Didn't get chief resident spot. How upset should I be? Interested in Forensics

[ladysmanfelpz]

From everything I've read on here and reddit is that chief resident spot is the most overrated, extra-work you can take on for little CV benefit. Regardless I came to the decision to apply for our spot. I had no incentive previously, but recently significant other took a job at a location that has a forensic fellowship. I figured taking a chief spot could bolster the resume and give some extra responsibilities. The program I am in is not too intense. Ended up applying and found out yesterday that I did not get it.

What is upsetting to me is that the decision is arbitrary. It really is our program director selecting favorites. I did have one bad review from an attending last year, but nicely recovered and thought all was going well. There were only three of us who applied for two spots. Was it that one bad review, you can only speculate, but oh well, decision has been made. What also is upsetting to me is that the other two resident's do not benefit from this decision at all. Neither want to do fellowship. Although it is not much, it is still something to consider and show you've taken your residency seriously, manage responsibilities well, and try to rise to the top.

So how upset should I be about this? Is this something that does hurt chances of matching forensic spot? I was given a spot for our study and board prep which our PD sees as a leadership position, which I disagree with. Are there other leadership positions I should be pursuing? I am a mid-tier candidate (higher ranking at my program) and felt I could use this boost, no matter how minor, to my CV.

I am friends with both the resident's selected and almost feel like approaching one or both to discuss a conversation with PD as they really don't benefit from this at all. Thoughts?

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[calvnandhobbs68]

probably only matters if you really want to be a chief or not. Trust me chief is not all it's cracked up to be...I'm surprised people even wanted to be chief in your class we basically had to force people to be chief lol cause you end up having to do all the scheduling and interviewing med students and listening to residents complain etc etc

I highly doubt it matters for forensics...none of the psychiatry fellowships are that competitive on the whole. Go use all the extra time you have 4th year to make a bunch of money moonlighting in a "forensic" ish setting if you want or hanging out/rotating with the forensic attendings or do some away rotation at the location you want to do the fellowship at.

 

[soundnin]

Current forensic applicant here. I think programs care most about perceived and demonstrated interest in forensics for offering the interview. See relevant paper below. Offering a position depends on the interview day and perceived interest in the program.

"Leadership skills" wasn't even in the top 9 things they care about (out of 29) for offering the interview and it was within the top 10 for things they care about for offering a position.

A Survey of Forensic Psychiatry Fellowship Program Directors on Selecting Fellowship Applicants

In the 2019-2020 academic year, there were 48 accredited forensic psychiatry fellowship programs in the United States. Programs vary in application requirements and timeline. There are no published objective data on factors that fellowship program directors (PDs) use when selecting fellows. We...

jaapl.org

Regarding not getting chief position... every program has a different process for selecting chiefs. Mine seems to care most about "who can communicate issues to residents most effectively and will be easy to work with" for what it's worth. Bottom line I dont think not getting chief will mean anything for your application versus trying to do a poster or something related to forensics in the coming month or two.

 

[Sushirolls]

I share your gut punch. Years ago, I too wasn't selected, despite getting numerous co-resident feedback to run, and desire to have me as a chief. Some residents were notably distraught after PD decision, and were on verge of scheduling appointments, sending emails and scheming of ways to protest how upset they were. I discouraged these responses and tried to be a team player and encourage a 'trust the process' 'it'll work out in the end' type of thing. Thankfully no one did anything to cause themselves political fall out.

At one point I and several residents were in a more personable setting and the associate PD inquired about resident morale and people unleashed. Even about an example of how the chosen chief had backstabbed their co-resident cohorts on, with an earlier issue brought up to the PD and associate PD.

The associate PD at that time was sympathetic and a bit like, "oh." But the take home message for this to any med students and residents reading this:

Chief politics in residency programs are not like a democratic republic where you truly have a vote and this individual will represent you and your fellow residents to make your trenches a little less muddy. Nay, chief politics are like the banana republic, where the chief doesn't represent you, but is the voice of the admin to squash dissenters, and buffer them from the plight of the peasants. The chosen chief is picked to help the PD have less headaches.

