my name withdrawn from consideration.
You’re at the top of a heaping pile of crap. Attendings will still dog you, and you’re now the bad guy who always “inconveniences” your co-residents. It seemed like a no-win position; added stress wasn’t worth it to me.

I worked as a manager between college and medical school, and I experienced workplace politics, hierarchy, management challenges, etc. I didn’t want that interfering with my training and goals.

 

[Ronin786]

How comfortable you are in your own skills is probably important. I'd probably have shot myself from boredom if I didn't have the extra responsibilities as chief. But each resident and program are different.

 

[JiPo]

Yes, it was a difficult/busy/stressful year, but it was totally worth it. You learn and experience what most residents won’t. For fellowship application, it definitely helped. For job search, which I recently finished, every single place I’ve interviewed mentioned how they like recruiting chief residents because of the unique experience that chief year provides.

I highly recommend it if you have the opportunity unless…. you are at MGH and you have to do an additional year.

 

[Mehd School]

I was offered chief and turned it down. And I thank myself every day. My current chief is a glorified babysitter and schedule maker.

 

[nimbus]

Yes, it was a difficult/busy/stressful year, but it was totally worth it. You learn and experience what most residents won’t. For fellowship application, it definitely helped. For job search, which I recently finished, every single place I’ve interviewed mentioned how they like recruiting chief residents because of the unique experience that chief year provides

So they can sucker you into being chief at the new gig too😉 Even private practices need chiefs. Somebody needs to be willing.

 

[thinkorswim]

So they can sucker you into being chief at the new gig too😉 Even private practices need chiefs. Somebody needs to be willing.

S**t only flows upwards in medicine. It’s like daycare for adults.

 

[hiyaman]

I thought doing chief year was a good learning experience and there's some good perks to it. That said like others have said its dependent on your program exactly what the chief resident responsibilities are. It almost always involves schedule management for the resident call shifts though.

 

[coffeebythelake]

I was offered chief and turned it down. And I thank myself every day. My current chief is a glorified babysitter and schedule maker.

but you get a gold star!

 

[repititionition]

I am wholly unsurprised at how many regular posters were chiefs.

 

[Zekchar]

Yes it was worth it. If you wish to be a worker bee your entire career then no. If you wish for something greater or have the slightest ambition, then it adds a lot of value and opens your eyes to things that non-chiefs are oblivious to. I would do it again.

 

[Hork Bajir]

Incredibly painful, but definitely a valuable growth experience. As others above have already stated, the hardship of taking that role is considerable (maybe more or less so depending on the specific set up of your program and the responsibilities you will be tasked with). On the whole, I do think it opened some doors for me.

 

[repititionition]

I think the aggregate wisdom holds here.

You lose a lot in terms of social interaction with your (no longer) peers. You figure out what it feels like to be unliked and at times outright reviled. You learn how to shovel ****. You learn how to do a lot of other peoples’ work for them.

Also true: chiefs get hired.

 

[Beeftenderloin]

Its a terrible job. You have to hear complaints from EVERYONE. Attendings complaining about residents, residents complaining about attending (and schedules and vacation and call and what room they got put in and the weather and anything else you can imagine).

I did it because I didn’t think the alternative individuals in my class would be able to stand up to program leadership in the way that the job required, and to pad my resume for fellowship.

6/8 most recent chiefs at my program were on an SSRI by Christmas (not joking).

 

[dannyboy1]

I think the aggregate wisdom holds here.

You lose a lot in terms of social interaction with your (no longer) peers. You figure out what it feels like to be unliked and at times outright reviled. You learn how to shovel ****. You learn how to do a lot of other peoples’ work for them.

Also true: chiefs get hired.

Anyone gets hired. Have yet to see the unemployed anesthesiologist.

 

[thetoddJR]

Yes it was worth it. If you wish to be a worker bee your entire career then no. If you wish for something greater or have the slightest ambition, then it adds a lot of value and opens your eyes to things that non-chiefs are oblivious to. I would do it again.

any examples of things you felt it opened up

 

[Guillemot]

If you aren’t trying to leverage the position of chief to match a fellowship or coveted job, the main compensation for performing the services of chief resident, buffing your CV, loses most of its value to you.

