Everything You Wanted to Know About Being a Program Director

Program directorship is often framed as an administrative role or temporary leadership assignment. Less often is it examined as a structurally vulnerable position, balancing the needs of residents, faculty, institutions, and accreditation requirements.

In this episode of PDs@SEA, Dr. Marianne Chen and Dr. Bryan Mahoney reflect on the candid “Everything You Wanted to Know” session from the SAAAPM annual meeting, surfacing experiences program directors across the country rarely articulate publicly. The conversation opens with a striking finding: only a small minority of program directors anticipate staying in the role beyond six years, prompting discussion about burnout, identity, and the hidden labor of residency leadership.

The discussion explores how artificial intelligence is entering PD workflows, from letters of recommendation and promotion reviews to early scheduling experiments, alongside a clear-eyed assessment of where automation helps and where human judgment remains essential. Recruitment practices are also examined, including signaling, interview volume, second looks, and the tension between efficiency, equity, and applicant experience.

These themes are grounded in the daily realities of program leadership: evaluations, duty hours, follow-ups, and persistent administrative load. Practical strategies emerge around organization, delegation, habit formation, and boundary-setting, as well as how perspective shifts with experience.

The episode closes by asking whether the growing competitiveness of anesthesiology will translate into a sustainable pipeline of future leaders, and what institutions must do to support those entrusted with raising the next generation professionally.

Key Takeaways From This Episode

• Program director burnout is largely structural, driven by the role’s position between residents, faculty, institutions, and accreditation requirements.
• Short PD tenures signal sustainability challenges that cannot be solved through individual resilience alone.
• AI is beginning to reduce administrative burden for PDs, but only when paired with deliberate human oversight.
• Recruitment mechanisms such as signaling and second looks improve efficiency while introducing new equity tradeoffs.
• Administrative overload remains a central stressor and requires systems-level solutions, not incremental fixes.
• Sustainable PD leadership depends on habits, delegation, and boundaries rather than constant availability.
• Program directors shape the future of the specialty by “raising residents professionally,” extending their impact beyond individual programs.

Especially Useful For

Program directors, associate program directors, residency leadership teams, department chairs, and clinician-educators focused on the sustainability of graduate medical education leadership.

Related Episodes

• Why Residency Leadership Is Burning Out (And Why It Still Matters)
  A direct examination of PD burnout, structural pressures, and why sustaining leadership roles requires institutional support rather than individual endurance.
• Passing the Torch: How a Residency Survives (and Grows) Through Leadership Change
  Explores leadership transitions, continuity, and what departments can do to protect programs during periods of PD turnover.

Transcript

SPEAKER_02: 0:13

Hello, everyone. Welcome to the next episode of PDs at Sea. Last month, program directors and residency leadership from across the country came together in Chicago for the annual SAAPM meeting, also referred to as SAPAM. It's the Society of Academic Associations of Anesthesiology and Perioperative Medicine. And within SAPM, there's the Core Program Director Association where all the residency leadership meets and discusses topics related to being a PD, things going on in residency within anesthesiology. I find this meeting extremely helpful to learn and also network with other program directors. And I highly recommend it for any program director or associate program director who has never been before. For the past many years, we have ended each meeting with that everything you wanted to know session. Brian, do you want to share a little bit about the session and topics we discussed as you led it this year as one of the directors?

SPEAKER_01: 1:07

Well, I would love to, and I should just tell everybody I'm actually calling in from the uh New York State Society of Anesthesiologists annual postgraduate assembly meeting right now. I'm on site. It's very exciting. This is the second biggest anesthesia conference every year, everybody. So it's a delight to be here with you. I had the privilege of uh moderating the Everything You Wanted to Know session. And this is a session where all the program directors get surveyed and we get to find out what everyone's thinking or what they do, and maybe they're afraid to say in public. So we get some interesting data about where PD's minds are at, what's going on in their programs. Is there anything specifically you'd like to know, Marianne, that came out of that session?

SPEAKER_02: 1:47

Yeah, great. There was lots of great discussions, um, always a fun session. Uh, but what a few things came up that I thought were really interesting and would love to hear your perspectives on. So, according to the survey that was responded by program directors at the meeting, only 15% intended to stay in the role beyond six more years. What do you think drives the short lifespan of program directors?

