Lucey, Catherine R. MD; Sedmak, Daniel MD; Notestine, Mark PhD; Souba, Wiley MD, ScD, MBA
Star performers exist in all industries. Their status results from hard work and innovation that improves not only the bottom line but also the reputation of their organization.1–6 In industries such as economics, business, and professional sports, top-level performers are variably known as clever people,1 stars,2 or superstars.5 At times, the contributions of these individuals are either so unique or so significant that they achieve the status of celebrity within their company and among competitor institutions in their field. This subset of star performers is known as rock stars.7 The value they bring is at times coupled with demands for significant resources, unfettered access to business leaders, and special dispensation with regard to normal institutional policies and procedures.
High-performing faculty members at academic medical centers are no different. They contribute substantially to the prestige of their institutions, generally by making advances in basic or translational research, but at times because of superb clinical programs or tremendous success in philanthropy. When their stellar performance is coupled with unusually high expectations for space, funding, personnel, and open access to the dean and other institutional executives, they assume the persona of a rock star. Like their business counterparts, they, too, usually eschew bureaucracy and expect that policies and procedures not conducive to the success of their work will be ignored or changed.
We carried out the study reported below to examine medical school deans' experiences with the entity that we have labeled the academic health center rock star. With a national survey of the deans of U.S. medical schools accredited by the Liaison Committee for Medical Education (LCME), we sought to investigate the prevalence and characteristics of rock stars as well as the experiences of deans who are often in the position of recruiting and retaining these highly valued faculty members.
The population of interest comprised the deans of the 126 U.S. medical schools that, at the time of our research, were fully accredited by the LCME, including those in Puerto Rico. Demographics and contact information about the deans were obtained from the Association of American Medical Colleges (AAMC). The AAMC data were verified and updated through a review of each medical school's Web site.
We drafted a 13-item survey to ask the medical school deans their opinions about recruiting, retaining, and managing faculty rock stars, defined on the survey instrument as those faculty members “who are at the top of their field and thus add enormous value to your college and/or medical center, but at a cost of high and perhaps disproportionate demands for resources and attention.” After a review of the existing literature,1–7 survey items were generated in consultation with a survey expert and then piloted with a group of academic health center leaders. The responding deans answered questions about the characteristics of their institutions, the number of faculty in their institutions who the deans felt met the definition of rock star, and the number of these faculty whom the deans had personally recruited. Deans were asked to rank-order the value that rock stars brought to their institutions and to estimate the return on investment for the rock stars they have known. Deans used four-point Likert scales with answers ranging from “almost never” to “almost always” to respond to questions comparing the professional characteristics of rock star faculty with those of regular faculty and to respond to questions identifying recruitment/retention strategies. They were asked to choose all responses that applied from “pick lists” given in the survey instrument to identify personal qualities of this subset of faculty as well as the sources of pressure to recruit and retain these faculty. Four open-ended questions at the end of the survey addressed issues of recruitment and retention of high-performing faculty in greater depth.
Surveys were disseminated both in hard copy form through the U.S. mail and also in electronic format using the Zoomerang Electronic Survey Service (San Francisco, California). Follow-up reminders were sent twice from the Zoomerang Service and twice by mail. The study protocol was reviewed and approved by the Ohio State University behavioral science research review board.
Electronic and paper survey responses were merged into one data set and analyzed with SPSS for Windows 15.0 (Chicago, Illinois). Chi-square tests of proportion were conducted to verify that the respondent population was representative of the national population. These analyses were followed by descriptive statistical analyses and planned comparisons across public and private institutions, medical schools of various faculty sizes, various U.S. News & World Report (USN&WR) research rankings,8 and various regions of the country. Narrative comments obtained in response to open-ended questions were reviewed and categorized according to themes.
Deans of 64 of the 126 schools surveyed (51%) responded. We assembled demographic information to assess the representativeness of the institutions of the responding deans. Regions of the United States were defined in accordance with the AAMC Regional Groups: Northeastern, Central, Southern, and Western. Institutions were categorized by the size of their full-time faculty (self-reported and confirmed using AAMC faculty survey data), grouped into four categories: 200 or fewer, 201-500, 501-1,000, and greater than 1,000. Self-reported USN&WR research rankings were used to group institutions for competitiveness: top 10, 11-25, 26-50, or over 50.