This is the perspective of someone who wasn't chief.

 

[Zekchar]

any examples of things you felt it opened up

1) Some places will only hire or preferrentially hire chiefs
2) Learning to manage schedules and vacation requests and callouts primes you for running the board as an attending / medical director
3) Getting wind of what bitchees some attendings are and how childish they can be is eye opening and prepares you for dealing with that nonsense when you join their ranks
4) Anesthesia has a lot of multitasking involved - being chief and fielding petty complaints and solving resident issues in real time while managing cases prepares you for doing the same with CRNAs
5) Getting first dibs on vacation requests and daily scheduling is a major perk

At the end of the day, the chief is the valedectorian of their residency class. If one does not recognize the prestige in that then they aren't aspirational. Nothing wrong with simply doing your own cases and letting the world burn. That is the opposite of what chief work entails.

Extra work? Yes. Worth it? Yes (Caveat that being a chief during COVID must've sucked big time)

 

[Gern Blansten]

I did it and would do it again. It begins you on a trajectory that is sometimes difficult to find an entry point to if you wait until later in life. It prepares you to be in charge and manage people, which is not taught in college, medical school, or residency.
Then read, The One-Minute Manager to learn more tips about managing people in a way that you would wish to be managed. It is a short read (would take most less than 45 minutes).
If you have no interest in leading, then definitely do not do it. It will be many additional and uncompensated hours and headaches. If you choose to do it, lead from the front and never ask your people to do something that you would not do yourself. Early in the year, be an example and take a few calls that no one else wants. That way, you set the bar high and, when you need to lean on others, you approach from a position of strength in that you have done it yourself. It is a great way to win the respect of your faculty members who will, hopefully, be a resource for you for many years.

 

[PulseOx]

If it’s an additional year to be a chief I can say absolutely not to do it. You will never make back the lost income. If it’s being chief during tour Ca3 year then yes do it. Former chief and PP attending here.

 

[2Fast2Des]

We got to "vote" for our chiefs, 2 for CA2 and 2 for CA3, and somehow they ended up being the ones that had the highest ITE scores or the least controversial individuals. Couple of years, 2 of the chiefs who apparently weren't even in the running somehow "won". I kinda figured whomever were the PD's pets won despite whatever vote was cast because the guys who wanted it and seemed like good options didn't win. That being said, yeah doing secretarial work and being the admin's gopher doesn't seem appealing in any form. Sure doors may be opened, but if you want to maintain a normal relationship with your co residents and not lose all respect for them when they make dumb complaints then stay a grunt lol

 

[DesiredMemberName?]

If you enjoy admin work* (or think you might), then do it. The resume benefit probably only helps you if you go to a mid-tier or lower residency.

If you go into PP there will be plenty of “leadership” opportunities, regardless of your experiences as a resident.

*(The people who enjoy admin work tend to refer to it as leadership. The people who don’t tend to refer to those people as suckers.)

 

[AnonymousPD]

Offered chief position. Contemplating if it’s worth the extra time/stress with little extra pay. Undecided about academics vs. Private practice. Not doing fellowship. For those in either PP or academics, was it worth it? Why?

ToddJR,

Lots of responses here with information you should consider. Unsurprisingly, I largely align myself with the posters who feel the pros outweigh the cons of the job. How much you are bothered by things like fielding complaints, juggling schedules, and seeing colleagues representing themselves poorly is something you have to answer for yourself.

A few things here people haven't mentioned that I think are worth considering when trying to predict what the year would be like:

1. What is your relationship with your program administration? You, your PD, and APDs are going to spend a lot of time working together, brainstorming, and solving problems. Do you feel they are people you will have a good working relationship with? At this point, you might not know if the answer is yes. But oftentimes, you might already know if the answer is no. When the working relationship is bad and there is a lack of trust...that makes for a LOOONNNGGGG year.

