Leadership Trends in Academic Pediatric Departments
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《小儿科》
Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado
Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas
ABSTRACT
Objective. To examine recent turnover trends among chairs of academic pediatric departments.
Methods. Membership data for the 150 institutions represented by the Association of Medical School Pediatric Department Chairs in the United States, Canada, and Puerto Rico were reviewed for the time period of 1993–2003.
Results. From 1993 to 2003, 278 individuals (250 men and 28 women) held the position of chair. The mean time of service was 5.58 ± 3.2 years (median: 5 years). Twenty-nine individuals served continuously as chairs during the 11-year period. Seventy-two individuals served as interim chairs. Twenty-eight women were appointed either chairs or interim chairs during the 11 years. The number of female chairs decreased from 13 in 1993 to 11 in 2003. Female chairs were in office 3.42 ± 2.72 years. A total of 123 departments had a change in leadership, with a mean annual turnover rate of 17% (range: 4.6–24%). Three departments had 5 different leaders as either interim chair or chair and 6 departments had 4 different leaders during this time period. Neonatology was the most common subspecialty represented by recent pediatric chairs, although nephrology was the subspecialty with the greatest proportional representation.
Conclusions. Departments of pediatrics have high turnover of leadership. Women, in particular, serve for relatively short periods and appear to be under-represented within the leadership of pediatrics. Efforts should be made to ascertain personal qualities that allow sustained leadership and to attract more women into leadership positions.
Key Words: academic health centers education
Leadership in academic medical institutions has grown increasingly complex as budgetary demands, clinical competition, and regulatory compliance have becoming increasingly challenging. As the stresses and challenges of leading and managing the academic enterprise have grown, so has the turnover of medical school deans.1,2 The mean tenure of deans from 1980 through 1990 was 4.1 years.1 This rapid turnover can lead to institutional instability and can be an impediment to institutional progress. Changing leadership is not unique to medicine. Business executives also have significant turnover. In 2000, 17.9% of the 2500 largest companies in the United States had changes of their chief executives.3
Chairs of clinical departments face many of the leadership and management challenges of chief executive officers and deans. Turnover among chairs of internal medicine departments is significant.4 Little is known about the background and length of service of chairs of academic pediatric departments. There are several reasons why pediatric chairs might have unique demographic characteristics, compared with other clinical department chairs. Women constitute a significant percentage of department faculty and trainees. Currently, 68% of pediatric residents are women (American Board of Pediatrics, personal communication, 2004). It is possible, therefore, that women have greater representation among academic leaders in pediatrics. In addition, many academic pediatric department chairs also serve in a senior leadership position at a children’s hospital. These dual academic and clinical roles may present unique opportunities and stresses for pediatric chairs.
The Association of Medical School Pediatric Department Chairs represents 150 pediatric departments in the United States, Canada, and Puerto Rico. We reviewed the Association of Medical School Pediatric Department Chairs membership records from 1993 to 2003 to evaluate recent trends in the tenure of academic pediatric leadership.
METHODS
Membership records for 150 departments were retrieved for the time period 1993–2003. A total of 131 departments were in the United States, 3 were in Puerto Rico, and 16 were in Canada. Only data from this time period were included in the analysis. Canadian chairs have a limit of time of service of 10 years. Data are given as mean ± SD.
RESULTS
1993 to 2003, 278 individuals (250 men and 28 women) held the position of chair. The mean length of service during this time period was 5.58 ± 3.2 years, and the median was 5 years. Eight chairs (6 men and 2 women) moved from one institution to become a chair in a different department during the 11 years. Twenty-nine individuals served as chairs for the entire 11-year period. Twenty-five of the 150 institutions had the same chair for the 11-year period.
Seventy-two individuals (58 men and 14 women) served as interim chairs for a mean of 1.62 ± 0.92 years without becoming chairs. The longest term as interim chair without progression to chair was 5 years. For the interim chairs who became departmental chairs, the mean time as interim chair was 1.13 ± 1.37 years.
Twenty-eight women served as either chairs or interim chairs over 11 years (Table 1). In 1993, there were 13 female chairs. The number declined to 11 female chairs in 2003. The mean length of service for female chairs was 3.42 ± 2.72 years.
Individuals entered the position of chair from both general pediatric and pediatric subspecialty backgrounds (Table 2). Neonatology was the most common subspecialty represented by recent pediatric chairs. When factored by the total number of individuals certified by the American Board of Pediatrics within a specialty, nephrology was the specialty with the greatest proportional representation among the chairs. Determining the proportional representation was not possible for some disciplines.
One hundred twenty-three of the departments of academic pediatrics had a change in leadership during the 11 years. The mean turnover of pediatric chairs was 17% (range: 4.6–24%). From 1993 to 2003, 3 departments had 5 individuals as either interim chair or chair and 6 departments had 4 individuals as either interim chair or chair.