Chi-square tests of proportion indicated that the survey respondents were proportionally representative of medical school deans from the four regions of the United States: Northeastern, Central, Southern, and Western (χ2 = 1.60; df = 3; P = .660). Respondents also proportionately represented institutions of varying faculty size (χ2 = 2.72; df = 3; P = .438) and of varying research ranks as defined by USN&WR (χ2 = 5.37; df = 3; P = .147). The responding institutions were significantly more representative of public medical schools than private ones (χ2 = 16.54; df = 1; P < .001).
Prevalence of rock stars
The responding medical school deans universally agreed that they currently have or have had rock stars on their faculties. The average number reported by deans was 9.70 (SD = 19.52), or approximately 1.42% of the total full-time faculty at all of the responding medical schools (see Table 1). The prevalence ranged from 0.07% to 6.24% of the institutions' total faculty. The dean at one institution reported that 20% of his faculty met the definition of rock star; this was considered to be a statistical outlier with regard to calculations of mean prevalence and was dropped from the analysis.
Deans, on average, believed that they had inherited 78.9% of their institution's rock stars and recruited only 21.1%. When asked to select all sources of pressure to recruit or retain these high performers, deans most commonly identified the university president or provost (36/64; 56.3%) and department chairs (36/64; 56.3%). Twenty-five of 64 (40%) of deans felt that nonchair faculty exert pressure to retain faculty stars, and over a quarter (17/64; 26.1%) of deans felt that this pressure comes from high-impact donors. Five deans (8%) identified themselves as the source of pressure to retain their star performers. Ten of the 64 responding deans (15.6%) cited influence from other high-ranking university or political figures. No other sources of influence were identified.
The value and cost of faculty stars
To identify the ways in which talented faculty members add value to an institution, deans were asked to rank in order of importance the following contributions of their institutions' rock stars: national reputation, research dollars, clinical volume, and philanthropic contributions. The majority of deans (34/58; 58.6%) identified national reputation as the most important contribution of this subset of faculty, with research dollars ranked a strong second (28/61; 45.9%). These findings are consistent across public and private institutions of all sizes. Clinical volumes and philanthropic contributions were ranked either third or fourth, respectively, by three-quarters of all deans responding (see Table 2). There were no differences in region, type, faculty size, or USN&WR research ranking group for institutions ranking clinical volume and philanthropic first or second and those ranking them third or fourth. A total of 46/62 (74.2%) deans felt that rock stars were necessary for institutional prominence, with 12/62 (19.4%) neutral or undecided. Only 4/62 (6.4%) felt that faculty stars were not important to institutional reputation.
To recruit or retain a star performer, deans were almost always or often willing to offer higher salaries (53/64; 82.9%) and more space (48/64; 75%) (see Table 3). A much smaller minority (16/64; 25%) indicated that they never or infrequently negotiate with star performers regarding space. Similarly, only 11/64, or 17.2%, of deans indicated that they never or infrequently negotiate regarding higher salaries. Deans were evenly split regarding their willingness to grant star candidates positions of authority or titles or other perquisites as bargaining tools.
Despite the resource commitment, 39/62 (62.9%) deans believed that the return on investment for such uniquely talented faculty members was positive. Thirty-four of 62 (55%) said that the return on investment was more than positive, and 5/62 (8.1%) said that the return was much more. Slightly more than a quarter (17/62; 27.4%) said that this was a zero-sum gain, and 6/62 (9.7%) thought that the return was less than the resources committed.
Characteristics of faculty rock stars
Deans were asked to compare these stars with other faculty with regard to a set of performance metrics (see Table 4). In this comparison, deans felt that faculty rock stars typically meet or exceed productivity and financial targets. Fifty-seven of 64 (89%) deans felt that this high performance was often or always coupled with the consumption of a disproportionate share of the dean's staff time. Almost two-thirds of responding deans (41/64; 64.1%) felt that rock stars were effective leaders in their own environments, with about the same proportion indicating that they were infrequently or never effective leaders in the organization at large. Deans were slightly more likely to characterize these high performers as effective mentors and slightly less likely to characterize them as effective teachers in comparison with other faculty. The majority of medical school deans (53/64; 82.8%) believed that faculty peers of rock stars are always or almost always aware that the star performers receive preferential treatment. Slightly more than half (37/64; 57.8%) of deans expressed the belief that faculty accepted the need for this preferential treatment.
The average tenure of a faculty rock star was about 11 years and was not significantly different across public and private institutions. There was a trend toward shorter tenure for rock stars at institutions with fewer full-time faculty positions, but this trend was not statistically significant.