SPEAKER_01: 2:12

Well, it makes me feel old. I'm going on to my, I don't I think I've lost count, my 11th or 12th year now. So that makes me uh elderly or geriatric at this point. You know, I this is a hard job. And I think that there are many different stressors and many people's jobs, but you see, people stick around in the chair role a lot longer. I don't want to say our job is harder than a chair's job, but I think we do have unique stressors. And I'd like to hear if you uh feel the same way, Marianne. I feel like we are actually not really part of any designated population within the department. I mean, you're certain we're certainly not residents, right? We're practicing anesthesiologists. Uh, but we definitely, or I feel, apart from the core faculty group, too, because we are the single individual, and we have people on our team, of course, but we're the single individual who are put in a position to look out for the interests and the well-being uh of the residents, you know, make sure that we're meeting the core program requirements that ACG me insists upon. And oftentimes that's at odds with the interests of the faculty or the institution. So you end up being in an odd situation where you kind of take grief from both sides. Um, you get resident feedback, uh, we do our best to make them happy, hopefully they are, but sometimes they're not. Um, and then you also get a pretty constant stream from the faculty. They have their opinions about how we should do our jobs, and uh they're not always in line with the goals of the residency training program. Am I off to a great start? Is any of this resonating with you?

SPEAKER_02: 3:47

Absolutely. I think that was probably one of the first thing I noticed when I took over the program director role was that you're kind of in this divide of not being a resident, but not and and the faculty and your peers and your colleagues that you've known for many years also realizing that you may not always be on their side and that you're going to be the advocate for the resident and the residency program. Yeah. So it was definitely something I noticed and feel like I've worked on over the years as trying to figure out where I belong and, you know, kind of the conversations that I have with faculty that may be very different than the conversations I have with residents. Um, and you know, make how do I feel in that kind of gray area as the program director.

SPEAKER_01: 4:29

Has it changed your perspective? I guess I would say, now that you've done it for for a bit, has it changed the way that you look at situations, problems, challenges within the department um from the way you did previously?

SPEAKER_02: 4:42

Oh, absolutely. I think it's a different perspective that I have. I also am trying to think about, you know, who am I speaking for in these meetings? And also realizing the perspective of the other leaders in our department and who where they're coming from and trying to understand, like, oh, that that's probably in their role. They have this perspective, which is maybe different when, you know, I chatted with them many years ago and they weren't in that role. So yeah, it's it's an interesting place to be as a program director.

SPEAKER_01: 5:09

Other people, I feel they get to have they get to have simple takes. Um, you know, older people usually say kids these days, and the younger generation usually feels as though the older generation just doesn't get it or get where they're coming from. I feel like when you're in the program director role, you're not really allowed to land on those really easy, simple points of view. You kind of have to force yourself to take a very well-rounded point of view on things and understand it in a more complex manner to navigate that. And yeah, most of the people at the conference didn't see a long lifespan ahead of them in the role. Uh, I think if you do the math, most people applying to anesthesia right now, over 50%, are going to have a new program director when they get there or experience a change in program director over the course of their training. Uh it's a challenge. Um, we need support. And the the meeting we just went to is a great source of that support. Um anyway, what what else did you see there you wanted to hear about?

SPEAKER_02: 6:09

Yeah, uh another um important topic, I think you know, we talk about in all different anesthesiology meetings. It's kind of everywhere, it's the buzzword these days is AI. And when serving the program directors, it is not widely being used by program directors yet, especially when we think about residency administration. Do you use AI and how do you use it in your program?

SPEAKER_01: 6:31

I use it a little bit. I feel like you being in Palo Alto are going to put me to shame. Um, you guys are trailblazers. I'm a little bit embarrassed to say this. I am using AI a decent amount for things that were somewhat work-intensive, but not really critical. Medical student letters of recommendation for residency. That's probably the big area. And also um I'm asked oftentimes to put together reviews of um promotion for faculty from other institutions. So, what I'll do sometimes is I will take the promotion uh criteria, feed them into AI, and some elements maybe of a person CVD-identified, and that will give me a head start too. Because those can be very time-intensive. Those can be, you know, hours and hours of work. And in both instances, I feel as though my willingness to put my signature on something is 95% of what the person's asking for. So I am using it in that domain. I'm actually doing a workshop here at the PGA on how to use AI, and I'm doing a little section on AI for scheduling. Uh, and I've actually played with it a little bit. The input end of things might be a little bit more time-intensive than making it worthwhile, but I'm I'm trying to explore to see if I can use AI in that regard. But I'm almost afraid to ask, how are you using it? Because I feel as though at Stanford you guys are really leading the way, probably given where you are.