DISCUSSION
These data demonstrate frequent turnover of academic pediatric chairs. The mean time in position of 5.58 years is comparable to the mean tenure of chairs of internal medicine departments of 5.66 years in the 1980s and 5.7 years in the 1990s.5 Pediatric chairs served slightly longer than recent deans, whose average tenure was 4.1 years.1 Interim pediatric chairs also served for comparable periods (1.6 years) with respect to internal medicine chairs (1.3 years).5 The institutional turnover rate for pediatric chairs was 17%, which was almost exactly the same as that for chairs of internal medicine (17.1%) during the same time interval.5 Remarkably, the average turnover of academic deans from 1940 to 1992 was 16%.1 The similarity of these data suggest that the factors causing leadership changes may be ubiquitous within academic medicine.
Surprisingly, the number of women serving as chairs or interim chairs has not increased in the past 11 years, despite a growing female presence in the pediatric workforce (American Board of Pediatrics, personal communication, 2004). In 1999, Schaller noted that, among 85 female chairs of academic clinical departments, 11 women were pediatric chairs at that time, compared with 14 female family medicine chairs and 10 female chairs of obstetrics and gynecology.6 A survey of pediatric faculty members in 1996 found that only 3% of pediatric female faculty members aspired to become department chair, compared with 13% of male faculty members.7 Therefore, a lack of interest in assuming the role of department chair appears to be present for both genders but is particularly acute for women. Given the gender distribution of pediatric faculty members and trainees, the lack of female department leaders needs to be evaluated, with greater emphasis placed on identifying and nurturing female leaders for the future.
Leader turnover can create significant departmental instability, and replacement requires significant faculty time and institutional resources. The finding that, within 11 years, 3 pediatric departments had 5 leaders and 6 departments had 4 leaders was striking. Although the reasons for leadership changes among pediatric chairs are unknown, turnover of medical school deans was strongly correlated with public universities, low clinical revenue, and lack of financial autonomy.2 When deans were interviewed, they identified the stress of balancing the clinical and academic missions and the lack of financial resources as having the greatest negative impact on their job satisfaction.2 The balancing of clinical and academic missions may be the reason why common ownership of the teaching hospital and medical schools was also associated with shorter tenure among deans.2 These dual and potentially conflicting hospital responsibilities may be somewhat analogous to the requirements for pediatric chairs within children’s hospitals.
Pediatric chairs come from all pediatric subspecialties, as well as from general pediatric backgrounds. The large number of neonatologists is consistent with the large number of pediatric graduates who have chosen careers in neonatology. Only 10% of pediatric chairs were general pediatricians. This is somewhat surprising for an era in which primary care was a major national health emphasis. Nephrology was the subspecialty with the greatest proportional representation among pediatric chairs. It is not known why nephrologists were over-represented among the group of chairs.
This article represents only an 11-year snapshot of leadership among academic pediatric departments and thus understates the length of time in service for some chairs. The database did not provide information concerning the reasons why chairs left their positions or factors that led some to maintain their leadership. Clearly, many pediatric departments are faced with frequent leadership changes. The burden these changes place on the departmental faculty, as well as their affiliated hospitals and medical schools, may be significant. Furthermore, because it involves leaders responsible for the education of most future pediatricians, organizational dysfunction related to chair turnover may have an impact on child health in general.
To better prepare individuals for successful leadership, environmental factors leading to the high turnover of pediatric chairs should be identified and either addressed or considered when evaluating the requisite skills of potential chair appointees. Efforts should be made to ascertain personal qualities that may allow academic leaders to have sustained success and enjoyment in the complicated academic and health care environment. The lack of female chairs in pediatric departments requires special attention.
FOOTNOTES
Accepted Nov 23, 2004.
No conflict of interest declared.
REFERENCES
Banazak-Holl J, Greer DS. Tenure of deans of medicine during the last five decades. Acad Med. 1994;89 :1 –7
Levin R, Bhak K, Moy E, Valente E, Griner PF. Organizational, financial, and environmental factors influencing deans’ tenure. Acad Med. 1988;73 :640 –644
Yedida M. Challenges to effective medical school leadership: perspectives of 22 current and former deans. Acad Med. 1998;73 :631 –639
Pearson J, Ibrahim T. Turnover among APM members since 1971. Am J Med. 2002;113 :706 –710
McGeehan P. Corporate turnover at the top slowed in 2003, study finds. New York Times. May 17, 2004;C5
Schaller JG. Women in pediatrics. Pediatr Ann. 1999;28 :184 –189
Kaplan SH, Sullivan LM, Dukes KA, Phillips CF, Kelch RP, Schaller JG. Sex differences in academic advancement. N Engl J Med. 1996;335 :1282 –1289(F. Bruder Stapleton, MD, )
Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado
Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas
ABSTRACT
Objective. To examine recent turnover trends among chairs of academic pediatric departments.