Table 5 outlines the personality characteristics that deans believed differentiate rock stars as a group from other faculty. Although narrative replies indicate considerable variability in rock stars' personal styles, 50% or more of deans (depending on the characteristic) indicated that members of this subset of faculty more commonly demonstrate self-promotion, a strong work ethic, opportunism, charisma, and political savvy when compared with other faculty. Additional characteristics that deans felt were more commonly found in these high performers include narcissism and arrogance. Less than a third of deans felt that rock stars exhibited more leadership ability, self-awareness, collaboration, social skills, empathy, loyalty, or flexibility than do other faculty.
Narrative responses to open-ended questions
Fifty-one out of the 64 (79.7%) responding deans provided opinions on the reasons that rock stars changed institutions. Responses were categorized according to two themes: (1) attractive features of the institution attempting to recruit the star performer (“pull” factors) in contrast to (2) features that led to the star performer's dissatisfaction with the institution attempting to retain the performer (“push” factors). Forty-three of the 51 deans (84.3%) stated that star performers moved to a new institution because the package offered by the recruiting institution was better than at their home institution. Twenty-three out of 43 (56.1%) deans who focused on these pull factors emphasized the importance of greater resources (space, money, technology), 15/43 (34%) believed that better opportunities (including leadership roles and program-building opportunities) were the reason for the departure, and 7/43 (17%) stated that rock stars left because the receiving institution had a better reputation. Approximately one-quarter (12/51) of responding deans identified cultural problems such as interpersonal conflict or lack of respect at the home institution as the reason the star performer left.
Deans were asked to describe the impact that the departure of a rock star had on their institution. Responses were categorized in two types of themes: negative or positive (economic, social, or reputational). Of the responders, 37 (72.5%) felt that the departure had at least some negative repercussions. Commonly cited negative consequences included a loss of revenue (8/37; 21.6%) and reputation (9/37; 24.3%). Eleven of 37 (30%) of deans observed that the loss of a star performer left the remaining faculty feeling sadness and dissatisfaction with the institution. The need to identify resources to start new programs was described by 7/37 (16.2%) deans. A minority of deans (10/51; 19.6%) identified positive consequences of the departure of a rock star, most commonly describing increased opportunities for remaining faculty and programs as well as a personal feeling of relief.
Twenty-one of 51 respondents (42%) identified the consequences for the dean of failing to recruit or retain a rock star as variable or minor. The most frequent specific concern cited was a negative impact on the dean's reputation (as viewed by local and national constituents), described by 14/46 (30%) of those responding. Several respondents articulated that the negative impact on a dean's reputation could be minimized if the dean was supported by more senior institutional leaders or had previously established an ability to retain or recruit other high-performing faculty.
Deans identified factors influencing their decisions to cease retention or recruitment negotiations with a faculty rock star. Comments were closely divided between the themes of economic barriers to recruitment or retention (23/51; 45%) and concerns about values exhibited by the individual (26/51; 51%). Economic barriers included concerns about insufficient funds to meet the demands of the high performer, uncertainty about the anticipated or realized return on investment, and worries that supporting the individual would leave insufficient resources for others within the institution. Concerns about values were evident in observations about arrogance, disruption, lack of integrity, poor collaboration, bad faith, and disloyalty. Interestingly, four deans commented that it was support from others that helped them decide to stop recruitment or retention efforts.
This study provides preliminary insight into the perspectives of deans of more than half of U.S. medical schools about the subset of faculty we have described as rock stars. The deans recognized the phenotype of the rock star. They described them as hard-working individuals who bring tremendous value to their institutions. Deans accepted the fact that these individuals need substantial commitments of resources as well as attention and support from their institutions' leaders to achieve the stars' important goals. Deans also believed that other faculty in their institutions are aware of and, to some extent, accept the preferential treatment that is given to star performers.
An academic health center, with high concentrations of professionals, is the proverbial loosely coupled organization, one in which the individual employees are afforded a high degree of independence relative to institutional plans.9 Rock stars expect an even higher degree of autonomy than the average faculty member. Like Goffee's1 “clever people,” rock stars know that they have the potential to produce a disproportionate return on investment for the institution. As a consequence, they may see little value in “being led,” particularly by leaders whom they regard as having less potential for high- impact contributions.1 The challenge for the leader in managing star performers in his or her organization is to realize that the relationship between the institution and the individual must be symbiotic. The faculty star needs the support of a leader to maximize access to the resources of the institution, just as the leader needs the rock star to produce the aspired results.
