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Opinion |
1 All authors: Department of Radiology, Indiana University School of Medicine, Rm. 1053, 702 Barnhill Dr., Indianapolis, IN 46202-5200.
Received January 22, 2003; accepted after revision April 4, 2003.
Address correspondence to R. B. Gunderman.
[The people] have a right, an indisputable, unalienable, indefeasible, divine right to that most dreaded and envied kind of knowledge, I mean of the characters and conduct of their rulers.John Adams [1]
The search for a chairperson is one of the most important challenges academic radiology departments face. When a search is successful and the right person is matched to the right job, departments may reap benefits for years or even decades to come. Unfortunately, some chairperson searches fail. Because a truly outstanding chairperson affords a department so many benefits, and because a poor one can harm a department in so many different ways, it is vital that radiologists, particularly those in leadership positions, devote serious time and attention to how chairpersons are recruited and selected.
Recruiting a Chairperson
Two of the greatest dangers in the search for a chairperson are ignorance and apathy. Departments preoccupied by other demands on their time and energy may neglect the process. They may presume that their course is clear enough to continue its momentum inexorably forward in the same direction, no matter who is in charge.
Given sufficient time, however, even a great department can be undone by a poor chairperson [2]. With so much at stake, it is remarkable how little time and attention many departments devote to planning the development, recruitment, selection, and retention of chairpersons. Recently, national organizations have begun to sponsor leadership training initiatives, a hopeful sign for the development of future leaders. For the moment, however, most radiologists have received little or no formal leadership training. Moreover, the structure of medical school and residency tends to focus radiologists' attention on individual initiative and achievement, not on collaborative approaches crucial to effective leadership [3]. When it comes to recruiting a chairperson, many departments have little experience and rely on hospital administration or the dean's office to design and administer the search and screening process. Such an approach may produce good results if these administrators thoroughly understand radiology, but often this is not the case. Unfortunately, individuals from other disciplines, including some who may have conflicts of interest with radiology, sometimes dominate search committees and muffle the input of the very people who will work most closely with the selected candidate for years. Some institutions routinely stifle these voices completely by excluding a department's members from serving on the selection committee.
One of the most glaring problems in this arena is the failure of radiology departments to invest in retaining good chairpersons. Many chairpersons receive little feedback except complaints. Words of encouragement or praise are sparse, and everyone assumes that because the chairperson enjoys the most prestigious and best-compensated position in the department, he or she must be happy with the job. We forget what a lonely job that of chairperson can be.
One of the most worrisome recent trends in the selection of radiology chairpersons has been the tendency of some medical schools to appoint chairpersons of academic radiology departments without first conducting thorough national searches for first-rate academicians. Increasingly, some deans seem to regard radiology as a service department not unlike the clinical laboratories, whose sole function is to provide clinical support to the perceived revenue generators in the medical school, the departments that control patient referrals and generate significant extramural funding. This practice is not entirely without foundation; some academic radiology departments perform very little research or teaching and focus virtually all of their attention on clinical operations. Yet this trend of quickly filling vacant radiology chairs with clinically focused internal candidates bodes ill for the future of radiology because individuals who have been selected on the basis of their commitment to clinical service may display little enthusiasm for radiology's distinctively academic missions.
The future of the field depends on how far we push the envelope of radiologic research and how effectively we educate the next generation of radiologists [4]. If people with deep commitments to these missions do not lead academic departments, all of radiology will eventually suffer. To get deans to take these missions more seriously, radiology must be prepared to defend its academic legitimacy and play an active role in recruiting leaders with strong academic commitments.
The Need for a Good Chairperson
The costs associated with a poor chairperson can be quite high. An ineffective chairperson may represent the department poorly within the hospital or medical school, squandering important opportunities for collaboration and growth. An arrogant chairperson may communicate badly or act arbitrarily, damaging morale throughout the organization. An insecure chairperson may do a poor job of delegating responsibility, perhaps even distrusting other people, thereby squelching the development of other leaders and costing the department some of its best people. An unenlightened chairperson may unwittingly undermine the unity of a department by adopting budget and incentive systems that pit sections against one another. A socially inept chairperson may compromise recruiting efforts. In the worst-case scenario, a chairperson's duplicity may cast a pall of suspicion over an entire department.
Leadership transitions are vital stages in a department's life. When a transition is planned in advance, it is possible to appoint a successor before the departing chairperson steps down. In these situations, a department usually suffers little from lack of leadership. However, numerous problems may beset a department with an unexpected vacancy, because many months or even years may elapse before a successor can be appointed [5]. The lack of a chairperson can delay important choices, create a general atmosphere of indecision, inhibit recruiting, and leave the department vulnerable to others who may not have its best interests at heart. People may begin to look for greener pastures elsewhere, creating staffing shortages at a time when radiologists are in short supply. As people leave, those who stay may become increasingly overworked and discouraged. Their dismay can create a vicious spiral of departures and discontent. Because those who remain find it necessary to work harder and harder just to complete the clinical work, other missions such as research and education may suffer, and the department can become less attractive to candidates with strong academic commitments. The sheer uncertainty that may compromise recruitment of residents and faculty can exacerbate personnel shortages.