SPEAKER_02: 7:56

I would love to hear more about your AI for scheduling, because I think that is definitely an area where we could use where there's a lot of manpowers, like our chief residents still make our schedule, and AI could take away a lot of that manpower, and you know, we could just oversee the outputs that are coming out from it. I will say that I am part of Stanford and in Silicon Valley, but I am not the most tech savvy of the group here. Um so I do use AI for presentations. I do think it helps just kind of making slides sometimes for presentations on topics. I have used it for letters of recommendation, but I I do think the personal touch is still important. And so I will also um just kind of use as an outline and then add my my little notes and words in to make it a little bit more personal. Um, that was also surprising at the meeting that that many program directors were not yet using it for letters of recommendation. Um, as I think, as you mentioned, you have, and it's something or an area where I think many faculty across the country are probably using AI a bit more. Use AI in lots of different ways within our department, um, but not necessarily me and the residency program and administrative work.

SPEAKER_01: 9:09

Well, I have not yet used AI for my residence letters of recommendation for fellowship or jobs. I think it's I think it's guilt. I think it's my conscience because I know them so well and I feel as though they deserve that that personal touch, like you said. And I I also do use it for primarily the rough draft. Uh, and then I go back in. Sometimes the AI is uses over flowery language, and you want to go back there and change the tone and things, but uh it has saved considerable amount of time. Um it's gonna be interesting to see how much it penetrates our workflow over the next decade.

SPEAKER_02: 9:44

Oh, absolutely. Absolutely. And I I know our coordinators do use AI quite a bit for some of their administrative tasks and shortcuts, things that can make it easier for them in their work, uh, which is great. I think anything that can help um make sure that it's accurate is is gonna be a great way to use AI. So next big topic that we discussed in the survey is always recruitment, the different changes, signaling, um, interviews, in-person, virtual. So what we found were most program directors are satisfied with the current signaling structure. There was some suggestion for further tiering. I think there were a few platinum diamond signals thrown out there. Um do you do you see a benefit from that suggestion? Do you think that it's gonna change in the near future?

SPEAKER_01: 10:29

I don't see a change coming. I feel as though because of the high satisfaction rate amongst program directors, there's not gonna be too much of an impetus. Um, I kind of like the idea of a platinum signal. It's just it's fun to think of, but you know, announcing your number one choice at the beginning of the season might might not be the best. No, people seem to like it. I know that the applicants feel as though it's limiting their options. That being said, if you look at the data that's coming out, it is effectively distributing interviews more widely, meaning that graduates from your medical school, for example, who have great applications, aren't taking 45 interviews across the country. So if they're being limited to 15 plus or minus a few, that's opening up dozens of interviews for other people who might not be quite as competitive, but are more likely to go to those programs that were previously granting interviews to these outstanding applicants. The downside is, and I wonder if you're doing the same thing, if it's making it easier for us, are we interviewing fewer people? And if that isn't downstream effect of the signals, then it might actually end up obviating the benefits we think we're conferring to applicants. So are you interviewing less?

SPEAKER_02: 11:43

We are interviewing the same number uh that we have for the past few years with the signal starting and before that. So no change in our numbers. How about you guys?

SPEAKER_01: 11:53

A little bit less this year. We had a compliment increase last year, and I think I over-interviewed because of a little bit of concern. I didn't know how much it would it would change how far on my rank list I had to go, not much. So we're interviewing a little bit less. Uh and I think most people are also interviewing about the same. So it should be redistributing uh those interviews for the applicants. I like the signals. I'm guessing you love the signals too. Uh I hope the applicants can learn to love them as well.

SPEAKER_02: 12:20

Yeah. Yeah. And we touched up on this um in our previous episode, but what I always realize when I go to SWIPM and have this session is that programs are so different, right? Small, medium tier, large, all across the country, urban settings, suburban settings, rural settings. And every program needs something different. So it's hard to find the right number that everybody's going to agree with. But like you said, I think most program directors, I think it was 68%, were satisfied with the current structure. It seems to be working. Um, and so also agree that I like them and hopefully we'll continue to do this and likely not to change in the near future.

