Jessica Smith, MD, Program Director, Alpert Medical School of Brown University

1) Always anticipate the PD opportunity

It’s easy to think about living out the rest of your days as an APD: you totally get to be the fun one, you get all the adoration of a leadership role, but at the end of the day, there’s someone else to be the heavy or hold the bag. Sooner or later, though, the opportunity to become PD will arise. Are you prepared? You should be!

Don’t assume the transition will happen when you expect it; instead, anticipate it at all times. One way to help set yourself up for success is to start tracking the recurring “PD things” happening on the ground to help get a sense of the bigger picture. One method is to create email tags e.g. “PD-Monthly thoughts” or “PD-Surveys” to track the recurring emails/reminders/ annual surveys that you may need to send out yourself someday.

2) Take advantage of the team

PDs have many resources at their disposal: program coordinator (PC), chiefs, and faculty. Check in with your PC to learn what’s on tap for the day. Learn what the PD is doing, what the hiccups of the week are, and what is on the horizon. If you’re not already fully aware, ask the Chiefs what’s going on above your head. Ask the PD about higher-level issues with faculty or executive leadership colleagues to get a sense of what goes on in all those meetings you don’t have to attend as APD. Keeping a finger on the pulse of the day to day will prepare you for when you are at the helm. Use these valuable personnel resources to your advantage, and as PD, help the team succeed through their leadership development as well. When you actively invest in your team, the dividends will be amazing.

3) Get real

Realize what you’re getting into on a daily basis: think fires, floods, and famine. As the captain of the ship, the expectations change. The buck stops with you, and there are a lot of bucks. As PD, you get instant, full custody of all the children/residents. With that comes more worry, less sleep, and more work. But just like all the daily hard work of parenting, being a PD is totally worth it. Own the new responsibility, the group morale, and the consequences. A great way to maintain and build morale is through transparency. Let residents know how/why you make decisions. Make them a part of the process. But realize that on a daily basis, when the residents are good, they’re “our residents,” and when residents are bad, they’re “YOUR residents.” So always propagate the mantra: it takes a village.

4) Get organized

Create a monthly calendar or a timeline to stay organized. There are many recurring Program items, and each Program will have different things to do at different times of the year. Many APDs also have recurring items on their calendars, and it’s important to figure out what you do as an individual, what the PD does at the Program level, and what actually needs to be reinvented year after year. Talk about creating an organizational calendar with your PD team, and work on making your own “Residency Program Bible” or a “Hit By The Bus Calendar.” That way as transitions occur, the structural framework of the Program remains intact, and momentum isn’t lost.

5) Seek ground floor gratification

Despite the longer hours, the increased stress, and the unending requests and demands on your time, there are many daily doses of satisfaction from behind the PD desk. You get to lure residents into your office every day with the best candy, being in the office more frequently means you’re the first to learn of residents’ happy successes, new pets and pregnancies, and you’re there to help in times of crisis. You get to be the one they know they can count on when the going gets rough, and that is a very satisfying relationship to have when you sign their diplomas and you take a moment to recognize your role in the daily growth and development of the next generation of EM Physicians. There is much spontaneous mentoring to be done with an open door, and of course, a padded daily schedule to allow for pop-ins.

From the Ground Floor View, the day to day of a PD has its ups and downs, but for those of us who made the transition from APD, we know being a PD is truly the greatest gig there is.