We analyzed 15 years of American Academy of Pediatrics survey data collected from national random samples of residents graduating from 2009 to 2023. Residents were asked about the position they were starting directly following residency and their demographic and program characteristics. We used χ2 linear association to examine trends in starting a chief position across years and multivariable logistic regression to examine associations of demographic and program characteristics with starting a chief resident position compared to those starting other positions.

Response rate averaged across years was 53.4%. Overall, 983 of 7812 residents reported starting chief resident positions; the proportion was stable across years (12.8% in 2009, 11.7% in 2023, P = .41). In multivariable analysis, starting a chief resident position was associated with several characteristics. The strongest associations were medical school location and race and ethnicity. Residents who graduated from a US medical school had higher odds than international graduates of starting a chief position (adjusted odds ratio [aOR] = 1.52, 95% confidence interval [CI] = 1.20–1.94). Residents who identified as Asian (aOR = 0.54, 95% CI = 0.43–0.66), Other race and ethnicity (aOR = 0.57, CI = 0.36–0.91), and Hispanic (aOR = 0.74, CI = 0.57–0.95) had lower odds than white residents of starting a chief position. Black residents also had lower odds than white residents, but it was not significantly different (aOR = 0.77, CI = 0.55–1.07).