SPEAKER_01: 13:00

Yeah, I was surprised, right? That was a higher number than I expected.

SPEAKER_02: 13:03

Yeah. And it's been a few years. I think we've gotten used to it. We've adjusted how we look at applications, our interviews, things like that. So everything takes a few years before there's more wide adoption. The next topic that was also discussed within the meeting is second looks and in-person second looks. Um, 51% of programs are offering in-person second looks. Do you think this is the future of anesthesia interviews?

SPEAKER_01: 13:30

I think so. Are you are you guys doing them?

SPEAKER_02: 13:33

We are, yeah.

SPEAKER_01: 13:34

How long have you guys been doing them for?

SPEAKER_02: 13:36

This will be our second year. Yeah, we did it for the first time last year. Decided to do it again this year.

SPEAKER_01: 13:42

Uh the applicants seem to like it. I do think that the downside is that there was a large equity argument for um the virtual interviews. And obviously, the second looks, if they were to have some impact on ranking, would definitely negate some of that benefit to people who didn't have the resources to go. You know, we're going to be submitting, we actually already finalized our rank list. We do it really early. So we have second looks in February, so they will not impact ranking. That being said, I still think there's an equity argument just in terms of the ability for those who can afford it to go to second looks and get a better sense of where they want to go. So uh we're definitely losing a little bit on the equity. And that being said, I think the applicants are able to filter out the programs that previously they thought they would have had to go to in person. Maybe they go to the interview, they're not as interested. They can pick a half dozen of programs that maybe they want to visit for second looks, even fewer. Uh so it's definitely going to save them money. Uh, so I think it's probably the future, and I like it. I'm seeing a lot more of it this year. What what do you think? Do you think this is gonna be the new normal?

SPEAKER_02: 14:49

You know, we were hesitant to go back to in-person second looks for all of the reasons that you mentioned, just with equity and and also, you know, ensuring that applicants didn't feel that they had to and that, you know, we would submit our our rank list and that it was submitted and and locked, um, but that there was still no pressure on the applicant to come. And so we hesitated for a long time about doing it. But, you know, coming to California in February is is always wonderful and you know, bright sunny day and and and you get to see our beautiful campus. And so we thought there would be a lot of benefit of just checking out the hospital, checking out the area for applicants who may have never been to the Bay Area, been to California. Um, so thought we would, you know, showcase our program a bit with the second books.

SPEAKER_01: 15:35

We have the exact opposite situation because New York City in February is just a way of making them sure that they can tolerate the worst weather we have every year. But another benefit we found is I'm not sure if you're experiencing the same thing. Money is tight in healthcare systems. We've had some budget cuts in terms of our social events, and second looks have been my hack. It's a way for me to get some funding for some social time for the residents. They just have to hang out with a bunch of applicants at the same time. So it's it's four little get-togethers over the course of the winter when otherwise we're having some budget cuts in terms of our other social events. So there's also some side benefit for our program and our residency.

SPEAKER_02: 16:15

You know, you talk about the negating some of the benefits of the virtual interviews. How do you feel about um away rotations and that experience and how that might also not create a very equitable system?

SPEAKER_01: 16:30

Well, absolutely. To the extent that these away rotations are improving people's chances of matching, uh, they definitely would have that impact of decreasing equity for people with fewer resources. That being said, Mount Sinai actually offers some scholarships. So I believe this year we hosted three different rotators who got a scholarship. It pays for housing and it pays for some cost of living issues. There are some institutions that are trying to offset those things, but I gotta tell you, the benefit to me as a residency program director is huge. Getting a chance to work with someone for a month is better than any interview. It gets gives them a chance to get to know us, we get to know them. They're very happy when they match because they know the program well, and we're very happy when we match them because we know them so well. I would say that over the last three years, when we've focused more on our rotators, uh, between 30 and 50% of our incoming residents are now people who have done rotations. Are you seeing the same?

SPEAKER_02: 17:32

Similar. And we also are fortunate to offer a similar scholarship program to students to come and so uh offsets you know the the cost of living here in the Bay Area and the ability to come travel and stay here. We do not offer an automatic interview to all of our visiting students. So that's also something that we're very upfront when we when they apply and they they choose to come here. Um but I agree, I think this is the best in-person second look you can have of a program. I really see it as an opportunity for the students to really get to know the program, to live the life of the resident, um, and see if this is a place that they would be happy and successful in their training. Um, so I do think there are a lot of benefits, but I agree with the continuing discussion about how that may negate some of the benefits of the virtual interviews and equity issues with that as well.