Even when a department quickly names an interim chairperson, people may fail to take such a person seriously because of the impermanence and lack of durable institutional commitment implied by the "interim" designation. If people realize that the interim chairperson is a "toothless tiger," the department's shared purpose and discipline may deteriorate.
Why in recent years have so many departments lost their chairpersons? The explanations are invariably multifactorial and vary from institution to institution, but three themes deserve attention. One difficulty is the competition between radiology and other departments for the provision of services, such as endovascular intervention. In this situation, hospital CEOs and medical school deans may feel that they must bow to the demands of departments that can threaten to take their patients elsewhere. As a result, some radiology chairpersons find themselves in a difficult position; they lack the ability to control their own destiny and they see their department's clinical base bargained away by others.
Another problem is the failure of some departments to develop lieutenants with whom chairpersons can share responsibility, such as vice chairpersons for clinical affairs, research, and education. Particularly in larger departments, such governance structures can be crucial to a chairperson's effectiveness and longevity.
A third difficulty is the frequently stunted intellectual life of chairpersons [6]. If medical school deans are doing their jobs properly, they will appoint chairpersons with strong academic credentials whose ambitions extend beyond securing their department's clinical mission. Yet if clinical operations consume all the time and energy of department chairpersons, they may lose enthusiasm for the job when they sense that their other interests and abilities are atrophying.
The Leader as Servant
The search for a chairperson should prompt a serious examination of the organization that a candidate will be invited to lead, not just who is going to lead it. Important questions need to be asked, both by the department itself and the candidates who interview for the job [7]. Does the department have a clear picture of its own mission? How effectively has it been able to achieve it? What resources are available to pursue its goals? What additional resources are needed, and is the institution prepared to provide them? What are the most important internal weaknesses of the department? Will the chairperson have the authority and tools necessary to redress them? What external challenges face the department, and what plans are in place to meet them? Are there any skeletons in the closet that a prospective chairperson should be informed about? What is the culture of the department, in terms of commitment to excellence, approaches to communication and problem solving, and past leadership styles? How great a challenge would it be to lead this department? Is the institution prepared to invest in the chairperson's development as a manager and a leader, and what opportunities would it make available? What level of commitment do the administrations of the hospital and the medical school voice to radiology's health, and what role do they envision radiology playing in their own larger success? A useful technique for getting to know a department is a SWOT (strengths, weaknesses, opportunities, threats) analysis, which provides valuable insight into which leadership attributes would be most essential to the organization.
When a candidate interviews for a chairperson position, it is vital that he or she quickly adopt a perspective that places the long-term interests of the department foremost. In the first place, an effective search and screening committee should quickly weed out candidates whose primary interest focuses on their own personal success. More important, a transition in leadership presents a vital opportunity for the department to secure greater support from the hospital or medical school. Rather than feeling flattered at being considered for the position, serious candidates should function as the department's advocate, basing their negotiating position on a sober assessment of the department's needs and the larger organization's ability to meet them. Major bargaining points might include new equipment, more space, new or renovated facilities, supplementation of faculty salaries in key areas, expansion of the residency program, a greater voice for radiology in key policy-making forums, a larger discretionary fund for the chairperson, a serious commitment to the ongoing education of departmental leadership, and a role for radiology in major fundraising campaigns.
No radiologist should seriously consider becoming chairperson unless he or she is prepared to make an earnest commitment to the success of the department, and the recruitment phase represents one of the best opportunities a prospective chairperson will ever enjoy to promote that success. When a candidate leaps immediately at the chance to become chairperson, the department loses this bargaining opportunity, and a good CEO or dean will recognize such behavior as a sign of weakness that may ultimately compromise not only the department but the entire institution.
Attributes of a Good Leader
What should departments look for in a prospective chairperson? Again, key questions must be addressed. Is the candidate a person of integrity [8]? Is the candidate an autocrat or a team builder? Is the candidate the type of leader who tends to act independently and shoot from the hip, or someone who consults with others before making important decisions? Is the candidate good with people, someone others look up to and feel comfortable talking with? Will the candidate promote two-way communication throughout the department, enabling everyone to make better-informed choices? Is the candidate patient, someone who can resist the "tyranny of the annual report" and do what the longer-term interests of the department require? Is the candidate gifted with common sense, the ability to see through that which fogs the judgment of others? Is the candidate capable of making tough decisions and delivering bad news? Will the candidate be able to cope with adversity, to maintain a clear sense of purpose amid an atmosphere of crisis, and to remain energetic in the pursuit of that purpose when others might throw in the towel?
