What exactly is a psychiatry Chief Resident?

[nancysinatra]

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So, I tried searching on this topic and nothing much came up. Anyway, people please tell me what the Chief does at your program, how they are elected vs chosen vs crowned, and what qualifications or lack thereof are essential for them to attain this honor. Otherwise I seriously cannot for the life of me figure out what psychiatry chief residents (at least where I'm at) are supposed to do. In Internal Medicine they practically run hospitals, take a year after residency to be the Chief, and they are on call all the time. Our chiefs do nothing of the like. At my program they don't even make the call schedule. They do attend a lot of meetings, from what I can tell. Is there something I'm missing?

 

[nitemagi]

It's going to vary a lot between programs. Our program has a chief for each clinical site (academic inpt unit, outpt clinic, VA hospital).

Speaking for myself the chief has many duties (off the top of my head)-
1. Advocate for junior residents
2. Make call schedule and changes to it, as well as vacation schedules
3. Supervise junior residents and a treatment team, especially when attendings aren't available
4. Teach medical students one-on-one
5. Manage the daily problems of an inpatient unit
6. Liaison with nursing staff on all issues related to the residents
7. Troubleshoot and cross-cover when residents are sick/out
8. Do teaching sessions for junior residents and even for medical students
9. Attend administrative meetings with nursing, hospital administration, departmental administration, residency administration and help troubleshoot larger systems issues that the residency is a part of
10. Keep the peace 😉
11. Maintain a sense of calm 😎
12. Remember there's only 5 weeks left 😀

In other programs senior and chief residents I'm sure do a lot less, and have more elective time.

 

[whopper]

A chief's responsibilities will vary per program. In some they are elected by residents and/or faculty, handpicked by the PD, or sometimes literally the only PGY IV there so that person automatically becomes chief, what have you.

In general, they act as middle management, a go between with the residents and attendings. While chiefs should advocate for residents, they also need to keep them in-line. A chief is not doing their job right, IMHO, if they only advocate for residents. Often times residents will make inappropriate complaints or be slacking off. Better for the resident to have the chief put them in order before an attending does.

 

[nancysinatra]

At my program we have 4th year site chiefs who actually do something. They sort of manage the teams, although they are often gone a lot. However the overall chiefs from what I can tell do nothing but attend meetings and occasionally field complaints from residents. It's a somewhat prestigious title, but I'm not sure why.

 

[Manicsleep]

At my program we have 4th year site chiefs who actually do something. They sort of manage the teams, although they are often gone a lot. However the overall chiefs from what I can tell do nothing but attend meetings and occasionally field complaints from residents. It's a somewhat prestigious title, but I'm not sure why.

Thats basically what most people in administration do. It may sound easy but its really not, although I am sure there are plenty of unmotivated administrators who just ride the coattails of others.

 

[Majesty]

Thats the person you complain to when you have xmas and thanksgiving call and 'resident x' doesn't.
Its also the person you complain to when...list all your favorite complaints here. 😍

 

[nancysinatra]

Thats the person you complain to when you have xmas and thanksgiving call and 'resident x' doesn't.
Its also the person you complain to when...list all your favorite complaints here. 😍

Yeah but our chief doesn't make our schedule. This is the only actual job ever known to a psychiatry chief resident, and in our program it is delegated to the individual classes. Our chief just sits in an office and looks pretty all day. And our chief doesn't have to have any special knowledge or be a beacon of psychiatric expertise like they do in medicine. Yet the title carries prestige and I am not sure why. In fact, I am starting to think it should be a mark of shame to have been the Chief.

Sometimes I think psychiatrists are among the most naive people in all of medicine.

 

[Majesty]

Yeah but our chief doesn't make our schedule. This is the only actual job ever known to a psychiatry chief resident, and in our program it is delegated to the individual classes. Our chief just sits in an office and looks pretty all day. And our chief doesn't have to have any special knowledge or be a beacon of psychiatric expertise like they do in medicine. Yet the title carries prestige and I am not sure why. In fact, I am starting to think it should be a mark of shame to have been the Chief.

Sometimes I think psychiatrists are among the most naive people in all of medicine.

Let it out sister.
I am guessing you hate your chief(s).