SPEAKER_01: 18:24

If nothing else, they're saving money. If nothing else, you know, half of our people, half of our residents did not rotate. Uh, none of them have to do a second look. And I think they're still getting the benefits of the of the cost savings over the course of the interview season. And we're saving the environment. People aren't flying all over the country as much. So, I mean, there are still benefits there.

SPEAKER_02: 18:42

Absolutely. There was also a great discussion at the meeting about just angst with all the tasks that we need from others, you know, residents following up on patients, post-operatively evaluations, and that being asked of our both of our faculty and our residents. You've been in your role for over a decade now. What are some good strategies that you've developed over the years to help you with all these tasks that, you know, you don't necessarily have full control over?

SPEAKER_01: 19:09

Oh my goodness. I wish, I wish I had a really good answer to this question. We were talking about burnout earlier. I think this is probably one of the one of the bigger drivers of burnout. I used to wake up in cold sweats in the middle of the night thinking about my evaluations. And if the ACGME did a site visit, where are my evaluations at? It's hard. And I think a lot of it's driven by the amount of support that we have. My former program coordinator called me into her office one day. At the time, we were scheduling an international rotation with a Midwestern Department of Anesthesiology who had set it up. They were kind of uh running the whole thing. And she was interfacing with their program coordinators. So she called me into her office so I could look at the website, and she was scrolling down to see all of the office help, all the coordinators they had. They had Over a dozen, over a dozen for a program that was about the same size as mine. In New York City, the cost of living is very high. We meet the ACGE requirement, but we have a mere fraction of the help that they have. So it can be hard without people who are devoted and their job is, you know, tracking down these evaluations and making sure they're getting done. The strategy I have found is organization. So I tell all my coordinators when they start the job, we've got a little bit of turnover. I want two things. I want a calendar and I want our evaluations checked. And everything else is honestly not as big of a deal. So every month we do a quick audit and then just follow up to make sure that things are done. We put it on the calendar so we don't forget. And then we just have to continuously track people down. Now that needs help, and sometimes I have to step in and do it, but it's an ACG requirement to get all those things done. It's not, it's more than evaluations. It's you know, residents doing post-op evaluations, residents doing their tests, residents doing their evaluations for you. It's uh it's a constant struggle and it never ends. I'm gonna ask you at the most well-resourced program I've encountered so far, Stanford, uh, how do you guys handle all those kinds of things?

SPEAKER_02: 21:16

I think you're right. Organization is huge, kind of within our coordinator team, someone being the point person, so really leading those efforts. It does take a lot of reminders. I do think we, you know, bombard our residents with, you know, fill out your duty hours, fill out this evaluation, and maybe they'll read one of those emails, we hope. But same thing with faculty, it's constant reminders. We have the one of my coordinators and not the email. And if we're not caring back, then I end up having to get involved. And hopefully my email is gonna be read with a little bit more urgency to complete those evaluations. Or sometimes it's it's hallway conversations like, oh, by the way, like you have an evaluation you haven't filled out yet, and just you know, friendly reminders throughout um throughout the day. Uh, but it's hard. It's hard because everybody is very task saturated with everything else they're doing, right? And so we are asking a lot of our residents and of our faculty. Um, and you know, we're kind of the middlemen trying to make sure that they're doing what we ask them to do. But at the end of the day, we still need them to, you know, open their email, fill fill out the evaluation. Um, and we've also become a little bit, I think, as a faculty, and as I think a little bit about academic medicine, about, you know, what's the incentive for me to do this? And so there's a little bit of that too. It's as I talk to faculty. It's it's it's a lot to ask, right? They're just more tasks that that are needed. And what's the incentive for me? And try to make sure that they understand why it's important.

SPEAKER_01: 22:44

Well, some programs have instituted financial incentives or penalties. And that also carries its own its own issues. Uh I've spoken to some program directors where they've instituted penalties or incentives. And for example, the evaluations get done, but they end up being meaningless, um, meaning the person will fill out the minimum and you're not getting good information from it. So uh it's it's tough. But uh we don't want to be the person that everyone's avoiding in the hallways one day. But I think we might end up there.