This was a tuff pill to swallow for my younger energetic self who thought it was a way to make things better for residents and impact change. Nope. So let this be a warm up lesson for folks, that once you get done, and land a Big Box job, your Dept heads and medical directors are very likely to be the exact same - voice and buffer of the admin - to keep your peasant self in the wRVU mine, clinking away.

 

[comp1]

I genuinely don't believe a forensic program would be able to incorporate a chief role into their assessment of you. It doesn't really say anything about forensics other than that maybe you prefer the drama of academic medicine more than forensics? Like people above said, it's HIGHLY variable in terms of how the chief is selected. It's not like they're basing it on PRITE scores. Some programs have the residents vote. Some places only the PD decides. Sometimes it's a faculty panel. Also, the role itself is so variable. It can be absolutely nothing some places and you can be jr PD meeting with the chair daily at others. I just don't think it would mean anything either way. And yeah, forensics is a bit more competitive than other subspecialties at certain places, but it's not like you won't match, assuming you have a pulse and a license.

 

[soundnin]

I genuinely don't believe a forensic program would be able to incorporate a chief role into their assessment of you. It doesn't really say anything about forensics other than that maybe you prefer the drama of academic medicine more than forensics? Like people above said, it's HIGHLY variable in terms of how the chief is selected. It's not like they're basing it on PRITE scores. Some programs have the residents vote. Some places only the PD decides. Sometimes it's a faculty panel. Also, the role itself is so variable. It can be absolutely nothing some places and you can be jr PD meeting with the chair daily at others. I just don't think it would mean anything either way. And yeah, forensics is a bit more competitive than other subspecialties at certain places, but it's not like you won't match, assuming you have a pulse and a license.

OP seems to have 1 specific program in mind... as long as it's not the Ohio, NY, and CA programs it shouldn't be ultra competitive, relatively speaking.

 

[Cath Up]

Chief is underpaid and overworked. Not worth it. Like others have said it is not a meritocratic selection and is more of who the PD likes the most. Also trying to be competitive for chief is dumb in my opinion- one doesn't need to compete anymore, let yourself relax. You can still do fellowship if you want.

 

[Stagg737]

I'll add that I don't feel it adds much for most individuals. I got an academic position straight out of residency and it wasn't even asked about. So far it has not affected my career in academia at all and I don't think it's something to get hung up over.

Agree with Comp that selection is highly variable. Where I went the residents voted on who they wanted as chief and PD would leave it 100% to residents unless there was some major red flag that disqualified them. Our PGY-4 chiefs were also mostly clinical and were the junior attendings to the inpatient residents along with some liaison role with PD (PGY-3 chief was more admin and did scheduling and introduced speakers for grand rounds). I really wanted to be a PGY-4 chief and out of 4 candidates was the only one not selected, which hurt a bit more since it was selected by residents. However, in retrospect I'm glad I didn't get it for several reasons, mostly related to dealing with younger residents being unreasonable and an added half day of clinic which every chief hated. Ended up feeling more like I dodged a bullet than feeling bad that I didn't get to be chief.

 

[TexasPhysician]

Being selected for chief likely means you would be welcomed on staff if you want a job there. Other than that, I’m not sure anyone cares.

 

[Nasrudin]

Get to the bottom of it for sure. Make sure to prove your forensic prowess by interviewing your colleagues mining their timelines for inconsistencies. And above all else, be very, very, upset. For not being gifted with enough common sense to take giant step back when your overseers offer you the opportunity to work for free for no ostensible purpose.

 

[splik]

What is upsetting to me is that the decision is arbitrary. It really is our program director selecting favorites.

You are sounding like a sore loser. Of course the PD is going to select their favorite residents. That is how the real world works. That is no more arbitrary than anything else. Move on. You will experience various setbacks and disappointments in your career and in your life, and more often than not, you will eventually find that is a blessing though it rarely feels like it at the time. Most people in medicine fail upwards.

Take the opportunity to think about how you can maximize what time you have left in training to your advantage. No psych fellowship, let alone forensics, is so competitive that you can't end up somewhere, and most likely a half-decent program too.

