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The 2016 Association of Pathology Chairs annual meeting featured a discussion group of Association of Pathology Chairs senior fellows (former chairs of academic departments of pathology who have remained active in Association of Pathology Chairs) that focused on how they decided to transition from the chair, how they prepared for such transition, and what they did after the transition. At the 2017 annual meeting, the senior fellows (encompassing 481 years of chair service) discussed lessons they learned from service as chair. These lessons included preparation for the chairship, what they would have done differently as chair, critical factors for success as chair, factors associated with failures, stress reduction techniques for themselves and for their faculty and staff, mechanisms for dealing with and avoiding problems, and the satisfaction they derived from their service as chair. It is reasonable to assume that these lessons may be representative of those learned by chairs of other specialties as well as by higher-level academic administrators such as deans, vice presidents, and chief executive officers. Although the environment for serving as a department chair has been changing dramatically, many of the lessons learned by former chairs are still valuable for current chairs of any length of tenure.
There have been selected reports describing experiences, perceptions, and lessons learned by individuals who have served as academic department chairs.1-11 The Association of Pathology Chairs (APC) senior fellows have been previously described and have contributed to this literature.12 Some of these reports have suggested that the most challenging aspects of chairing a department are paperwork, faculty conflicts, responsibility without authority, financial concerns, sacrificing personal growth, and the relative lack of autonomy.1,5 Others have emphasized the importance of seeking mentorship from other chairs and learning to delegate some chair responsibilities to others.7,10 Such findings exemplify the importance of lessons of the past, particularly since the position of department chair is becoming more complicated and difficult with the rapidly changing environment of funding, technology, and regulations.
The 2016 APC annual meeting featured a discussion group of senior fellows that focused on how they decided to transition from the chair, how they prepared for the transition, and what they did after the transition.12 At the 2017 annual meeting, the senior fellows conducted a follow-up discussion group that assembled the lessons learned during their nearly half a millennium of combined chair service. This report of those findings is somewhat unique in the literature since it is the output of a homogeneous group of relatively long-serving individuals.
Thirty-one senior fellows participated in the 2017 annual meeting discussion group. These 31 individuals collectively represent 481 years of department chair service. More than half of them stepped down as chair 6 to 10 years ago, were external candidates for the position, and chaired departments of more than 25 salaried full-time faculty that were based in both a medical school and hospital. More than two-thirds chaired departments in public schools. The research ranking of the departments ranged from the top 10 to the lower half of academic departments. The senior fellows had a vast array of educational, clinical, and research accomplishments throughout their careers.
Prior to the discussion group, the fellows were divided into 3 work groups based upon their years of service as chair (5-10, 11-19, and more than 20). These groups were given the opportunity to provide both written and verbal input before the annual meeting. Because the findings in this article were the output of a discussion group, the University of California, San Diego Human Research Protections Program deemed that institutional review board review was not necessary. That said, it should be emphasized that quantitative information is lacking and that the reported outcomes represent the overall general opinions of the 31 senior fellows as gathered both verbally and from written comments submitted before the discussion group occurred and from additional verbal comments during the discussion group.
Many individuals reported that prior graduated responsibilities, mentorship and advice, and study of documents prepared them well for the chairship. Others reported that their prior work with professional organizations and experience from considering other chairships were important (Table 1).
Many senior fellows indicated that they would have taken courses on management, communication, business, leadership, financial management, and technology. They specifically mentioned courses for clinical service chiefs (eg, Harvard courses) and for new chairs (APC). Other senior fellows indicated that they would have spent more time walking through the department and talking with faculty before assuming the chairship, while several emphasized the need to learn how the institution works and how it evolved (Table 2).
Senior fellows indicated that they would have made changes in both the mission-based (clinical, educational, and research) as well as the structural and cultural aspects of their departments and would have spent more time on their own personal development and on acquisition of resources (Table 3).
Both internal and external support and collaboration were deemed to be critical factors for successful performance as a department chair as well as faculty productivity and success, personal job satisfaction, extramural financial support and fund-raising, personal values, skills, and prior experiences. Some commented that chairing is a team sport, advising that successful chairs coach/mentor and do not micromanage faculty while others noted the importance of involvement in the institution (“if you are not at the table, you will be on the menu”). Finally, the use of mentors and coaches by the chair herself or himself was considered to be important (Table 4).
Senior fellows articulated a variety of elements that they associated with failure as chair. These ranged from issues with the recruitment package offered to them, lack of shared vision of leadership, disruptive faculty, inadequate resources, inability to resolve conflicts, poor communication skills, and cultural differences (Table 5).
