Leadership in Medical Education: Why Make the Jump to Program Director?

By Michael Gisondi (@MikeGisondi

A graduate of the residency program that I formerly directed sent me a question a few years back. This individual – let’s call her, ‘Wonder Woman’ – was considering becoming a program director. I was touched that she sought my opinion before jumping into a role that she knew I loved.

I’ve been holding on to this email exchange in my inbox for quite some time because… well… I’m sentimental. I decided to share the conversation below, with permission from Wonder Woman, for consideration by those readers contemplating a move to a new leadership position. I hope the themes resonate and that some of you find the reflections useful.

Wonder Woman:

“A while back we had discussed my reservations about becoming a [residency] program director (as well as the opportunities that come with the position).

Do you have your own “Letterman Top 10” list for program director? Having done that job for a number of years, what were the best and worst things you remember about it?”


“Best things about being program director:

  1. You are the change agent.
  2. You get to leave a legacy.
  3. You learn a ton and you will have massive professional growth.
  4. You can determine the execution of your department’s mission and vision.
  5. Your professional network will increase.
  6. You can be the most important faculty member for the medical students.
  7. You get to manage a team.

Worst things about being program director:

  1. You aren’t the teacher anymore, you direct the teachers.
  2. Your professional growth will include many public mistakes. They can be tough on ego, embarrassing, and psychotherapy-inducing.
  3. The residents won’t love you like they loved you when you were the associate program director. Now you are the true boss, and there is a distance that comes from that.
  4. You are always on.
  5. The Match consumes all the oxygen in the room.
  6. Administration isn’t everyone’s favorite game.

You were made for this. Give yourself 5 years in the job. You are allowed to step down then, not before. Die empty, right? Give all you were meant to give and not one drop less. Otherwise, why did you put in the sweat equity that made you?”

Wonder Woman:

“Mike, this is gold. Thank you!”


“Can I ask what you would list in your pro column and in your con column?”

Wonder Woman:


  1. Opportunity for advancement to the next tier above program director (e.g. vice chair of education or some other amazing job)
  2. Opportunity to set priorities for residency program growth and development
  3. Opportunity to recruit incoming classes of residents
  4. More exposure to local and national contacts
  5. Opportunity to engage in more development of faculty as educators (if there is time for this)


  1. Less time for lecturing and clinical practice. I actually worry more about clinical practice — maybe it’s an irrational fear that I’ll be seen as clinically inept by residents if I only work 5-6 shifts/month?
  2. Requirement to address individual ‘non-learning’ problems (e.g., residents behaving badly, resident burnout/mental health/personal life problems). I just don’t see myself as very good or very interested in this.
  3. More accountability to the chair. While I think this will be an opportunity for professional growth, I’m worried about how our styles mesh.
  4. Requirement to manage budgets/finance.
  5. Commitment to being “always on” and available to handle crisis. No time is ever my own anymore.

I suppose my biggest reservation about the opportunity surrounds whether there’s enough stuff that I like about the job to justify the time and energy commitment. I realize that sounds selfish, but I’m ok with it…

The way you make it sound, it is all worth it. Thanks for your input.”


“So… What’s your decision???”

[end of exchange] … and I know the answer…

The above email exchange was edited only for formatting purposes and is posted after review by and permission of… Wonder Woman.


Michael A. Gisondi, MD is an emergency physician, medical educator, and education researcher who lives in Palo Alto, California. Michael currently holds a position as Associate Professor and Vice Chair of Education in the Department of Emergency Medicine at Stanford University.


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