Should You Run for Chief Resident?

October 31, 2022
I was the chief resident during my PGY-3 year of family medicine residency. Frankly, until the application deadline, I wasn’t sure I’d even run for chief. My program selected the chief based upon votes from your peers, but naturally, applicants had to be in good standing with the administration as well. Weighing the pros and cons along with a nudge from the former chief ultimately tipped my decision toward the positive. In this post, I share my experience and duties as chief resident and hope to help you consider the position.

The decision to run for chief resident isn’t always an easy one. Will the responsibilities be too great or the time commitment demand too much? How impactful is the role? Furthermore, depending on your class, you might find yourself neck-and-neck with fierce competition, which can be very intimidating. Here are a few factors to consider when weighing if you should run for chief resident.

What are the responsibilities of a chief resident?

The duties of a chief resident will vary from program to program. The size of the program, the number of chief residents in a senior class, and even the structure of the position are all important factors when defining a chief’s exact responsibilities.

For example, in pediatrics and internal medicine programs, most programs require chief residents to take a dedicated extra year of residency to serve solely in the chief position. However, in family medicine programs, as is the case in many other specialty programs, a chief resident is a senior resident who has a specialized duty.

1. Call shifts

Typically, the chief is in an administrative office but will often wear many hats. The chief plans the call and rotation schedule for the entire residency, handles the logistics of call shifts, and covers call when residents are out sick. They are also the first point of contact for interpersonal issues among residents, which occur more often than you’d think. Furthermore, the chief may be accountable for creating the didactic lecture schedule and for hosting guest speakers.

2. Working with co-chief(s)

I was part of a medium-sized program with a class size of about eight residents per year. Fortunately, I had the help of my wonderful co-chief. We split the duties—she organized our didactics arranging guest lecturers for our weekly sessions. She also organized annual research and wellness events such as our program retreat. Meanwhile, I drafted our call schedules and handled call coverage and vacation requests for the residency. We worked well together and would always cover each other’s roles if needed.

3. Interpersonal & professional development

We were both heavily involved in the interpersonal and professional development of our residents. Moreover, we bridged any gaps between residents and faculty, often addressing issues among residents, such as unforeseen scheduling changes, sick leave, episodes of professional misconduct, or inadequate work quality.

4. Helping with the application process

A fun responsibility that I enjoyed was getting involved in the application process and selecting the new incoming class of interns. Interviewing excited MS4s, touring them around our clinic, planning socials, and having a hand in the decision process was a great memorable experience. 

What are the benefits of being chief resident?
1. Personal relationships

One advantage that some might take for granted is the opportunity to form close relationships with the administration and faculty. I would say this is a natural result of working more closely with the administration and faculty to make sure everything runs smoothly. There is often an assumption of goodwill and an increased amount of exposure and camaraderie showed to you as the chief resident as opposed to another resident, who might blend more into the woodwork. Your fellow residents and faculty can see you out there trying your best to make the program better and appreciate it. 

I formed close relationships with program leadership and teaching faculty due to my position and my multiple interactions with them. Eventually, these relationships helped me immensely during my job search. Not to mention, just having the title of chief resident on your resume is impressive and will pique employers’ attention. In every interview I went on, the fact that I was chief resident was discussed with admiration. Employers look for leaders, and “chief resident” is a well-known accolade that helps you stand out as an applicant. 

2. Experience & program impact

Another benefit involves personal experience—as chief, you will intimately learn the inner workings of the residency. You will be involved in the application process, conflict resolution, and scheduling, and in doing so will learn the reason things are done the way they are done. You can be privy to more, and as a result, you can often have insight on how to improve any weak spots in the residency or make suggestions to make the residency better for those to join, even after you graduate.

The positive impact you make is lasting and may influence your program for years to come. Seeing your ideas take shape to the benefit of your colleagues and your program creates satisfaction and a swelling sense of pride.

3. Extra administrative time

Fortunately, we also had extra administrative time structured into our weekly schedules to allow us to accommodate the extra work. This was able to be done from home and allowed space for administrative duties during a busy year.

What are the drawbacks of being chief resident?
1. Pressure to fulfill every request

Hopefully, you’re a people person. If not, you will become one as chief resident. You will be dealing with people a lot during this job, and the pressure will come from all sides: your residents, faculty, program leadership, and even residents from other programs. Sometimes, there will be opposing interests and values, and you will find yourself in the middle of a push and pull of differing opinions.

People will ask a lot of you. Meaning that, occasionally, you have to be the bad guy, because there’s no way to fulfill every request, address every complaint, and make everybody happy. Even on your vacations, people will reach out with their dilemmas, which can be mentally taxing.

In addition to putting out clinical fires on your rotations, you will also be putting out fires on the residency front. Most of it is logistical, someone might call out sick for a call shift in the middle of the night, and now it’s up to you to make sure someone is covering and that the covering resident is compensated fairly down the line. And if no one is available, it defaults to you.

2. Interpersonal conflict

As chief, you will be juggling a lot of personalities and dealing with interpersonal conflict that may not even involve you, but you are suddenly required to mediate. A lot of time your friends and colleagues will come to you about uncomfortable situations. Sometimes you will see your peers behaving in ways that are simply unprofessional, in which case you’ll have to lead a meeting with them. There are days when you have to play counselor and HR or disciplinarian, and this can make you unpopular or controversial. 

3. Unrealistic expectations

Additionally, your colleagues may have expectations from you that are too unrealistic. Since you are chief, sometimes your peers assume you must be able to make something happen. However, they may not always understand the limitations of your role. You are the chief resident, not the program director.  Sometimes, even though you may agree with a criticism of the residency program, you are powerless or unable to change what your colleagues demand from you.

Should you run for chief resident?

All in all, spending my senior year as a chief resident was an amazing experience. It helped me develop professionally and brought me closer to my colleagues and faculty, many of whom I remain in contact with. In addition to juggling my clinical duties, being chief was almost like taking on a whole second job during residency.

In many ways, it was extremely rewarding, and the experience has helped me become a more well-rounded person. A crucial part of the art of medicine is how you interact with people. Serving as chief resident is a crash course in dealing with people in awkward or difficult situations, in a different way from what clinicians are often used to. The boost to your resume isn’t a bad perk either, especially if you’re applying to fellowships

Hopefully, this insight into the experience, benefits, and drawbacks of the chief resident role can give you some guidance to see whether running for chief resident is the right choice for you. Looking back, knowing what I know now, I certainly would do it again!

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By Mike Ren, MD

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