The Importance of Department Chairs to Academic Medical Centers

In our July issue there are three contributions about the changing role of chair of a clinical department. Dr Kastor interviewed a group of chairs of Internal Medicine and found consensus that the job has changed over the last generation from intellectual, educational and scholarly leader to a more administrative and business oriented role with little time left for teaching or individual scholarship. Dr. Kastor raised concerns about the implications of these changes for the identity of the chair and long term viability of the role. Drs. George Sheldon (sadly recently deceased) and Jack Ende provide commentaries based upon their own perspectives as chairs. Reading their accounts caused me to reflect upon my own previous experience as chair of a department.

What I first noticed when I became a chair was the larger size of my office and the expansive view that the window provided. This is a symbolic message about the important hierarchical role of the chair and the privileges that accompany the additional responsibilities. Not all chairs are initially comfortable with this change and may find it awkward.  I imagined that the view of the mountains might inspire deep thoughts or at least provide some perspective at times of stress. In addition to the office  I also had a secretary to help with appointments, communications, and helpful advice about interdepartmental etiquette, departmental birthdays and social events. I quickly learned that the secretaries’ informal information network could be as valuable a source of information for me as the weekly chairs meetings with the Dean.

I also noticed that the other chairs of departments now would acknowledge my presence when I walked by with a greeting or at least a “Hrmph” as I approached. The development of trust took a longer time, but after a while I developed close friendships with several of the other chairs that enriched my job and made it feel less isolated. During times in which I had to make difficult decisions, I called these friends and received valuable advice and support.

At the committee of Chairs meetings we learned about important information, and were cautioned to keep much of the information confidential. It was comforting to have this group of talented and committed leaders with whom I could discuss the secret information.

In my department, faculty began to bring important personal details of their lives into our conversations, their impending divorces, illnesses, alcohol or drug problems or errors in patient care. These discussions often led to requests for some time off or reduced responsibilities. Such personal discussions were among the most difficult but rewarding conversations I had because I could really make a difference in someone’s career and life if I could provide the right support and guidance. I figured out quickly that such conversations were part of the job of chair and sought out institutional experts who could help me provide useful advice and direct faculty to institutional resources.

I got invited to four or five retreats every year. We would discuss our vision and mission, and I could never remember which was which or whether the blue dots or the red dots we applied to a list of priorities should indicate my support. Although I should probably express more support for these efforts, I have to admit that the annual adoption of a new lingo or model favored by the facilitator of the retreat reminded me more of changes in fashion than advances in serious problem solving.

When I went into the hospital to care for patients and teach, the nurses and residents formed a phalanx to protect me from some imagined danger (probably that I would cause) rather than to look to me for the answer to a perplexing clinical problem. They also used the occasion of my visit to discuss ideas for improvements in the waiting room, patient and staff food services, parking or some other department that was misbehaving.

Although I make the above comments partly to poke a little fun at some of the less academic sides of the chair job, I also recognize that they are important. I agree with our authors that the job of chair is critical to the success of departments and ultimately the medical school. For chairs to enjoy their roles they must have the opportunity to grow intellectually and experience the joy of creative accomplishment. If the chair’s cannot provide creative growth, and mainly focus on complaints, billing, competition with other hospitals, or legal battles, chairs will soon burn out or the person who becomes a chair will change. We need to identify how to protect and strengthen chairs as academic leaders as well as administrative problem solvers.

I hope the readers of the Journal will contribute their own impressions of the current role of chair whether from personal experience or as an observer. As we enrich our picture of the chair with our reflections, I hope we can consider the role models who are currently succeeding and what we can learn from them as well as what we can do to help those who are struggling. In either case we must prevent the chair from becoming an endangered species or our academic medical centers will not be far behind.

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One Comment

  1. Kemi Tomobi
    July 7, 2013 at 12:05 AM

    Department Chairs convey perception of prestige and intellectual accomplishment, and I hope that does not go away.  However, as mentioned, it appears that the role is becoming more administrative and businesslike.  Therefore the role of the administrative staff under the chair becomes even more valuable.  To further consider the changing role of the Department Chair, we must also consider from which population a Department Chair comes from, and what experiences does the prospective Department Chair bring to the position.  My experience has been that the Department Chair has previously been a Residency Program Director or Clerkship Director.  Thus, these skills have been brought into the role of the Department Chair.  To preserve a certain role of the chair, perhaps one should preserve the skills that one wants the chair to have, and means seeking these skills in the populations of physicians under consideration for chair.

    I have always found Department Chairs to be very busy but definitely more available than most other high ranking physicians in the Department.  When the Department Chairs are made more available to students, residents, faculty and others invested in that particular department, the chair has opportunity for intellectual growth (and promoting intellectual growth in others) because students train in a different era from that of the chair, and will have much to bring to the discussion.  

    I have increasingly found chairs (and prospective chairs) more invested in medical and surgical education research projects as they advance in the department. This is expected when one is in leadership.  One advantage of this new generalization is that the contributions will benefit more than just the area of expertise that they have studied for decades (example – pain research would be specific, but neurology or anesthesia training would be more generic).  One possible disadvantage is that they move away from the area of expertise that originally made them prominent in academia in the first place.  Does this make the chair any less prominent in academic centers?  I hope not. Does it make chairs long for those topics that made them prominent in the first place?  I don’t have the answer to this one, but more department chairs would know.

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