Why do a chief residency?

[padastra]

So for many fields being a Chief Resident does not necessitate an additional year and you get some benefit to your application, etc. I understand that. In IM it takes an extra year, and the only reason I'm aware of is for increasing your fellowship competitiveness.

My question is thus: assuming you are competitive for the fellowship you want, is there any reason to do a Chief Residency that is worth the $150k+ of income lost? Does it help your job applications for life or something?

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[bronx43]

So for many fields being a Chief Resident does not necessitate an additional year and you get some benefit to your application, etc. I understand that. In IM it takes an extra year, and the only reason I'm aware of is for increasing your fellowship competitiveness.

My question is thus: assuming you are competitive for the fellowship you want, is there any reason to do a Chief Residency that is worth the $150k+ of income lost? Does it help your job applications for life or something?

If you are already competitive for your chosen subspecialty, then I would not do a chief year. It MAY help you later on if you want to do academic medicine, but the return on investment of a chief year is diminishing. I honestly see no reason to do a chief year, unless you somehow felt compelled by some misguided sense of loyalty to your program. You're better off taking that year and cranking out some research papers.

 

[IM2GI]

If you need the year, do a hospitalist year at an academic program. Do research on your weeks off. I see no reason to sacrifice the atleast $100,000 to do a chief year, unless you really want to do hospital admin or something. Chief year is not worth it for most people IMO, and is full of bureaucracy and administrative garbage that most people do not anticipate. Most of my friends have regretted their chief years. So, do it for yourself or your loyalty to your program, but not for the career benefit.

 

[Enteroid]

..because they are a tool.

 

[bronx43]

If you need the year, do a hospitalist year at an academic program. Do research on your weeks off. I see no reason to sacrifice the atleast $100,000 to do a chief year, unless you really want to do hospital admin or something. Chief year is not worth it for most people IMO, and is full of bureaucracy and administrative garbage that most people do not anticipate. Most of my friends have regretted their chief years. So, do it for yourself or your loyalty to your program, but not for the career benefit.

I would go further and say that chief year would not even help you for hospital admin. Administration at academic centers is based on research merit. Administration at private hospitals is based on climbing the corporate ladder. IM really needs to get rid of the whole extra year thing for chief, but unfortunately they always sucker these idiots into wasting their time and money.

 

[sacrament]

It has always mystified me that extremely bright people get suckered into doing a chief year. There is the notion of chiefdom being a prestigious role reserved for the top residents, and so there is an element of ego at play. And, indeed, it often is some of the very top residents who get sweet-talked into it. So if somebody has done a chief year at a decent institution, you can be pretty confident that they aren't a complete stooge. (They are at worst only a partial stooge--for being gullible enough to do a chief year.)

 

[padastra]

It has always mystified me that extremely bright people get suckered into doing a chief year. There is the notion of chiefdom being a prestigious role reserved for the top residents, and so there is an element of ego at play. And, indeed, it often is some of the very top residents who get sweet-talked into it. So if somebody has done a chief year at a decent institution, you can be pretty confident that they aren't a complete stooge. (They are at worst only a partial stooge--for being gullible enough to do a chief year.)

So you're trading a chance of either a complete stooge or non-stooge for a guarantee of a partial stooge?

 

[AlmostAnMD]

Is the paygrade still at PGY-3 for most places? I hope they would at least give you ~something~ for staying an extra year, even if it's not an attending's salary.

 

[gutonc]

Is the paygrade still at PGY-3 for most places? I hope they would at least give you ~something~ for staying an extra year, even if it's not an attending's salary.

You generally move up to the PGY4 scale and there's a "chief supplement". IMHO, anything less than $150K isn't worth it.

At my program, I think the supplement was something like $10-15K.

 

[CanIMakeIt]

You generally move up to the PGY4 scale and there's a "chief supplement". IMHO, anything less than $150K isn't worth it.

At my program, I think the supplement was something like $10-15K.

I agree, at most places - PGY4+(10-15K). As others have said - it MAY help you at some academic administration spot but no use if you are going the hospitalist or PP route.

 

[Bbon]

On the interview trail, I came across a fair number of recent chiefs staying on as academic general medicine faculty +/- associate program directors. It's one of the possible career paths I'm considering, so I've been paying attention to this thread with that in mind.