Other questions are equally crucial. Is the candidate able to articulate a clear mission for the department and the role he or she would play in achieving it? How well does the candidate understand the department and the larger institution and health care market in which it is situated? How would the candidate respond to real or even hypothetical challenges facing the department? What mistakes has the candidate made in the past, how did he or she respond to them, and what did he or she learn from them? How much insight does the candidate display into his or her strengths and weaknesses as a leader? Is the candidate a successful radiologist who will be respected by others, both locally and nationally? Does he or she bring a proven track record as a researcher, educator, or administrator? Or does the candidate view this job as a way to jump-start a sagging career?
A good chairperson must be prepared to deal with personnel issues that might seem trivial to an outside observer but are crucial to the people involved. Many of these issues, and perhaps 90% of what the chairperson does, generate as much frustration as fulfillment. Yet chairpersons must be able to see past those responsibilities that are not intrinsically fulfilling and derive satisfaction from the 10% of activities that are truly challenging and enjoyable. Confronting complex issues and problems is part of the chairperson's mission, and he or she must earnestly engage such challenges, despite the fact that they are not rewarding to deal with. In this respect, a good chairperson must be not only unselfish but also optimistic, and capable of fostering optimism in others.
The measure of successful chairpersons is not how famous they have become, but how well their departments have fared under their leadership. Great chairpersons focus less on their own achievement than on that of the organizations they lead. They are able to subordinate their personal ambitions to the needs of their department and its institution. The chief responsibility of good leaders is not to propel themselves to national prominence, but to find satisfaction through the success of others. What the leader does is less important than what the leader enables others to do, and many new chairpersons have failed precisely because they could not make the transition from working for themselves to working for others.
The chairperson's mission is to recruit and retain good people, to nurture the abilities of others, and to recognize and reward excellence [9]. For this reason, very high achievers do not necessarily make the best leaders. The need of such people for personal achievement may override their commitment to the best interests of the organization. In most cases, a good chairperson more closely resembles the coach of a successful sports team than the ruler of a monarchy. To determine whether a candidate genuinely seeks to serve, a selection committee should carefully seek out evidence of service, past coaching and mentoring, and in general, a commitment to meeting the needs and promoting the success of others.
Selection committees should assure themselves that candidates understand the mission. Key questions should be posed. How much time does the candidate believe would be required to excel as chairperson? What other professional pursuits, such as research, education, or clinical work, would the candidate propose to continue? Does the candidate have major personal commitments, and how would he or she balance professional demands with those of family? For the right person, the chairperson's job opens up new possibilities for professional fulfillment. For the wrong person, however, serving as chairperson can be a painful experience, at best merely interrupting an otherwise successful career.
Resources
The Association of American Medical Colleges has produced a helpful resource for departments, hospitals, and medical schools involved in the search for a chairperson. Titled The Successful Medical School Department Chair: A Guide to Good Institutional Practice—Module I: Search, Selection, Appointment, Transition [10], it provides a theoretical framework for thinking about the chairperson's role, practical suggestions for improving the search process, and illustrations of alternative approaches used by various academic medical centers.
In systematic fashion, it covers such topics as preparation for the search, the search and selection process itself, the search committee and its makeup, examples of good practices in chairperson searches, recruitment of the first-choice candidate, and the successful leadership transition. It also contains references to other resources, including both generic studies of leadership and studies specifically focused on academic medical centers and the role of chairpersons within them. A recent commentary on the subject offers helpful insights into the operations of search committees [11].
Conclusion
Radiology departments, medical schools, and hospitals neglect the selection of a chairperson of radiology at their own peril. A good leader can preserve what is best in a department and serve as a catalyst for important improvements in other areas. By contrast, a poor leader can cause grievous harm. An individual who assumes the role of chairperson must work hard to find ways to continue to thrive personally and professionally in the midst of its many demands.
The chairperson must understand how to perform the role of manager in such areas as budgeting, scheduling, and reward systems. More important, he or she must also excel as a leader. Although no two chairpersons are exactly alike, the best chairpersons have certain leadership traits in common, including high personal integrity, strong strategic planning and communications skills, a deep commitment to the academic missions that will define the future of their field, and a willingness to subordinate the pursuit of their own achievement to that of their colleagues, their department, their institution, and their profession.
The best chairpersons not only understand why it is important for their department to flourish, but also communicate that rationale and nurture the development of that larger vision in others, both inside and outside their organization [12]. They determine what is most worth aspiring to, build consensus among others toward its pursuit, and define their own success by its achievement. Recruiting a great chairperson is one of the best things a department can do; and when such an opportunity presents itself, seizing it more than repays the time and energy required.
Acknowledgments
We thank D. Craig Brater, dean of the Indiana University School of Medicine, for helpful suggestions regarding this manuscript.
References
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  S. R. Baker, R. Gunderman, and J. Farber Seeking an Academic Department Chairperson Am. J. Roentgenol., July 1, 2004; 183(1): 244 - 245. [Full Text] [PDF]
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