Medical Education, Wellness, Leadership

Should I Run for Chief?

It's that time of year again. "Are you gonna run for chief?" Two former chiefs share some tips to help guide your decision-making.

Note: Reposted with permission from Maimonides Emergency Medicine blog.

It's that time of year again. "Are you gonna run for chief?"

After you get asked for the ninth time, you start to panic a little. You've debated with yourself, drafted a pros and cons list, yet feel just as lost as when you started. The time is ticking for you to make a decision. Well, are you going to do it?

Everyone has their own journey to this decision but here are some thoughts from two former chiefs to help guide you to make your decision.

Reasons you should run for chief

  • Leadership is in your future — If you're entertaining the idea of a leadership position after residency, even if that position isn't in academics, or even in medicine, this is a good opportunity to flex those muscles early. Gaining experience with managing swaths of people from all parts of the department is dizzying, and doing it in the chief environment is a nice stepping stone before taking a larger step into an official management position after residency. At the end of the day, you get some decision-making power, but not enough to tear down a program. It's safe, but exploratory.

  • Peek behind the curtain — If you're the kind of person who wants to be involved in the administration of the department on a day-to-day basis, being chief affords you the opportunity to interact with ED admin as well as all of the other services that depend on adjustments in the department. This includes off-service residents and pathways through the department into other parts of the hospital.

  • Stretch your brain... more — If you thrive on challenge and problem solving, then this is a good spot for you. We all enjoy this to some degree in the ER, but consider how much you enjoy handling quibbles, interpersonal nonsense, and policy struggles. Chief year is different for everyone. Some deal with interpersonal conflict, some deal with global pandemics, staffing shortages, financial changes. There will be rough spots during every era. Decide if you want that added to the regular stressors of being a resident.

  • Pay it forward. Make it better... as chief — Maybe there is a specific aspect of the program you wish to improve that you can only do (or is considerably easier to accomplish) as chief, such as scheduling, certain education initiatives, pandemic-related crisis management, or any other responsibilities that fall under the "chief" domain that year. Your residency program made you into the amazing doctor you are. It can be incredibly fulfilling to make the program better for future generations.

Reasons you should not run for chief

  • Pay it forward. Make it better... not as chief — If you have specific interests and pet projects you want to work on, and those do not require you to be chief, you may be able to accomplish more without being chief resident. Expect that much of the free time you would have had to work on your specific-interest projects (your diversity initiative, that cool ultrasound study, resident recruitment) will be instead spent fulfilling chief duties. Not all of it, but if your priority for the year is to sink your teeth into research, get heavily involved in national projects, or focus intensely on a curricular track, chiefing will take time away from that.

  • But I need a job! — If you are depending on this as a career advancement strategy or to improve your chances at getting a job, remember there are wildly successful EM physicians who were never chief. Being a chief resident can look good on paper for sure, but it is unlikely to advance your career by leaps and bounds. If career advancement is a large part of your future goals, use the time you gain from avoiding the more time-consuming, monotonous tasks of chief to bolster your resume in other ways. Yes, the job market has been tough in recent years and in some instances it may give you a leg up in being a preferred job candidate, but if obtaining employment is your primary reason for being chief, you are more likely to be unhappy and unfulfilled in this new role.

  • I want the scheduling perks of being chiefThis is not a good reason. In reality, chiefs should probably have the worst schedule. Being a good leader means supporting those who you represent, and manipulating the schedule so you only work weekdays and no holidays is the opposite of what it means to be chief. Your clinical hours may, technically, be less, but as a leader you need to be available to cover people for emergencies, staff holidays, and don't forget the many hours of non-clinical duties. (You thought 8 am-1 pm conference was long? Get ready for another 2 hours of Zoom meetings after that.)

What to expect

  • Consider that your relationships may change, including with your residency leadership, your co-residents, and even at home. Sometimes this can be a good thing. You will work more closely with those behind the engine and may find yourself bonding with and learning from the experts. Or, those relationships may suffer as you find yourself on opposing sides of every issue.

    You will start to see your co-residents in a different light and will quickly learn who the complainers are. You become forced to separate "the resident, your friend" from "the resident, your responsibility." These can be very different people. Learning how to find and walk that line between your role as their leader and your role as their friend is tough, but helpful. You will likely develop a closer bond with your interns as their guide and lifeline as they orient into residency.

    Remember that if you have loved ones at home, they need to be on board with this too — being chief means losing some of your personal time with them.

  • Be prepared to be the punching bag on either side. You may often be blamed by both your leadership and your residents. Residency is hard, and even under the best of circumstances, your residents will still be working long hours. Most people do not go out of their way to pay compliments — you will often only hear when things have gone wrong. It does not mean you're doing a bad job, but it can be grating if that's the only thing you hear. You may start to see the people you are trying to support as ungrateful. They're not. But it can seem like it.

  • You'll grow. Being chief is an incredibly formative experience. Regardless of whether you end your chief year feeling positive or negative, you will at a minimum feel changed. You will be forced into situations that help you learn how to lead. You will learn to make the difficult decisions. And yes, you will undoubtedly get it wrong sometimes. But also undoubtedly, you will come out of the year with lessons learned and stories to tell.

Running for chief is a big decision. Committing to a year of this stuff takes a lot of introspection and gut-checking, ensuring you are looking at the reality of the situation and not just your ideal of what you hope it'll be. It is undoubtedly a year of growth — whether or not you want that kind of growth is up to you.

It's OK to not run. You're not a lesser resident. You're not a better one if you run. Or get selected. Or don't. You should do what makes you happy.

And, if you become chief, know there are likely others who wanted the position. Be mindful. 

Remember you are there to support your fellow residents. Power trips are stupid and people will hate that behavior. Don't fall victim to what you perceive to be a prestigious title. In reality, consider yourself a servant.

Talk to your current and prior chiefs. Get their perspective. Get as many as you need. They are a smart bunch and an incredible wealth of information. Every chief has had their own experiences and their own perspective, and all of that information can you choose the best path for yourself.

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