In this issue of Academic Medicine, Rayburn et al1 report that two chair positions per year are filled by first-time chairs at the typical U.S. medical school. An informal survey of deans’ assistants at 18 medical schools (conducted by the administrative assistant in the Office of Faculty and Administrative Affairs at Pennsylvania State University College of Medicine) revealed that each typically had one to two interim department chairs in place on July 1, 2007. Indeed, at Association of American Medical Colleges (AAMC) member schools, and perhaps other medical schools as well, interim leadership of many academic departments is more common because turnover rates for chairs have become more frequent.2–4
Yet little is known about the interim chair role. * Appointment of interim department chairs occurs when the department chair has left. Chairs accept jobs at other organizations, some choose to “step down,” and others may leave because of illness or, in the worst case, unexpected death. Presidents and deans must fill gaps created by the departure of established leaders. However, little is known about the process of selecting an interim leader or about the role of the interim leader. In an attempt to learn more about these questions, we reviewed the literature related to interim department chairs in academic medicine and found it to be very limited. In their 29-year retrospective review of department chair recruitment and retention, Rayburn et al1 report the occurrence of 5,317 first-time chair appointments. Although not specifically addressed in that report, it is reasonable to speculate that interim chairs served in many of these cases. These same researchers report that shorter chair tenure began in the 1990s, suggesting that acceleration in the number of interim chair appointments may be under way. Another study of department chairs, in obstetrics–gynecology, found 254 turnovers in leadership during a 25-year time period. In 110 (43.3%) instances, interim chairs served for at least one year. The longest term of service as an interim chair was eight years. Most interim chairs who became permanent chairs remained at the same institution where they had served as interim chairs. However, a small number were appointed as department chairs at another institution (7 of 110; 6.4%).5
The Qualities of an Effective Interim Chair
Grigsby et al6 previously described the characteristics of “future-oriented” department chairs. We believe these same qualities apply to the selection of interim leaders. Interim chairs are typically appointed on the basis of their length of service to the department and their willingness to assume a temporary leadership role. Interim chairs must immediately begin to demonstrate a variety of skills and leadership abilities if they are to be successful. Newer competencies for effective leadership include an understanding of the business of medicine, interpersonal and communication skills, the ability to deal with conflict and solve adaptive challenges, and the ability to build and work on teams.7 An essential quality for interim leaders includes humility (recognizing and acknowledging that no one individual has all the answers). Almost immediately, interim leaders may be faced with challenges not previously experienced in their careers. Active mentoring and/or coaching by an experienced chair or member of the senior leadership team can enhance the ability of an interim chair to deal with particularly challenging issues related to people and finances. Rayburn et al recommend that the AAMC and individual chair societies support training workshops, mentoring, and coaching especially for first-time chairs. We believe this is important for interim chairs as well.
Preparing for Interim Leadership
Succession planning refers to a deliberate process designed to promote organizational stability during changes in leadership.8 Transitions in leadership might be planned, as in the case of a leader’s retirement, or unexpected, as in the case of a leader’s sudden death. In either case, organizations must meet their leadership needs until permanent leadership can be reestablished. As such, department chairs should have a leadership succession strategy in place to secure the future of the department in case of unforeseen events. Developing a leadership succession plan offers the opportunity to identify individuals who are poised to take the leadership role in the case of unanticipated loss of the permanent chair. We found many transitions in department leadership were unexpected. Rapidly regaining efficient organizational performance represents the great advantage of having a succession plan in place.
Opportunities for Women and Other Underrepresented Persons
Rayburn et al report that the percentages of non-Hispanic white department chairs declined from 91% to 85% during the 29-year period of study. The percentage of women increased from 4% to 14%. Rayburn et al also found that once women and nonwhite faculty members became chairs, they were just as likely to be retained as were men or white faculty. It seems interim leadership experience may be useful as a means for “opening the door” to underrepresented persons, including women. Far too often, underrepresented persons are not part of the selection pool when searching for new or interim leadership. As Fennell and Miller9 point out so aptly, potential leaders cannot “start at the top.” Many talented women and other leaders from underrepresented groups can benefit from being mentored during an interim leadership position. In fact, it may be critical to help them prepare to be full-time leaders. Adopting this strategy is a promising approach to helping organizations increase the pool of potential leaders from underrepresented groups.
