Declining Chief Resident offer

[FunnyDocMan1234]

Are there any downsides do declining a Chief Resident offer to go straight into fellowship instead? Does this hurt your fellowship chance / do program directors generally get upset if this happens?

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[wholeheartedly]

moving to the general residency forum

 

[Animalcules]

Are there any downsides do declining a Chief Resident offer to go straight into fellowship instead? Does this hurt your fellowship chance / do program directors generally get upset if this happens?

No. There are Nobel laureates who declined chief resident offers. It only has relevance in the little microcosmos of residency.

 

[BigSib]

I'm a bit confused by this question. In our program 'chief' was an elected senior resident; has nothing to do with staying behind for an extra year and as far as I'm aware you can't leave early to do fellowship elsewhere.

And if that's the case why the heck would you stay behind (unless going into academia) for an extra year of residency on a resident's salary???

 

[Raryn]

I'm a bit confused by this question. In our program 'chief' was an elected senior resident; has nothing to do with staying behind for an extra year and as far as I'm aware you can't leave early to do fellowship elsewhere.

And if that's the case why the heck would you stay behind (unless going into academia) for an extra year of residency on a resident's salary???

In IM and Peds, the chief year is (typically) an optional fourth year where you stay behind as a junior faculty member with a significant administrative role. The pay is often (but not always) a fair bit better than a resident, but also significantly worse than a true faculty member. For example, chiefs where I did residency had built in moonlighting where they made ~$100k, and often did additional moonlighting for $50-100k on top of that (if they wanted to hustle, not everyone did).

People do it for resume building, for love of the program, and for administrative experience. It's not 100% necessary for any of those things, but it is certainly helpful for many fellowships.

I'm not aware of any consequences to turning it down, except that it may decrease your odds of staying for an internal fellowship (where I came from, chiefs were practically guaranteed match at the internal fellowship of their choice if they wanted to stay at the program. Turning it down would decrease those odds, especially if applying at the same time as a current chief).

 

[gutonc]

In IM and Peds, the chief year is (typically) an optional fourth year where you stay behind as a junior faculty member with a significant administrative role. The pay is often (but not always) a fair bit better than a resident, but also significantly worse than a true faculty member. For example, chiefs where I did residency had built in moonlighting where they made ~$100k, and often did additional moonlighting for $50-100k on top of that (if they wanted to hustle, not everyone did).

In my program, the "Chief Supplement" was $10K over the PGY-4 base salary. They were given production bonuses based on RVUs they generated while attending on the wards and they could have their own outpatient clinic if they so chose, in addition to attending the resident clinic. Without moonlighting (which some of them did as well, either on the hospitalist service, or the BMT service...which paid $30/hr more than the hospitalist service), they generally made 40-50% more than the base PGY4 salary. Which is still too low by about 150% given what they have to put up with.

 

[jhamaican]

In our program, residents had to apply to be a chief resident. In this way it bypassed that whole issue.

 

[rokshana]

I'm a bit confused by this question. In our program 'chief' was an elected senior resident; has nothing to do with staying behind for an extra year and as far as I'm aware you can't leave early to do fellowship elsewhere.

And if that's the case why the heck would you stay behind (unless going into academia) for an extra year of residency on a resident's salary???

Ours was selected by faculty and you were asked to be chief during your second year...so the decision to stay as chief was made long before you would decide on whether you would apply for fellowship.
And as raryn mentioned, staying on as chief pretty much guaranteed you the internal fellowship of your choice, so if you were looking to do something competitive like GI, staying guaranteed you a fellowship, but declining it didn't directly hurt you.

 

[mvenus929]

In my program, whoever is interested in the position applies during their second year (it used to be the start of second year, now we've pushed it back to after the new year because there are no second year matches anymore), and the program solicits feedback from residents and faculty, then the program leadership sits down to decide who gets it. We strongly encourage some people to apply, because we think they would be good chiefs, but there is no backlash to deciding not to apply. [We don't have many fellowships, so there's not that unwritten benefit available].

We get a $5K bonus on a PGY-4 salary for being chief, then an additional $20K for our clinical time. We can do extra moonlighting shifts, and pick up an evening clinic in the continuity clinic, to make more, so I estimate that most of us make somewhere in the ballpark of $100K. My friend is a PCP making somewhere around $130K, and my schedule is a lot more flexible than hers is, so I don't feel so bad. It pains me a bit that I turned down a job for $169K, though.

 

[michaelrack]

Mvenus929, it should not pain you to turn down a 169 k job, that salary is ridiculously low

 

[mvenus929]

Mvenus929, it should not pain you to turn down a 169 k job, that salary is ridiculously low

Not in Peds—that’s at the higher end for positions fresh out of residency in our area (yes, you can find jobs that pay more, but they are pcp jobs in the middle of nowhere). And not compared to the $100k I’m currently making as a chief (which is what I turned down the job for).

 

[Perrotfish]

Not in Peds—that’s at the higher end for positions fresh out of residency in our area (yes, you can find jobs that pay more, but they are pcp jobs in the middle of nowhere). And not compared to the $100k I’m currently making as a chief (which is what I turned down the job for).

I am not sure what area you are in, but you don't need to be in the middle of nowhere to break 200 out of residency on Peds. Most initial offers in the mid sized city near me were around 200 out of residency for clinic only 5 day per week, 25 patient per day jobs. My friends in similar cities we're getting similar offers.
Truely middle of nowhere practice with call at the local hospital pays 280-300/year.

If you are in DC, New York, Boston, or an desirable city in Cali then you are getting fair offers. I don't think it's worth it to you to stay there, but you wouldn't be alone if you disagreed and that is what those cities pay. If you are anywhere else you are getting low balled, and your friend got screwed

 

[mvenus929]

I am not sure what area you are in, but you don't need to be in the middle of nowhere to break 200 out of residency on Peds. Most initial offers in the mid sized city near me were around 200 out of residency for clinic only 5 day per week, 25 patient per day jobs. My friends in similar cities we're getting similar offers.
Truely middle of nowhere practice with call at the local hospital pays 280-300/year.

If you are in DC, New York, Boston, or an desirable city in Cali then you are getting fair offers. I don't think it's worth it to you to stay there, but you wouldn't be alone if you disagreed and that is what those cities pay. If you are anywhere else you are getting low balled, and your friend got screwed

Not that I care to get into the details of my choices (or those of my friends), but I was looking for a one year job while I was applying for fellowship. Most residency graduates (at least, out of the programs I’m familiar with, maybe your programs are better) aren’t going to be able to see 25 patients per day, 5 days per week when they don’t know anyone in their panel. While trying to study for boards. They will get there and, of course, their pay will increase as they do. And most of the contracts for new grads I was seeing were at least 2 years, which precluded most of those jobs for me, not to mention the fact that I’d have to move twice in less than 12 months (largely because this area is not hiring for Peds pcp).

 

[michaelrack]

The salary of 169 k for an only 1 year job makes sense....I don't understand why you would need to spend so much time studying for boards fresh out of residency, but maybe things have changed in the 15 years since I took my initial board exams