Methods. Membership data for the 150 institutions represented by the Association of Medical School Pediatric Department Chairs in the United States, Canada, and Puerto Rico were reviewed for the time period of 1993–2003.
Results. From 1993 to 2003, 278 individuals (250 men and 28 women) held the position of chair. The mean time of service was 5.58 ± 3.2 years (median: 5 years). Twenty-nine individuals served continuously as chairs during the 11-year period. Seventy-two individuals served as interim chairs. Twenty-eight women were appointed either chairs or interim chairs during the 11 years. The number of female chairs decreased from 13 in 1993 to 11 in 2003. Female chairs were in office 3.42 ± 2.72 years. A total of 123 departments had a change in leadership, with a mean annual turnover rate of 17% (range: 4.6–24%). Three departments had 5 different leaders as either interim chair or chair and 6 departments had 4 different leaders during this time period. Neonatology was the most common subspecialty represented by recent pediatric chairs, although nephrology was the subspecialty with the greatest proportional representation.
Conclusions. Departments of pediatrics have high turnover of leadership. Women, in particular, serve for relatively short periods and appear to be under-represented within the leadership of pediatrics. Efforts should be made to ascertain personal qualities that allow sustained leadership and to attract more women into leadership positions.
Key Words: academic health centers education
Leadership in academic medical institutions has grown increasingly complex as budgetary demands, clinical competition, and regulatory compliance have becoming increasingly challenging. As the stresses and challenges of leading and managing the academic enterprise have grown, so has the turnover of medical school deans.1,2 The mean tenure of deans from 1980 through 1990 was 4.1 years.1 This rapid turnover can lead to institutional instability and can be an impediment to institutional progress. Changing leadership is not unique to medicine. Business executives also have significant turnover. In 2000, 17.9% of the 2500 largest companies in the United States had changes of their chief executives.3
Chairs of clinical departments face many of the leadership and management challenges of chief executive officers and deans. Turnover among chairs of internal medicine departments is significant.4 Little is known about the background and length of service of chairs of academic pediatric departments. There are several reasons why pediatric chairs might have unique demographic characteristics, compared with other clinical department chairs. Women constitute a significant percentage of department faculty and trainees. Currently, 68% of pediatric residents are women (American Board of Pediatrics, personal communication, 2004). It is possible, therefore, that women have greater representation among academic leaders in pediatrics. In addition, many academic pediatric department chairs also serve in a senior leadership position at a children’s hospital. These dual academic and clinical roles may present unique opportunities and stresses for pediatric chairs.
The Association of Medical School Pediatric Department Chairs represents 150 pediatric departments in the United States, Canada, and Puerto Rico. We reviewed the Association of Medical School Pediatric Department Chairs membership records from 1993 to 2003 to evaluate recent trends in the tenure of academic pediatric leadership.
METHODS
Membership records for 150 departments were retrieved for the time period 1993–2003. A total of 131 departments were in the United States, 3 were in Puerto Rico, and 16 were in Canada. Only data from this time period were included in the analysis. Canadian chairs have a limit of time of service of 10 years. Data are given as mean ± SD.
RESULTS
1993 to 2003, 278 individuals (250 men and 28 women) held the position of chair. The mean length of service during this time period was 5.58 ± 3.2 years, and the median was 5 years. Eight chairs (6 men and 2 women) moved from one institution to become a chair in a different department during the 11 years. Twenty-nine individuals served as chairs for the entire 11-year period. Twenty-five of the 150 institutions had the same chair for the 11-year period.
Seventy-two individuals (58 men and 14 women) served as interim chairs for a mean of 1.62 ± 0.92 years without becoming chairs. The longest term as interim chair without progression to chair was 5 years. For the interim chairs who became departmental chairs, the mean time as interim chair was 1.13 ± 1.37 years.
Twenty-eight women served as either chairs or interim chairs over 11 years (Table 1). In 1993, there were 13 female chairs. The number declined to 11 female chairs in 2003. The mean length of service for female chairs was 3.42 ± 2.72 years.
Individuals entered the position of chair from both general pediatric and pediatric subspecialty backgrounds (Table 2). Neonatology was the most common subspecialty represented by recent pediatric chairs. When factored by the total number of individuals certified by the American Board of Pediatrics within a specialty, nephrology was the specialty with the greatest proportional representation among the chairs. Determining the proportional representation was not possible for some disciplines.
One hundred twenty-three of the departments of academic pediatrics had a change in leadership during the 11 years. The mean turnover of pediatric chairs was 17% (range: 4.6–24%). From 1993 to 2003, 3 departments had 5 individuals as either interim chair or chair and 6 departments had 4 individuals as either interim chair or chair.
