A medical student who thinks he wants a career in academic surgery asks, “You were deep into academic medicine and walked away from chairman, program director, etc. Why?"
[Background: For over 23 years, I
was a full time surgical chairman and residency program director in
three different community hospitals affiliated with medical schools.]
question. For many years I had always said something like, “No matter
what crisis happens with the residents or the chairman’s job, it pales
in comparison to having a patient with a complication.” In other words,
non-clinical problems were annoying but manageable.
Then one day
I realized that was no longer so. Patients with complications still
caused me many sleepless nights and that hadn’t changed. What had
changed was that resident issues and administrative hassles finally
The rules set by the accrediting bodies, the
ACGME and the Residency Review Committee [RRC] for Surgery, had always
been difficult to comply with, especially for a small program. They
became more onerous every year or two until it reached the point where I
can’t imagine how anyone can stand it. Residents can complain to the
RRC anonymously and no matter how factually you refute the complaint,
the RRC always believes the disgruntled resident. Add in the work hours
rules and the lack of motivation of some of today’s med school graduates
and I had had enough.
The position of surgical chairman in a
community teaching hospital is like that of a football referee. At any
given time, half your constituency is not happy with you. The
administration pays your salary and expects you to spout the party line.
But you need your attending surgeons to treat the residents well and
support the program. Many times you have to make decisions that are
guaranteed to alienate many people.
A lot of energy was spent
investigating complaints. Families were unhappy with the residents;
attending surgeons were unhappy with the residents and conversely;
nurses were unhappy with the residents and/or the attendings; someone
was rude to someone else; someone shouted; someone cried and on and on.
the site visits. Drop everything; the state is here to investigate a
case or the state is here to interview the residents about their work
hours. The Joint Commission is coming in six months. We need to meet
twice a week to make up for all the unnecessary but JC-mandated stuff we
haven’t been doing for the last two-and-a half years. Countless hours
were spent buffing up the paperwork for an RRC site visit. I think
that’s where I learned creative writing.
And the meetings. Risk
management meetings could last three hours during which time you would
have the opportunity to try to explain why a surgical complication
occurred to a room full of non-surgeon MDs and non-physician
administrators. We used to deal with this sort of thing quite
effectively at morbidity and mortality conference.
were the committees. At one of my former hospitals I was either chairman
or a member of the following committees: Pharmacy, Critical Care,
Infection, Medical Executive, Operating Room, Surgical Performance
Improvement, Strategic Planning Work Group, Product Evaluation, Library,
Clinical Leadership Group, Cancer, Trauma, Budget, Graduate Medical
Education, and Risk Management. I’ll save you the trouble. That’s 15
For a long time, I enjoyed being a residency program
director. I am proud of the more than 50 chief residents I helped
train. I view them as my legacy. I regret that running a program and
teaching residents stopped being fun a few years ago. I also liked being
a chairman until medicine took a turn toward the dark side.
I could go on but this post would reach 20,000 words.
So my young friend, think long and hard about that decision to become an academic chair.