Senior fellows described an array of stress-reduction strategies for themselves. These included networking for advice and support from professional colleagues, family, and friends; using escape mechanisms; delegating activities; developing more self-awareness; and others (Table 6).
In addition to reducing stress for oneself, the senior fellows emphasized the importance of stress reduction for their faculty and staff. Effective communication and engagement were deemed to be an essential component of reducing stress on others as well as being visible and accessible as the chair (Table 7).
The importance of consulting with others for advice was emphasized as an important element in dealing with and avoiding problems. Another important mechanism was to establish an equitable, transparent, and explicit system of reward and recognition for faculty and staff. The personal qualities and characteristics of the chair, such as being pleasant, available, and engaged with faculty and staff, were also significant factors in avoiding and dealing with problems (Table 8).
Dealing with problem faculty was a major focus of discussion by the senior fellows. A key to resolving problems with faculty was felt to be in communications, in trying to both understand the issues and resolve them. Evaluating potential underlying medical and behavioral causes was mentioned by several. Providing explicit expectations for performance and discussing other career opportunities were often helpful. When active intervention was needed, following institutional policies and procedures was essential, along with engaging appropriate institutional leadership. It was observed that all chairs have problem faculty from time to time and that being empathetic often makes it more difficult to deal with struggling faculty who are trying hard but just cannot make it (Table 9).
Reflecting upon their years of service as pathology department chairs, the senior fellows especially noted the satisfaction they derived from recruiting and mentoring faculty, staff, and trainees and from supporting them in defining and achieving their goals. They also stressed the satisfaction obtained from creating innovative educational, research, and clinical programs and from finding new sources of revenue and creating financial stability in their departments. They valued working with faculty and staff to improve the status and sustainability of the department and working with fellow chairs (pathology and nonpathology) as well as deans and other health system leadership to define and achieve institutional goals. A number of senior fellows mentioned their satisfaction from working with other institutions and organizations as chair representatives to help develop programs and activities that enhance the missions of pathology and medicine (Table 10).
Although the population size involved in the discussion group was small (31 senior fellows) and the information was not based on a formal survey, the total number of years served as chair by the group was large (481 years), and there was general concurrence on the lessons learned by this homogenous group of people. These lessons included preparation for assuming the chair, reflections on what they would have done differently as chair, identification of critical factors for success and factors associated with failures, stress reduction techniques for themselves and for their faculty and staff, methods for dealing with and avoiding problems in general and with problem faculty, and the satisfaction derived from serving as chair. Interestingly, despite the fact that the 3 work groups engaged in preliminary discussions prior to the annual meeting were divided by years of service as chair (5-10, 11-19, and more than 20), there were no apparent differences in the views expressed by each group. Furthermore, it was not possible to determine when in the course of one’s chairship (early, midterm, late) certain lessons were learned.
We speculate that the lessons articulated in this study may be representative of those from disciplines other than pathology and may even be applicable to higher-level academic administrators (eg, deans, vice presidents, health system chief executive officers). Indeed, a few of the lessons described have been previously reported by others. The work of Mets et al9 indicated the value of serving as a vice chair prior to assuming the chair, while Fisher8 noted the importance of chair interactions with the prior chair. Keith and Buckley5 noted the significance of the chair’s personal attributes and skills as a factor for success in the role of chair. Ness and Samet7 corroborated the value of the chair’s delegation of selected responsibilities, and Roediger6 highlighted the importance of walking around the department and being visible. The study of Lee1 emphasized the satisfaction derived from improving departments and programs and developing the faculty. Similarly, while the APC senior fellows concluded that service as a pathology department chair was far from easy, they also felt that the satisfaction derived from it was most rewarding.
Becoming a department chair can be a life-changing experience for people who assume this role. Informal discussions with APC members over the past several years have indicated concerns in handling difficult faculty, balancing work life with personal life, coping with stress, and the feeling that perhaps they did not prepare adequately for becoming chair. Review of lessons learned by this homogeneous group of relatively long-serving former chairs can be of potential help to current chairs in facing these challenges, regardless of the length of service as chair.
The authors gratefully acknowledge the following Association of Pathology Chairs Senior Fellows for their contributions to this discussion: M. Buja, S. Cohen, R. Colvin, R. Folberg, E. Friedberg, R. Friedman, R. Geiss, A. Gottlieb, R. Green, M. Hart, R. Heffner, W. Hickey, R. Johnson, D. Korn, J. Madara, J. McDonald, S. Pizzo, D. Powell, S. Robboy, E. Rubin, D. Ryan, C. Taylor, G. Threatte, L. Tilzer, P. Ward, and R. Weinstein. The authors also appreciate the support of Priscilla Markwood, Mel Limson, and Jennifer Norman from the APC Office.
Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.