By Eric Rosenberg, WCI ContributorIn the United States, a chief resident plays a crucial role in the education of new doctors and in coordinating patient care. The leadership role includes some administrative duties and mentoring responsibilities, and typically it comes with a higher salary and a notable resume boost when applying for fellowships.
Here’s a closer look at what a chief resident is, what they do, how much they’re paid, and answers to other frequently asked questions about chief residents.
What Does a Chief Resident Do?
Chief residents are senior students in a medical residency program. Typically in their final year of residency, the chief resident acts as somewhat of a general manager of the other residents and a go-between to coordinate with the program director.
In addition to most of what the other residents do, a chief resident also commonly handles these responsibilities:
- Scheduling and operations: Develop rotation and call schedules that comply with Accreditation Council for Graduate Medical Education (ACGME) rules and meet service needs. Coordinate coverage for vacation, sick leave, and emergencies, and monitor duty hours to avoid violations. Standardize handoff workflows and maintain up-to-date contact lists to ensure seamless communication.
- Education and teaching: Plan and run teaching conferences and simulations. Coach interns and students on clinical reasoning, documentation, and procedures with timely, actionable feedback. Partner with faculty to refine the curriculum using case mix and exam data.
- Clinical leadership: Oversee inpatient and clinic flow to match acuity with staffing. Triage admissions and consults, assign patients fairly, ensure safe handoffs, and close loops on critical results. Escalate clinical or systems issues to attendings when necessary.
- Resident liaison and welfare: Represent resident concerns to program and hospital leadership. Mediate conflicts, connect trainees with mentorship and resources, and monitor for signs of wellness struggles. Organize orientation and communication so expectations are clearly shared.
- Quality improvement and program development: Lead quality improvement and patient safety projects and prepare morbidity and mortality (M&M) conferences. Track outcomes—such as length of stay, readmissions, and incident reports—to identify areas for targeted fixes. Support recruitment, onboarding, evaluations, and continuous program improvement.
Of course, nearly any employment contract will include “other duties as assigned,” so chief residents may find themselves handling some less-desirable tasks as well.
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How to Become a Chief Resident
Becoming a chief resident begins long before the selection process. Starting on the first day of your residency, always arrive on time and be prepared, meet deadlines, take ownership of patient care, and ensure excellent communication related to rounds, handoffs, and other projects. Always act professionally and show that you’re a reliable member of the program.
At the same time, work to demonstrate your leadership potential by stepping up to teach interns and medical students, volunteering to run projects or serve on committees, and taking the initiative to solve problems on busy days.
It’s OK to share with your program director that you’re interested in the role well in advance. In the earlier years of your residency, work closely with a mentoring doctor who provides regular constructive feedback and documents your progress. Keep a portfolio of presentations, conferences, and major successes from your residency to accompany your application and interview, highlighting why you could be a perfect fit for the job.
About 6-12 months before chief selection, clearly inform your program director and core faculty that you’re interested and ask about the criteria. Line up strong advocates who have seen you lead and perform well, and be ready to discuss your vision for scheduling, wellness, education, and QI during interviews. If your program values scholarship and teaching, consider presenting or publishing even a brief report.
Finally, protect your reputation every day. Chiefs are chosen as much for judgment, reliability, and emotional steadiness as for test scores or relative value units (RVUs). If you’re already a calm and trusted colleague, you’re a natural fit for chief resident.
Do Chief Residents Get Paid More?
In many cases, the chief resident is paid more than other residents, but that’s not a firm rule. Every program can set its own salaries, and you may have an identical salary to that of other residents or a noticeable pay bump. Remember that extra cash can help build your investments or cover critical insurance, like disability insurance.
Many chief roles require an additional post-graduate year (PGY) with a standard PGY-step salary bump, plus a small chief stipend. Others earn the same base as their peers, plus the additional stipend as a bonus. Stipends typically range from a few thousand dollars to the low five figures. Chiefs may get other perks, such as funding to attend conferences or add-on employee benefits.
While the increased salary is nice, that’s not the main reason to apply to be a chief resident—more on that in the next section.
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Is It Worth the Additional Effort and Responsibility to Be a Chief Resident?
If you have ambitions to be a top doctor in your field or take on a leadership role in a practice, hospital, or medical school, having “Chief Resident” listed on your CV is undoubtedly an asset. A successful year as chief resident demonstrates to application reviewers that you took the initiative to be a leader in your program.
However, the role does come with extra work, including sometimes stressful or frustrating extra meetings and personnel issues. If your goal is simply to become an attending physician and maximize your income as soon as possible, you may do just fine completing the standard residency program.
Your decision ultimately comes down to your goals. If you aspire to complete a fellowship or take future leadership positions, it’s probably worth the additional effort. If you don’t have those goals, you’re probably safe taking a (slightly) easier final year of your residency.
Is It Easier to Get an Attending Physician Job If You Were a Chief Resident?
Short answer: It can’t hurt!
If you’re looking for a job as an attending physician, having been a chief resident is still a valuable addition to your resume and CV. A program director or manager would want to hire a former chief resident to join the faculty of a medical school or their research program for many of the same reasons someone would choose a chief resident to join their organization as an attending.
There’s no such thing as a golden key that unlocks the door to all attending gigs. Chief residents have taken one extra step to stand out from a field crowded with overachievers, 4.0 GPAs, and lengthy volunteering histories.
Tips to Excel as a Chief Resident
- Set expectations early and in writing. Make an agreement with your program director covering clear goals (education, QI, coverage metrics) and expectations. Review progress regularly, at least quarterly, to ensure timely feedback and solutions.
- Build rock-solid schedules. Maintain a single source of truth for rotations and call schedules with backups preassigned. Track duty hours to prevent violations.
- Standardize handoffs and enforce them. Select one template (e.g., I-PASS), use it for rounds and signout, and audit a few charts weekly to identify best practices and opportunities for improvement.
- Maintain open communications. Send a concise weekly update; announce changes on the same day; and maintain a living FAQ with policies, tips, and contacts so newer residents aren’t left guessing.
- Coach in the moment and document as soon as possible. Provide specific, behavior-based feedback immediately, then follow up with a brief written summary of what went well and what needs adjustment.
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The Bottom Line: Should I Apply to Be Chief Resident?
Chief residents sit at the intersection of education, operations, and clinical care. The upside includes stronger mentorship and teaching experience, measurable leadership experience, and the potential for a modest pay bump. However, you would also have to take on more meetings, personnel challenges, and occasionally the wrath of a resident program director—so it’s best for residents who want future leadership, medical education, or fellowship opportunities rather than those aiming to maximize income immediately.
If you’re still in medical school and want to explore what lies ahead, check out what one doctor should have said to themselves before becoming a resident.
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