SPEAKER_02: 23:16

Yeah, I think sometimes when they see me walking down the hallway and they turn the corner, like, I know there's evaluations due, I must avoid conversations with her, hoping to avoid that. But uh I do have a lot of great faculty who who just get it done. And and I agree, right? I think don't just do it, but they need to have some meaningful evaluations, meaningful feedback so that they actually are worth something to our residents. So you mentioned that your rank list is done, which I'm very jealous of. Very busy season for PDs across the country as we're in interview season, um, still have all the other residency administrative duties as well. Um, how do you manage that? And how have you learned over the years to manage kind of the lift of application cycle while juggling your clinical work, running the residency program, personal lives over the holidays? What's the secret sauce? What have you figured it out?

SPEAKER_01: 24:11

Well, I've learned a lot of lessons, and I'm I'm also interested to hear if any of this resonates with you. I see a lot of people who have strategies for getting tasks accomplished. I see a lot of to-do lists out there. I don't make to-do lists, I don't keep a running list of anything. My secret sauce is organization and habits. Um, I tell people that my organization and habits will eat through any amount of work. I know someone who once said, if you want to get something done, give it to someone who's busy. Which seems counterintuitive, but I know exactly what he meant now. I'm a busy person, but I just keep very organized. I use certain strategies, I use like a zero inbox for my email strategy where my if my resident asks me for a letter of recommendation, I say email that. If someone texts me a request, I say thank you for this, I'll do it, email me that. So that's my central hub. I keep a calendar. When I go to bed at night, I don't think about all the things I have to do because I just know there's a place where it's sitting and I have a system and I will slowly chug through it. And it really allows me to get a lot of work done. I don't let things hang over my head, I let them hang out there in the inbox, and I know that I'm gonna see it whenever I open that darn thing, and it'll get done eventually. Habits and organization. Whenever I meet someone who takes on this role, I really try to impress the importance of that. Because as a program director, especially, our residents have to be able to rely on us and our colleagues. I know when I started this job 12 years ago, I was maybe not the most responsible and organized person. And I realized that in this role I had to be that for people. So I developed a system. And uh, you know, you don't want to miss things. You don't want to have one of your mentees, one of your residents coming to you and saying, you know, I was trying to apply for this fellowship uh through the SCA to, you know, to travel and I missed the deadline because you didn't finish my letter. That would be terrible. I'd be devastated. So organization, habits, and allows you to sleep at night because you know that even if you have some things out there that have to get done, you have a system, it won't get lost, it will it will get caught. Um and it allows me to work through a lot of uh a lot of volume of work. How about you? How are you hanging in there in this busy season? And did anything I say resonate with how you do things, or you have a different system?

SPEAKER_02: 26:24

I'm a list person, so I do like to make lists, but my email inbox also is what keeps me really well organized. Reminders in there of things that I need to do. I also try to keep a zero inbox rule and try to get through everything as much as I can. I will say that compared to two years ago, which was my first recruitment season, first six months as a program director, I feel so much better today than I did two years ago in the same spot. Um, I think you or you figure out what works for you, how to how to organize yourself, like you said, um, and and and just how to get through it. And in my first year, I I would go to bed and think about all the things that I needed to do. Now I know like I will get it done, it'll get done, and make sure that I I hit those important deadlines, like you mentioned, like for those fellowship letters or things that are on a timeline, and everything else will fall into place. Um, I think it's uh it's lessons learned over the years, right? Of of that you can get through it, things will all things will work out, and um it's a lot of work. I'm not saying it's not a lot of work, you know, it's a lot of work, but um I think most of us thrive, right, in these environments where we just got a lot going on and we just get it done.

SPEAKER_01: 27:34

Have you started saying no yet?

SPEAKER_02: 27:36

A little bit more. A little bit more. Um, and I have uh relied a little more on my associate program directors, definitely, compared to when I first started, as I was I was trying to learn about the things the program needed and the responsibilities of the program director. So it was hard for me to, you know, ask someone else to do these tasks if I didn't necessarily know what the task was or how to do it myself. So definitely this year um I've asked more of my program director or of my associate program directors um in different ways.