Try to get some forensic electives in. Some programs offer away rotations for residents and that could be a way to get a foot in the door. It is a bit late now to be thinking about how to improve your application. The deadline for the AAPL meeting is past but you could have submitted a poster or oral presentation for that. There may be other conferences you could present related things (The international academy of law and mental health conference is in july in barcelona - not too late to submit something). You could do some forensic related didactics for the med students or junior residents, or look at reviewing the forensic curriculum in your program. If you are competitive, you could apply for the Rappeport fellowship. you could join some AAPL committees. You could do a book review or legal digest for the AAPL journal or an article for the AAPL newsletter. You could write a forensic related article for some comic like the AmJPsych resident's journal, or current psychiatry or the psychiatric times etc. You could write an op-ed for the local paper on some psychiatric topic. You could do some sort of QI project that is somewhat forensic related. You don't have to do any of this, but these are some examples of things that may be helpful certainly more than being a chief.

You want to make sure you have some good references and ideally at least one forensic psychiatrist (though this isn't a must). Read some forensic books. Watch mindhunter. Watch the testimony from some high profile cases.

 

[clausewitz2]

. You could write a forensic related article for some comic like the AmJPsych resident's journal, or current psychiatry or the psychiatric times etc.

Ah yes, AKA Psychiatry Tiger Beat

 

[Merovinge]

You should be negative 50% upset. Unless you wanted the spot to learn how the game works in academic settings, there is probably a net negative impact of being chief. That time can otherwise be spent to learn to be a better psychiatrist or just touching grass.

 

[ObsequiousAplomb]

In time you will see that not being chief was best gift your program could have given you. Nobody in the future who matters will ever care that you were or weren't a chief in psychiatric residency.

 

[PsyDr]

Not a psychiatrist.

But you may found it helpful to look at the CVs of forensic psychiatrists you admire, and see how many have “chief resident” on there.

 

[FlowRate]

The only time not being selected as chief matters, IMO, is if you're shooting to be future PD of your program. But more because it speaks to the faculty not having a strong preference for you being around making administrative decisions than for the credential itself.

Being program chief is a pain. Depending on the program, it can even mean being effectively on-call 24/7 for any sudden resident coverage issues (e.g. people calling out of night float sick after a few hours on shift.)

 

[romanticscience]

I feel ya, the sting will eventually go away. There are goals of the program and there are your goals; sometimes they won’t align. This was my experience as someone planning a PP.

Success in forensics isn’t granted automatically through the academic track. Many who do the fellowship do very little afterward. It takes a lot of self initiative.

I’ve found a career in forensic psychiatry and I wasn’t chief; heck, I didn’t even do the fellowship!

What I found most helpful was paying close attention to the wisdom of those here like @splik and @PsyDr, actually taking forensic work relative to your competence (so get experience in low stakes cases while protecting your reputation), reading, reading, reading, active participation with SEAK, having a senior well known forensic psychiatrist review my reports and having effective soft skills with attorneys.

Hang in there! Use it as motivation!

 

[mistafab]

Dude.

It’s a nothing burger.

Grieve it and move on. In four days no one else will care. In four years not even you will care.

Psych fellowships are not competitive and you will be able to do forensics if you want to. If you want a spot at a particular program - what happens if you don’t get it, think about that… you would FAIL UPWARDS and TRIPLE YOUR SALARY by taking a real psychiatry job.

You don’t even need the fellowship to do the work. Cmon bro. Let’s wake up and smell the roses here. You were just gifted FAR LESS work this year than the chief was - enjoy your time.

 

[Merovinge]

As an aside, can anyone imagine making this same post in the NSGY board? Would be wild to see the responses.

 

[calvinhobbes]

No one cares. Not enough psychiatrists and not enough applicants for fellowship. You’ll get in somewhere don’t worry!

 

[esob]

Nay, chief politics are like the banana republic, where the chief doesn't represent you, but is the voice of the admin to squash dissenters, and buffer them from the plight of the peasants.

From my experience, this is spot on.

 

[jbomba]

While unfortunate, all hope should not be lost. Try to stir dissent amongst the younger residents who are perhaps less attached to the new chiefs. Consider a coup when the time is right, perhaps around fall retreat or other resident getaway.

Let us know what you end up deciding.

 

[Mad Jack]

The only thing being chief grants you is the shared misery you can discuss with other former chiefs. It did help me a good deal with leadership skills as well, but otherwise it's nothing special and not even likely in the discussion for fellowships