I had good chiefs and bad chiefs. I was even asked to be chief (but only va chief and that job sucked) so I refused.

The prestige comes from the secret handshake which they taught me when I almost got the VA job. Its the same handshake as the Masons so you can use it to do some pretty powerful stuff. Don't tell anyone. Other than that its pretty useless.

 

[nancysinatra]

Let it out sister.
I am guessing you hate your chief(s).

I had good chiefs and bad chiefs. I was even asked to be chief (but only va chief and that job sucked) so I refused.

The prestige comes from the secret handshake which they taught me when I almost got the VA job. Its the same handshake as the Masons so you can use it to do some pretty powerful stuff. Don't tell anyone. Other than that its pretty useless.

Thanks. I don't really hate my chief personally, I just hate that my chief walks around with this pompous self important all knowing attitude and pretends like he/she does this essential job when in fact the chief does absolutely nothing except take up space and extemporize about how this or that complaint must "feel" rather than actually responding to said complaints. In other words the chief does LESS than the regular 4th years. Also a chief should have to demonstrate some quality such as a high PRITE score in my opinion, so as to make some use out of the PRITE in psychiatry since otherwise what use does the PRITE have in our profession? Plus it is annoying to think you might be complaining to someone who doesn't know anything. (I think this is a problem throughout psychiatry!)

 

[Manicsleep]

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[nancysinatra]

LOL. Sounds like you have a really crappy chief or your chief has a really cushy job.

I seriously disliked chief year at the time of being chief, I felt like I was an intern all over again. It did teach me several things I would not have otherwise learned so I am thankful for the opportunity. It gives you a lot of insight into the way academia works so if you want to stay in academics, its very helpful. As I did stay in academics after my chief year, this was really important.

Manicsleep, can you say more about what you did as chief and how you interacted with residents or faculty?

I don't think my chief is crappy, it's more that they don't really serve any major purpose from what I can tell other than to hold a fancy title, similar to people in England who are named "Lord" this or "Lady" that but otherwise you never hear of them. They may well have important jobs that I don't know about on these various committees they serve on, but if that doesn't get brought back to us residents in some way, then what's the purpose? Anyone could be on those committees. And plus, committee work is not the larger purpose of academic medicine.

I guess I don't understand why psychiatry is a 4 year residency when there is almost no hierarchy to climb up and the people that do rise to the top, in the form of being chief, then don't really DO anything. At most they just placate people by using their therapy strategies, which is super annoying.

 

[Doctor Bagel]

Our chiefs do our call schedule, plan retreat, do intern orientation, and I'm sure a bunch of other stuff, although sometimes it does seem like they're not around. The weird thing is that we have 4 chiefs (and are going to have 4 chiefs again next year) in spite of only having 7 and then 6 people in the 4th year class. So pretty much everyone gets to be a chief, I guess. 🙂

At my medical school, there was one chief (small program), and she did pretty much all the scheduling stuff including call and everything else. She was also very involved with recruitment. It seemed like she was quite busy. With our 4 chiefs, who btw do not really have specific positions, I've have the feeling that some do much more work than others.

I guess our big question as an intern class about chiefs is that we really felt like chiefs should try to make sure communication with residents is happening and should attempt to reach out to interns to make sure things are going OK. We've had a few particularly stressful times this year and were surprised that the chiefs were pretty much not there to talk to us about it. But then, I think they were just modeling after our administrative, so I guess it's not too surprising.

 

[bounds]

Like has been said, it varies from program to program.

I am one of two Chief Residents in my program with a final year class of five. I make the call schedules, approve the vacations, attend a ton of meetings, resolve resident issues with attendings 😡, nurses and yes, on occassions have to put residents in check. As Chief, you can't and won't be loved by everyone, but such is life.

I still carry along my share of " residency training responsibilities " be it in the psychotherapy clinics or regular outpt/inpt duties. Its been a very challenging year for me and I have to honestly say I am not sure I would accept the position if I had to do it over again.

Basically my impression is " you are asked to lead the revolution by your fellow residents at the same time you are being asked to put down the revolt by the attendings ".

And yes, I was top on the PRITE in my program, a fact which gave me more standing and " unspoken authority " in the eyes of the program and most of my fellow residents except for a few egg heads 🙂

 

[Manicsleep]

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