The Junk Drawer
There’s a drawer in every house. It has batteries in it, and a tape measure, and three keys nobody can identify, and the manual for an appliance you no longer own. Nothing in it belongs there. Everything in it is there because it had to go somewhere.
That drawer is a program coordinator.
And let’s be clear about what the junk drawer actually is in a house: beloved. It is the drawer that comes in clutch. It’s the one you open at 10pm on a Sunday thinking there’s no possible way I have that thing, and there it is. The right size battery. The little screwdriver. The takeout menu from the place that doesn’t have a website. Nobody organized that drawer into existence. But when it matters, it’s the drawer you go to, and it never lets you down.
So not an insult. A description of a structural fact nobody has ever bothered to name.
What the job description says
Coordinators have a job description. It’s real, it’s written down, and it covers a lot: accreditation compliance, scheduling, ERAS and the interview season, evaluations, onboarding, ACGME surveys, the annual program evaluation, the resident who needs a letter, the file that has to be current.
That’s a job. That’s a whole job.
What the job actually is
Now here’s what coordinators describe when you ask them what the week really looked like.
A trainee starts in a week and has no housing.
A trainee secured housing, arrived, and found it unavailable. Or found it uninhabitable, which is a different word for a worse morning.
An IMG wants to buy a home. They want to plant roots in the city where they’ll train. They’re not sure whether their visa status makes them eligible, and they don’t know who to ask, so they’re asking you.
A trainee started working with a general realtor and is about to spend thousands of dollars they don’t need to spend, and nobody in that transaction has told them so.
None of that is on the job description. All of it lands on the coordinator.
And underneath the emergencies is the constant hum: handholding people through processes that should be self-service. Walking a bright, capable adult through a form. Again. Not because anyone designed it that way, but because the coordinator is the person trainees know to call.
That’s the junk drawer. Not the listed duties. The in-between.
The in-between is the whole problem
Some responsibilities get named in a job description. But there is always the in-between — the part that goes unaccounted for and never gets named — and the in-between is where all the weight actually sits.
It doesn’t sit there because someone assigned it. It sits there because unnamed work travels until it reaches the person who won’t let it reach the trainee. That’s the coordinator. Every time.
So the work gets done. It just gets done invisibly, by one person, at the cost of the work they were actually hired for.
This isn’t a resourcing problem, exactly. Nobody’s asking for a bigger budget here. It’s that nobody has ever said out loud what the in-between contains.
Most of it doesn’t belong to the coordinator at all
Look at that list again. Housing that fell through. Visa-conditioned homebuying. A trainee getting bad real estate advice. A move that hasn’t happened with seven days on the clock.
Not one of those requires a program coordinator specifically. They require someone. They landed on the coordinator because the coordinator was standing there.
Some of it could be distributed across the team. And a large share of it — the housing, the relocation, the community, the buying question the IMG is carrying alone — has an obvious home outside the department entirely. There are organizations for whom that thing is not the in-between. It’s the whole job. It’s what they think about all day, the way you think about the ACGME survey all day.
The coordinator absorbing that work isn’t the only option. It’s just the only one that’s ever been named.
What I’d ask of a program director
One thing.
Be in partnership with your coordinator.
Concretely, that means three moves.
Ask them what trainees are actually asking for and needing — and then take the answer seriously, because they have so much ‘boots on the ground’ data. They’re generally the ones fielding the 9pm text about the apartment.
Believe them about the in-between. When a coordinator tells you where the unnamed work is piling up, that’s not a complaint. That’s a report from the only person with visibility into it.
And give them the autonomy to fix it. Let them decide who to partner with and how to fill the gap. They know what the gap is. They’ve been standing in it.
That’s it. No budget line, no new FTE, no restructure. Just: ask, believe, allow.
To the coordinators
You’ve been holding together everything that doesn’t fit anywhere else, and you’ve been doing it without a name for it, which means you’ve also been doing it without credit for it.
The work you do that isn’t in your job description is not the small part of your job. It’s the part that makes the program survivable for the people in it.
Somebody sees the drawer.
