What is the impact of the chief resident designation on career direction: a cross-sectional analysis of a US database over 15 years

It is unclear whether recruitment into academia will keep pace with attrition. Examining the events and opportunities that occur in residency, including the Chief Resident (CR) opportunity, will add to the pre-existing understanding about the proximate step to academic career choice. We evaluated whether there is an association between CR and type of employment the following year. Given that minoritized communities are underrepresented in academics, we evaluated whether the association varies by race-ethnicity. We performed a cross-sectional analysis using de-identified individual-level data from the Graduate Medical Education (GME) Track, a national database and tracking system, from 2005 to 2020. The GME Track pulls data from the National GME census and is managed by the Association of American Medical Colleges (AAMC) and the American Medical Association (AMA). Participants were residents in their final year of training. Exposure variable was CR status (y/n). Main outcome was intended employment type the following year (fellowship, academic, other, or private practice [referent]). Multinomial logistic regression was used to estimate the adjusted odds ratio (aOR) and 95% confidence intervals. We assessed, through interaction analyses, how intended employment varied by self-identified race-ethnicity. Among the study population (N = 450,598), 103,204 (22.9%) were CRs. CRs had increased odds of pursuing academics (1.04, 95% CI 1.01–1.06), but decreased odds of fellowship (0.76, 95% CI 0.75–0.78) or other careers (0.63, 95% CI 0.62–0.65) in comparison to private practice. Interaction analysis was significant (p < 0.0001). CRs who were Asian (1.13, 95% CI 1.07–1.19), Black (1.16, 95% CI 1.05–1.29), or multiracial (1.10, 95%CI 1.01–1.21), but not those who were Hispanic (0.94, 95% CI 0.83–1.08) or White (0.99, 95% CI 0.96–1.03) had increased odds of pursuing academics compared to non-CRs in those same race-ethnic categories. CR was associated with the odds of initiating academic careers, which varied by race-ethnicity. The CR opportunity can be leveraged to diversify the pipeline into academic medicine.