2. Who are the other chiefs going to be? Would you be the only one or does your class size necessitate there being 2+ of you? Similarly, the relationship you have with your co-chiefs is critically important. Equitably splitting duties, seamlessly covering for each other, having complimentary skill sets, are all things that make for an easy and productive year. If someone else enjoys and has a knack for scheduling rotations and vacations...that means you don't need to do. If you enjoy talking to recruits and doing the public speaking at meetings, that takes the load off of someone else. Again, some of that you might not know...but you probably know if you like and respect each other.

3. What did the previous chiefs actually do? This is different from program to program. Were their duties really only limited to schedules and vacations? Were they given the agency to implement their own ideas into the program? Were they actively involved in decision making and problem solving, or were they there simply to carry out the decisions from higher up? The perspectives in this thread are all valuable. But the people with the best insight are the ones from your own program.

 

[JiPo]

3. What did the previous chiefs actually do? This is different from program to program. Were their duties really only limited to schedules and vacations? Were they given the agency to implement their own ideas into the program? Were they actively involved in decision making and problem solving, or were they there simply to carry out the decisions from higher up? The perspectives in this thread are all valuable. But the people with the best insight are the ones from your own program.

This part is HUGE. I can't emphasize enough how important this is. I was fortunate that our program leadership was very conducive to our ideas and we implemented meaningful changes to the program during my term. I can also see it being completely miserable if you are treated like a glorified secretary.

 

[AnonymousPD]

We got to "vote" for our chiefs, 2 for CA2 and 2 for CA3, and somehow they ended up being the ones that had the highest ITE scores or the least controversial individuals. Couple of years, 2 of the chiefs who apparently weren't even in the running somehow "won". I kinda figured whomever were the PD's pets won despite whatever vote was cast because the guys who wanted it and seemed like good options didn't win. That being said, yeah doing secretarial work and being the admin's gopher doesn't seem appealing in any form. Sure doors may be opened, but if you want to maintain a normal relationship with your co residents and not lose all respect for them when they make dumb complaints then stay a grunt lol

There are so many theories about how Chiefs actually get picked, you'd think there was widespread voter fraud in residency programs all across the country.

That said...a number of things can happen even at programs that do everything they can to honor the results of a vote. It's entirely possible that the Chief year would actually be bad for the selected resident. An easy example would be a resident who is borderline academically. Being a chief might be the worst thing possible for someone who is struggling on their ITEs and barely passed ABA Basic. Personally, I wouldn't let anyone be chief if the likely result would be a failure on ABA Advanced. Similarly, the additional duties of a chief year place stress on immediate family members. It's usually not in the best interests of residents who are single parents or have complex/tenuous family dynamics to be chiefs either.

Sometimes the responsible thing to do from the administrative side is to have very frank discussions with selected residents and ultimately decide to save them from themselves.

 

[Gern Blansten]

There are so many theories about how Chiefs actually get picked, you'd think there was widespread voter fraud in residency programs all across the country.

That said...a number of things can happen even at programs that do everything they can to honor the results of a vote. It's entirely possible that the Chief year would actually be bad for the selected resident. An easy example would be a resident who is borderline academically. Being a chief might be the worst thing possible for someone who is struggling on their ITEs and barely passed ABA Basic. Personally, I wouldn't let anyone be chief if the likely result would be a failure on ABA Advanced. Similarly, the additional duties of a chief year place stress on immediate family members. It's usually not in the best interests of residents who are single parents or have complex/tenuous family dynamics to be chiefs either.

Sometimes the responsible thing to do from the administrative side is to have very frank discussions with selected residents and ultimately decide to save them from themselves.

Good point. We have always had an unwritten rule that struggling residents need not apply. They have almost always self selected themselves out of the running and, if they don't, the reality is that no one is going to vote for them anyway. If they somehow get selected by their colleagues, the PD and Chair always maintained the right to go against the residents' selection. In my experience, it always took care of itself without coming to that, but I always made sure at the outset that it was made clear that the final selection decision was made by the chair and PD. Having the wrong chief resident(s) can be a nightmare for the residents, the faculty, and especially the PD.