The Shifting World of AMC Deans and Department Chairs

As academic medical centers feel more pressure to change and to serve students and communities in new ways, new types of leaders are needed. In this interview, Karen E. Otto, managing partner and practice leader, Academic Medicine & Health Sciences, considers the implications for AMCs and executive recruiting.

Question: What’s happening around the role of a typical clinical department chair or dean? Are the responsibilities of leadership expanding in scope and scale?

Karen Otto

Otto: Deans and department chairs are increasingly expected to employ “system-based thinking” when engaged in the 21st century academic medicine enterprise. They are expected to create clinical, education and research collaborations with community and regional organizations, and ironically some of these collaborations may be with historic competitors, especially within the clinical arena.

For example, with the formation of multi-hospital health systems with geographic reach, dean and chair roles can vary dramatically depending on whether the academic medical center is at the center of the new enterprise or one of many parts. With the latter, the clinical enterprise becomes managed at the system level of the organization, and the dean role may primarily provide oversight of the academic program only. Juxtaposed, when the academic medical center is the driver of the multi-hospital system, the dean and chairs have the opportunity to play a greater strategic role directing the clinical programs and outreach for patients and the communities the health system serves.

Question: Are skills changing, too?

Otto: Yes. Deans and department chairs need to possess different management competencies than what was valued a generation ago. There is more to understand, for example, around the business aspects of the organization – the management of and strategy behind clinical community-outreach programs, for example. There is also a need for deans and chairs to reach beyond their traditional academic medical center footprint and to partner with entities outside of one’s own organization in order to achieve the tripartite mission of academic medicine. There is greater recognition that no medical school and department can operate in a silo.

Question: Deans and chairs are asked to lead the clinical, research and education missions of their institutions. Does this make recruiting them more difficult?

Otto: Yes, historically universities looked for “triple threat” candidates – that is, those who have achieved success in research, managed complex clinical activities and have been considered outstanding educators. For those few that are accomplished in all three areas, they are in great demand. Most candidates are typically going to be focused on one area or the other, and unfortunately, strong educators are often not considered the highest value for most institutions.

The usual priority is research – it’s so hard to be a continuously funded investigator. The belief is that if you can recruit a dean or department chair who has been a significantly funded investigator with national standing, the institution or department’s overall reputation will rise sharply. As we know, however, what makes one successful in research may not always translate to success as a dean or department chair.

Question: How are candidates gaining the expertise they need in budgeting and financing, innovation and partnering, fundraising, and other business elements that are critical to ensuring sustainability in the marketplace?

Otto: A lot of them are going back to school, getting advanced degrees such as MBAs or MPHs, or taking certification programs to enhance their management competencies. They get executive coaches and get specific help in specific areas such as personnel management, communication skills and conflict resolution strategies. It’s also not unusual for a dean to have a associate dean or chief administrative officer who is the point person on some of these things. It’s understood that the business skills of these positions aren’t developed overnight.

Question: From a recruiting standpoint, what will be the greatest challenges in searches for chairs and deans going forward?

Otto: Ideally you would like candidates who present the broadest understanding and experience in research, clinical service and medical education. But quite frankly the art of search is to be able to match the capabilities of the candidate to the institution’s needs, aspirations and culture. In the end, leadership character, empathy and evoking the joy of academic medicine predict long-term success for a successful dean or department chair.

The Witt & Wisdom Team

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