DISCUSSION
These data demonstrate frequent turnover of academic pediatric chairs. The mean time in position of 5.58 years is comparable to the mean tenure of chairs of internal medicine departments of 5.66 years in the 1980s and 5.7 years in the 1990s.5 Pediatric chairs served slightly longer than recent deans, whose average tenure was 4.1 years.1 Interim pediatric chairs also served for comparable periods (1.6 years) with respect to internal medicine chairs (1.3 years).5 The institutional turnover rate for pediatric chairs was 17%, which was almost exactly the same as that for chairs of internal medicine (17.1%) during the same time interval.5 Remarkably, the average turnover of academic deans from 1940 to 1992 was 16%.1 The similarity of these data suggest that the factors causing leadership changes may be ubiquitous within academic medicine.
Surprisingly, the number of women serving as chairs or interim chairs has not increased in the past 11 years, despite a growing female presence in the pediatric workforce (American Board of Pediatrics, personal communication, 2004). In 1999, Schaller noted that, among 85 female chairs of academic clinical departments, 11 women were pediatric chairs at that time, compared with 14 female family medicine chairs and 10 female chairs of obstetrics and gynecology.6 A survey of pediatric faculty members in 1996 found that only 3% of pediatric female faculty members aspired to become department chair, compared with 13% of male faculty members.7 Therefore, a lack of interest in assuming the role of department chair appears to be present for both genders but is particularly acute for women. Given the gender distribution of pediatric faculty members and trainees, the lack of female department leaders needs to be evaluated, with greater emphasis placed on identifying and nurturing female leaders for the future.
Leader turnover can create significant departmental instability, and replacement requires significant faculty time and institutional resources. The finding that, within 11 years, 3 pediatric departments had 5 leaders and 6 departments had 4 leaders was striking. Although the reasons for leadership changes among pediatric chairs are unknown, turnover of medical school deans was strongly correlated with public universities, low clinical revenue, and lack of financial autonomy.2 When deans were interviewed, they identified the stress of balancing the clinical and academic missions and the lack of financial resources as having the greatest negative impact on their job satisfaction.2 The balancing of clinical and academic missions may be the reason why common ownership of the teaching hospital and medical schools was also associated with shorter tenure among deans.2 These dual and potentially conflicting hospital responsibilities may be somewhat analogous to the requirements for pediatric chairs within children’s hospitals.
Pediatric chairs come from all pediatric subspecialties, as well as from general pediatric backgrounds. The large number of neonatologists is consistent with the large number of pediatric graduates who have chosen careers in neonatology. Only 10% of pediatric chairs were general pediatricians. This is somewhat surprising for an era in which primary care was a major national health emphasis. Nephrology was the subspecialty with the greatest proportional representation among pediatric chairs. It is not known why nephrologists were over-represented among the group of chairs.
This article represents only an 11-year snapshot of leadership among academic pediatric departments and thus understates the length of time in service for some chairs. The database did not provide information concerning the reasons why chairs left their positions or factors that led some to maintain their leadership. Clearly, many pediatric departments are faced with frequent leadership changes. The burden these changes place on the departmental faculty, as well as their affiliated hospitals and medical schools, may be significant. Furthermore, because it involves leaders responsible for the education of most future pediatricians, organizational dysfunction related to chair turnover may have an impact on child health in general.
To better prepare individuals for successful leadership, environmental factors leading to the high turnover of pediatric chairs should be identified and either addressed or considered when evaluating the requisite skills of potential chair appointees. Efforts should be made to ascertain personal qualities that may allow academic leaders to have sustained success and enjoyment in the complicated academic and health care environment. The lack of female chairs in pediatric departments requires special attention.
FOOTNOTES
Accepted Nov 23, 2004.
No conflict of interest declared.
REFERENCES
Banazak-Holl J, Greer DS. Tenure of deans of medicine during the last five decades. Acad Med. 1994;89 :1 –7
Levin R, Bhak K, Moy E, Valente E, Griner PF. Organizational, financial, and environmental factors influencing deans’ tenure. Acad Med. 1988;73 :640 –644
Yedida M. Challenges to effective medical school leadership: perspectives of 22 current and former deans. Acad Med. 1998;73 :631 –639
Pearson J, Ibrahim T. Turnover among APM members since 1971. Am J Med. 2002;113 :706 –710
McGeehan P. Corporate turnover at the top slowed in 2003, study finds. New York Times. May 17, 2004;C5
Schaller JG. Women in pediatrics. Pediatr Ann. 1999;28 :184 –189
Kaplan SH, Sullivan LM, Dukes KA, Phillips CF, Kelch RP, Schaller JG. Sex differences in academic advancement. N Engl J Med. 1996;335 :1282 –1289(F. Bruder Stapleton, MD, )