More puzzling for me are the programs that have their chief years after the first year of fellowship. And the programs I know who do it are some of the most well-regarded. Hard to figure why people sign up for that.

 

[Instatewaiter]

I would go further and say that chief year would not even help you for hospital admin. Administration at academic centers is based on research merit. Administration at private hospitals is based on climbing the corporate ladder. IM really needs to get rid of the whole extra year thing for chief, but unfortunately they always sucker these idiots into wasting their time and money.

Some places like Duke guarantee you an academic position if you do a chief year. For others like the Brigham, Hopkins and MGH, they are very prestigious and will go a long way for an academic career. It will make you more competitive for fellowship because it basically says, I am one of the best residents from this program.

In the end, if you are not going to do academic medicine and are already competitive for fellowship, it's probably a waste of your time rather than going straight to fellowship.

Most of the cheif spots I know of paid much, much more than a normal resident (most the same as a first year attending) so if that's the case, doing that over 1 year of hospitalist is probably worth it if you're going on to fellowship. If you're going to be a hospitalist, don't waste your time with a chief year.

 

[dozitgetchahi]

Most of the cheif spots I know of paid much, much more than a normal resident (most the same as a first year attending) so if that's the case, doing that over 1 year of hospitalist is probably worth it if you're going on to fellowship. If you're going to be a hospitalist, don't waste your time with a chief year.

This is interesting - I've never seen anything like this. I think the 'chief bonus' at our program is perhaps $5k. Add that to the PGY-4 pay and you make like $60k in total. Wowee zowee.

 

[Flavivirus]

Some places like Duke guarantee you an academic position if you do a chief year. For others like the Brigham, Hopkins and MGH, they are very prestigious and will go a long way for an academic career. It will make you more competitive for fellowship because it basically says, I am one of the best residents from this program.

Actually the chief residents at BWH (except for the primary care chief resident) have already finished one year of fellowship training (pretty much always at BWH/MGH/BIDMC), so doing a chief year there doesn't help get you into a fellowship.
I think being an IM chief resident makes sense for people who are really interested in academic general medicine and medical education. Otherwise I generally agree that I'm not sure the opportunity cost outweighs the benefits. As an MD-PhD subspecialist interested in lab research, a chief year did not make sense for me--I made much better use of that year being in the lab.

 

[Bostonredsox]

in the AOA world IM chiefs are third years. So no extra year of lost pay.

That said....we stil dont want to to do it. Because its administrative burecratic Bullsh** that frustrates you and gets you no where and is in no way worth the extra pay.

The only plus to it at my program is you get an office with a desk and you make the call schedule.
Still wasnt enough to convince me.

 

[DermViser]

in the AOA world IM chiefs are third years. So no extra year of lost pay.

That said....we stil dont want to to do it. Because its administrative burecratic Bullsh** that frustrates you and gets you no where and is in no way worth the extra pay.

The only plus to it at my program is you get an office with a desk and you make the call schedule.
Still wasnt enough to convince me.

Oooh, an office with a desk!!! Nice to know they're bringing out all the perks. (sarc off).

 

[bronx43]

in the AOA world IM chiefs are third years. So no extra year of lost pay.

That said....we stil dont want to to do it. Because its administrative burecratic Bullsh** that frustrates you and gets you no where and is in no way worth the extra pay.

The only plus to it at my program is you get an office with a desk and you make the call schedule.
Still wasnt enough to convince me.

Making the schedule is a plus? It's a no-win situation. The best you can do is break even, otherwise you'll have self-righteous residents up your ass about why you couldn't accomodate their schedule so they can make their sister's cousin's friend's uncle's second daughter's wedding.

 

[Instatewaiter]

Making the schedule is a plus? It's a no-win situation. The best you can do is break even, otherwise you'll have self-righteous residents up your ass about why you couldn't accomodate their schedule so they can make their sister's cousin's friend's uncle's second daughter's wedding.

Perhaps at his program the cheif residents still had to take call.

 

[Bostonredsox]

Perhaps at his program the cheif residents still had to take call.

/nod. Thus by being chief you chose when you were on call.