SPEAKER_01: 28:07

Yeah, delegation is also a very, very hard lesson to learn. I don't think I've learned it yet, um, but I'm still working on it.

SPEAKER_02: 28:14

Um so you know, we talked about busy time of year and and back to the statistic that we first started with that you know, very few program directors see themselves in a career in more than four to six years brings up the topic of burnout. And how do we avoid that in our our roles? And and how do we keep the pipelines of program directors you know continuing and and successful?

SPEAKER_01: 28:39

Well, there are so many lessons that we learn, and you you mentioned it gets easier, and it gets easier and easier as the years go on. And it's a shame that people don't build up that skill set and continue to utilize it. They leave, they leave the profession or they leave this line of work. You know, also clinically. I'm an obcetric anesthesiologist, and it's kind of frightening to think about how much I've learned over my over a decade of practice. Um, I feel bad that I was so much less of a physician 10 years ago for the patients I was taking care of, but unfortunately, nothing but time can give you that enhanced skill set, that better judgment, and it applies to clinical practice, it applies, it applies to our administrative work. So it's a shame that we're losing people who are acquiring those skills. I do think that institutions and chairs can go a long way in helping program directors. Uh, we mentioned previously that we're in this position that can oftentimes be at odds with the interests of the faculty. That's not to say faculty aren't on board with the educational mission. It's just because of their position in the department, there are things they would probably love the residents to do for them to make their life easier. That's just not the resident's job. Also, for the chair. I think there are a lot of chairs out there that look at all of these residents floating around doing these, oh, is that research they're doing? Or what is this, uh what is this non-clinical rotation they're on? They're like these choice selectable like uh bodies they could be putting in operating rooms to help their bottom line so the hospital administration is happier with the job they're doing. So I think that faculty, um, specifically the leadership of uh of the department chairs can really help out. So I think meetings like the SAAPM where we're networking are good, maybe we should have more cross-pollination where the chairs get to hear about some of our struggles. Luckily, a lot of chairs were in our chair or our shoes at some point in time, um, so they understand. Also, I I don't know how much uh over the last couple of years you've had to deal with this, but we, you know, learning to not take things too personally, I think all of us have to get there. You know, a lot of what we deal with is structural, has nothing to do with us. When I started my job, one of my mentors says your assignment is to memorize the ACGME program requirements. Because whenever someone gives you a hard time, that's your that's always going to be your answer. It's not about me. So never let people personalize things. Oftentimes in the workplace, things can get very political to the extent that we can depoliticize, depersonalize, just make it very much about what the job is, can go a very, very long way. I just said a lot. So you you're kind of earlier. So I I wonder if um your experience right now is different from where I am kind of over a decade in. Like, what do you think would help you be in this role a decade from now?

SPEAKER_02: 31:28

So many of the things that you talked about. I think things I've learned in in my short tenure is to not take things personally that um people are in roles uh that they're advocating for what they think is best because of their role. And it's not personal. Um, when residents come up with issues, there are requirements that we can always refer back to, um, that we need to be thinking about their educational experience. And they may be angry about something, but it's not you. It's not personally attacking you. And um, that has definitely helped me deal with issues that have come up over um the past year or two, and uh realizing you know that I need to have an objective approach to how I'm dealing with these issues and responding. And it's not that they are personally trying to attack me. Um, they're just angry with something within the system that I can hopefully help them understand a little bit better as I respond. Uh, I also agree that support from the department, um, which may be non-clinical time resources, uh, understanding that these are the struggles that you're going through and having those conversations with your chair and having them help you as well is huge. And I love that idea of a crossover because I do think they probably have very similar thoughts about uh leadership issues dealing with faculty and as we deal with residents. And so it'll it'll likely resonate in a lot of uh synergy and in and the feelings that uh and issues that we have. My biggest thing is when things seem hard, I think about my why, right? Like why am I doing this? When am I getting out of this? What do I want to achieve? And and why does this bring me joy? And you know, I think that's a lot of what I remind the residents, my friends and faculty that are are struggling with burnout is it's what's your why? Why why did we start to do this in the first place? And um, kind of always going back to that as kind of the guiding light.

