Diverging Paths: Examining Initial Career Choices of Chief Residents in Emergency Medicine.

BACKGROUND AND OBJECTIVES: The career trajectories of emergency medicine physicians are thought to be shaped by various factors, including leadership roles during residency. Serving as a chief resident may be seen to be associated with a greater likelihood of pursuing an academic career, there are still important questions about the impact of this leadership experience unanswered. This study aimed to investigate whether serving as a chief resident increases the likelihood of pursuing academic or fellowship positions in the first post-residency job compared to peers who did not serve as chief residents. METHODS: Initial post-residency positions of 170 residents (35 chief residents, 135 non-chief residents) from a single academic emergency medicine residency program (2013-2024) were gathered and analyzed. Chi-square tests were performed to compare the frequencies of initial career choices (fellowship, academic, or community) between chief and non-chief residents, and effect sizes were calculated to determine the strength of the associations. RESULTS: Of 35 chief residents across 12 years, nine pursued a fellowship (25.71%), seven accepted an academic position (20%), and 19 obtained a community position (54.29%). Fifteen non-chief residents pursued a fellowship (11.11%), while 13 accepted an academic position (9.63%), and 107 obtained a community position (79.26%). Chief residents were statistically more likely to pursue fellowship positions (χ²: 5.19, p = 0.028) compared to non-chief residents. Though chief residents were twice as likely to accept an academic position compared to their non-chief resident colleagues, this result was not statistically significant (χ²: 3.14, p = 0.0766). Non-chief residents were statistically more likely to pursue community positions (χ²: 8.87, p = 0.0029). CONCLUSIONS: While many factors shape career decisions, this study suggests that serving as a chief resident may increase the likelihood of pursuing a fellowship or academic position. Future research should explore the specific skills and experiences gained during chief residency that contribute to these career outcomes, and examine how residency programs can better support leadership development to optimize long-term career trajectories.