What I wish I knew in residency about becoming chief resident

Becoming a chief resident can be an uneasy experience. After all, sometimes it isn’t even a choice—some programs make all final-year residents chiefs, while others simply select chiefs without asking for volunteers. For still others, however, it’s an elective, competitive process. Given that the chief resident role requires a lot of additional work often for little additional pay, why would a resident going into their final year want it? And assuming they do, what should they do to boost their chances of getting it?

AMA member Victoria Gordon, DO, is an emergency medicine chief resident in the Houston area. Her reasons for pursuing the role veered from the norm.

Victoria Gordon, DO

“A lot of people think it's going to help them reach their next career goal. Fellowships, for example, often look for people who are chiefs,” Dr. Gordon said. “But I thought I had something to offer to my program. I think it's important to go where you’re needed, and I'm organized—I love answering emails for some reason—and I have experience managing people. Programs need strong leadership to continue to grow.”

In an interview conducted at the 2024 AMA Interim Meeting, Dr. Gordon gave her top-level recommendations to residents seeking to be chief residents and outlined what she wish she had known before starting the process. One of the themes: It will test your perception of yourself and your program.

Before you can truly commit to pursuing the chief resident role, you have to first understand how your relationships with your co-residents will change and be at peace with that.

“People should know that it's a lot of work and no one is ever happy with you, but it's a really big period of growth,” she said. “No one ever remembers the good and fun decisions you make. They only remember the ones that upset them.”

For example, Dr. Gordon plays a big part in making the program’s schedule. She said residents rarely remember when they have worked mornings, but they always remember when they have had to work at night.

“Even last year, before I was doing it, I knew what a hard job it is,” she said. “I would think of the chief, ‘I hate you, but thank you for all your work—I know you work really hard.’ But some people have a hard time separating those things.”

Similarly, before you get too far into the process, figure out if you will have the backing of your program’s leadership.

“If you have seen that your chiefs don't have the support of your program director and assistant program director—if they're just getting hung out to dry all the time—that’s a bad sign,” Dr. Gordon said, noting that one of the red flags is public dissent. “Discussion should happen behind the scenes.”

The residents in Dr. Gordon’s program hold town halls where they discuss pressing issues. They then bring them to the program director anonymously to provide a measure of protection to individual residents. 

“My program director is very supportive, very reasonable,” she said. “If we come up with an idea, he’ll say, ‘Great, you guys have thought about it. Thank you so much.’ That’s the kind of response you need to see.”

But if the program director shoots down all of your ideas without even considering them, “that's going to make your job a lot harder, because everyone's going to come to you with problems and you're never going to be able to solve them,” she said.

When she had the idea to pursue the role, Dr. Gordon started out by floating it to her predecessor as emergency medicine chief resident.

“It's important in any leadership role to ask the person who's in it what they think,” she said, noting that this will first help you understand what their job actually is, as your impression of it might not be accurate. 

Then you want to know what they think you need to improve upon to serve in that role.

“I did this early on—about six months ahead of time—so that I had time to actually look at myself, evaluate if I could make the changes and then make them before elections,” she said. “I was able to model the qualifications for the job and feel really prepared to explain where my strengths and weaknesses were and where I need to grow.”

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Dr. Gordon asked many of the same questions of her program director and assistant program director.

“It puts the bug in people's ears and gives them a chance to consider you,” she said.

In particular, it gives them a chance to reflect on your growth, she noted. Dr. Gordon remembered struggling at first in residency, so she asked them to list some things she still needed to address.

“They couldn't because they realized that it had been so long since anything had happened,” she said. “They came back to me and said, ‘Listen, I've talked to people. I've seen that you're working really hard. I'm glad you came and talked to me. You have my full support.’ It's important to start early to get your foot in the door and be able to dispel any concerns or questions.”

This is important, even if program leadership doesn’t play a role in the selection process.

“The other piece to this is making sure you have the support of your program directors, because even if it's just a peer-resident election and you get elected, you’re not going to be very successful if you don't have the support of your boss,” she said.

Similarly, you need to be well-liked by your co-residents—or if not well-liked, at least well-respected. 

“You will play a big role in controlling your co-residents’ lives, so they have to trust you,” Dr. Gordon said. “They have to know that you're going to get the work done.”

Each residency program breaks out the chief resident’s responsibilities differently, so keep an eye on what yours will be.

In her case, one of the big ones was scheduling.

“I think it’s tough for all chiefs, the way residents get lost,” she said. “We work so much that no one's responding to emails, no one's doing their modules, and then it’s the chief's job to say, ‘Hey, why aren't you doing it?’”

She made a point of letting her co-residents know that she understood their pain points.

“They needed to trust that I would get them their schedules as soon as I could because that’s so important to their success,” she said.

In preparing for the role, consider that you may need to change your tone.

“It’s so important in the leadership role to not just yell about what’s wrong, and I think that's the big step in going from being an advocate to a leadership advocate,” Dr. Gordon said. "You can't just talk about problems, you have to do something about them. If you're someone who's already doing something about problems, people will see you as a leader in your program.”

But it’s crucial to also remember that, as a chief resident, you will need to serve the needs of two distinct groups, and their needs won’t always be aligned.

“You’ll be managing both residents and administration,” she said. “I had actually been too good of an advocate for the residents, and my administrators said, ‘Listen, you have to be an advocate for your residency program too.’ That was really good feedback. I had to learn to walk that line.”

One of the things that prepared her for that was serving as a delegate for the AMA Resident and Fellow Section, where she has had to keep some things confidential.

“I've gotten so much better at advocating for residents a little more quietly. I still get everything I want done, done, but I know how to be in the game a little bit more—the administrative game,” she said. “To me, it’s about making sure our program is successful, because the residents can't be successful if the program isn’t.”

Learn more about the AMA Resident and Fellow Section, which gives voice to—and advocates on—issues that affect resident and fellow physicians.