Implications for Medical Schools and Teaching Hospitals
Because interim leadership of academic departments has become so common, medical schools and teaching hospitals are at risk. Unplanned loss of a department chair creates instability or, in worse cases, chaos in the department and may have a negative effect on the organization at large. Reestablishing order as quickly as possible is in the best interests of the organization. It is clear that high attrition rates of academic department chairs have created the need for skilled interim leaders of academic departments. However, it is unclear whether persons serving as interim department chairs are prepared for the job.
To protect the best interests of our medical schools and teaching hospitals, several actions should occur related to interim leadership, leadership recruitment, and leadership retention.
- We need to know more about the interim chair role and, in turn, need to meet the unique training and support needs of persons serving as interim leaders.
- Formal training, mentorship opportunities, and conscientious succession planning seem to be good first steps in preparing to meet the needs of academic departments during transitions in leadership.
- Medical schools and teaching hospitals need assistance to prepare for periods of interim department leadership. We believe Rayburn et al are on target and support the recommendation that the AAMC and individual chair societies help our medical schools and teaching hospitals by developing programs to allow current academic department chairs to reflect on their present positions and personal strengths and weaknesses. Chairs should speculate about and plan for their next positions and work with deans to identify potential successors and develop succession plans.
- During the last 29 years, two thirds of the first-time department chairs appointed were internal candidates. Appointment as an interim leader may provide an opportunity for on-the-job training for candidates who are under consideration for appointment as the permanent department chair.
- The numbers of women and persons from other groups underrepresented in medicine who are serving as department chairs are likely to continue to increase. However, persons from these groups are still underrepresented as chairs. Interim leadership provides an excellent opportunity for women and other underrepresented persons to demonstrate their leadership skills. Once women and nonwhite faculty members become chairs, the data indicate that they are just as likely to be retained as are men or white department chairs.
1 Rayburn WF, Alexander H, Lang J, Scott JL. First-time department chairs at U.S. medical schools: A 29-year perspective on recruitment and retention. Acad Med. 2009;84:1336–1341.
2 Rayburn WF, Schrader RM, Artal R, Anderson GD, Merkatz IR. Tenure of academic chairs in obstetrics and gynecology: A 25-year perspective. Obstet Gynecol. 2006;108:1217–1221.
3 Stapleton FB, Jones D, Fiser DH. Leadership trends in academic pediatric departments. Pediatrics. 2005;116:342–344.
4 Chapman JE, Chapman JJ, Lostetter JO. The acting or interim leadership position: Expectations, perceptions, realities. Health Care Manage Rev. 1988;13:81–88.
5 Rayburn WF, Schrader RM, Cain JM, Artal R, Anderson GD, Merkatz IR. Tenure of academic chairs in obstetrics and gynecology: A 25-year perspective. Obstet Gynecol. 2006;108:1217–1221.
6 Grigsby RK, Hefner DS, Souba WW, Kirch DG. The future-oriented department chair. Acad Med. 2004;79:571–577.
7 Souba W. The new leader: New demands in a changing, turbulent environment. J Am Coll Surg. 2003;197:79–87.
8 Thorndyke L, Grigsby RK. The need for succession planning. Acad Phys Sci. April 2005:2–3.
9 Fennell M, Miller SD. Follow the “Rooney rule” for leadership succession. Univ Bus. August 2007:80.
*When referring to or titling temporary leadership, many institutions use the terms interim and acting synonymously. We feel it is important to differentiate between the two, and we made the following distinction: An interim chair serves as the leader while a search is conducted to find a new department chair expected to occupy that role indefinitely or for a specific term of service. In contrast, a person filling the leadership role while the permanent leader experiences a temporary absence, but who anticipates returning, is referred to as an acting chair.