SPEAKER_01: 33:18

That's an awesome statement. It actually brings something to mind. So I always tell my residents when it's 6:30, 7 p.m., you didn't think you'd be in the OR that late. You're starting to grind your gears a little bit. I say just take a moment and look down. There's gonna be a face under a bear hugger with an and a tracheal tube coming out of it. And just know that there's someone in the in the waiting area who's anxiously awaiting word that their loved one, their daughter, their mother, their husband is okay. And you've been put in charge of guiding them through that. So stop grinding your gears and become a little bit other focused, and it will really snap you out of it. And I don't know if you've had this experience, but I I get invited to some resident weddings. And honestly, you know, I don't have a lot of time on my weekends, so it takes up some of my personal time, but it's always worth doing. And the reason it's worth doing is I go to these weddings and it's not the residents that I'm always watching. I'm looking at their parents. And I'm thinking about all of the work, all of the love, investment, hopes, and dreams that have been put into this person that I've been tasked with raising professionally. And it reminds me of how important the role that I've been blessed with is, and that it really helps me through all this and makes me realize how worthwhile everything is. So uh I think you're so right. The why goes a very long way in every aspect of our life. And it's helped me. I think I have a number of years still left in me, but those little reminders go a long way to help.

SPEAKER_02: 34:56

Yeah, I love the phrase you're raising them professionally. That's so spot on. So to end, you know, I think as we are getting through interview season, we are seeing some amazing applicants, meeting them, um, folks that are doing really amazing work across the country, across the world. Is the future of anesthesia brighter because of this?

SPEAKER_01: 35:17

Wow. I think one would think it would be. We're getting some of the top applicants. I want to say something that's maybe maybe a little controversial. I wonder if with getting those more competitive applicants, we are getting the future leaders, editors for anesthesiology, and anesthesia, you know, the heads of all these professional societies. Obviously, these are the cohort that are going to fill those roles, but I'm not actually sure if we have a higher quantity of people who want to fill the roles. I'm wondering if anesthesia is becoming very competitive for a number of reasons that aren't solely professional in the terms in which we were speaking, you know, like the rewards you get from the work. I mean, there are a lot of benefits. These people are graduating with a lot of debt. The future is uncertain financially. Anesthesia currently is providing a strong, secure financial future. I still think that many medical students look at the different branches of medicine and do believe that anesthesia is more of a lifestyle profession, which I really try to disabuse them of. So sometimes I'm afraid that the increase in competitiveness is not going to have payoff in terms of producing a higher quantity of the leaders, future leaders of anesthesiology. I don't know. Is that a hot take? How does how does that hit you?

SPEAKER_02: 36:35

That's interesting. Um, I think that I meet these folks and I'm like, you will be the next, you know, president of the ASA. And I see that in you, and I see the potential. And I really hope that for those that are interested in that and that um have the skills and the qualities to take them there, um, that they will be nurtured and continually raised professionally during residency and encouraged to pursue those endeavors. Because we we we need them in our um in our profession. Um we need these folks to um want to take on these roles, right? We need people that want to be us in uh many years. Um and so I I hope to have a different take and a more optimistic that, you know, with the right encouragement, the right mentorship, that they'll continue and be leaders in the field.

SPEAKER_01: 37:24

Well, for all of our listeners, this is a great life. You know, we get to take care of patients. That's a a real privilege we have as educators, raising the next generation is real privilege. But there's also this other step of fostering the future of our profession. I'm at the PGA, I'm on the board for the NYSSAA. You know, these other roles are really fulfilling and gratifying. And for those of you looking for a great life, the kind of diversity of your day-to-day practice when you are involved not just clinically, but also administratively and then in the professional society level is is really quite fun. So I hope that you, Marianne, are absolutely correct, and these people will take advantage of these opportunities.

SPEAKER_02: 38:03

Well, thanks so much, Brian. Always great to chat. And uh we'll see you everyone and chat with everyone on our next episode. Thanks.

SPEAKER_00: 38:10

Thank you for joining us on PDs at SEA. If you found this conversation valuable, we invite you to subscribe and share the podcast with colleagues who are committed to advancing anesthesiology education. You can access additional episodes and resources from the Society for Education in Anesthesia at SEAHQR.org. We welcome your questions and suggestions for future episodes. Please contact us at P D S A T-S-E-A-R at SEAHQ.org. This podcast is produced by the Stanford AIM Lab on behalf of the Society for Education in Anesthesia. Thank you for your dedication to teaching the next generation of anesthesiologists. We'll see you next time on PDS at SEA.