The return on investment for a star performer
Deans ranked enhancement of the institution's reputation as the most important value added by the rock star. Thus, the rock star must be engaged in high-visibility, high-impact work and must be considered a leader in his or her national and international discipline. Our experience leads us to believe that individuals are more likely to become rock stars when their research or clinical work promises or delivers true breakthroughs rather than steady, incremental progress toward goals.
Deans seemed to have an internal measure of a star performer's current and future worth that guides the deans as they make decisions about initial recruitment and subsequent retention packages. In all probability, their mental equation balances the importance of the goal, the likelihood of achieving the goal, and the time and resource commitments needed to accomplish the goal. Because the timelines of research accomplishments are generally measured in years, deans must be prepared to plan the distribution of institutional resources so that they last for the time needed for the high performer to achieve success. Although it may take time for a research rock star to achieve the promised breakthrough, it is widely believed that the reputational impact of such a transformative discovery tends to be very long lasting. Clinical stars are generally recruited because they offer a unique skill or management innovation and thus have already amassed a sizable following of patients. The economic return on investment for a clinical star researcher is likely to be more immediate than the return on investment for their peers in research.
Personal characteristics of star performers
Deans responding to this survey believed that rock stars make better leaders within their own program than in the institution at large. It is conceivable that highly talented performers who are engrossed in their work may direct their loyalty to the people on their team who make it possible for them to pursue their work with a singular focus. They see their responsibility as obtaining the resources needed to achieve their goals. Deans observed that these high performers are effective self-promoters, using charisma and political savvy to persuade others to share in and support their vision. Deans less commonly described them as flexible or empathic to the needs or concerns of others within their institution. Less socially skilled rock stars may be labeled opportunistic, narcissistic, or arrogant as they attempt to convince others of their worth.
Retaining star performers
The average tenure of a rock star in the institutions surveyed was relatively long at 11 years. Nonetheless, deans in our survey commented that rock stars often consider changing institutions; many deans described multiple attempts to retain a given faculty member. In this survey, deans felt that high-performing faculty members are susceptible to offers either from institutions with greater prestige than that of their home institution or from institutions able to promise significantly more resources or autonomy.
It has been observed that star performers in other industries rarely seek leadership positions that carry significant administrative responsibilities, because doing so would distract them from their most important priority, their work.1 Star performers in academic medical centers seem to view leadership opportunities more positively, as evidenced by the fact that 37/64 (57.8%) of the responding deans used promotion to a senior position of authority to recruit or retain rock stars and 17/51 (34%) of the deans commented that these faculty leave their institution for leadership positions at other institutions. Limitations of our study prevent further characterization about the type of leadership opportunities that are attractive to top performers.
Deans commented that high-performing faculty may also leave if they feel that they are not receiving what they were promised. A change in the leadership of an academic medical center may be a particularly vulnerable time for star performers, because they may be concerned that they will not receive what has been contractually promised or tacitly agreed on. New deans may find that these faculty expect early and frequent meetings with them to insure that their resource needs will continue to be met. This may establish the reputation of individual faculty as rock stars early on, compatible with the belief expressed by deans that most of their rock stars were inherited from prior administrations.
The decision to cease recruitment or retention efforts for a star performer
Deans were clear that the price of recruiting or retaining a rock star is too high if the continued pursuit of the individual threatens the economic viability or integrity of the institution. It is relatively easy to recognize the point at which it is economically ill advised or impossible to retain a star performer. The economic package offered cannot be so great that there are no resources for cultivating other talented faculty. Furthermore, deans are aware that resources will be needed to counter future recruitment efforts by competitor institutions.
It is more difficult to recognize when the behavior of a rock star is no longer compatible with the values of a given institution. In their narrative responses, deans commonly articulated that the decision to forgo further negotiations with a star performer depends heavily on the pattern of behavior and interactions over time. Deans tolerated confidence and overconfidence but drew the line at arrogance (or perhaps prolonged arrogance). They tolerated bending of internal rules but not breaking of legal or regulatory rules. They acknowledged the value of providing extra time and attention to the rock star but internally knew when enough is enough. Deans continuously benchmarked the demands and return on investment from their star performers with the same parameters they used for other talented faculty. They found it helpful when those other talented faculty agreed with them that a rock star's value was not worth his or her new or renewed demands.
The impact of the departure of a star performer
There can be substantial negative consequences to the institution after the loss of a rock star. The opportunity costs of choosing to back such an individual rather than a greater number of lesser stars may be painfully apparent at the time of the star performer's departure, particularly if he or she leaves before the institution has reaped the rewards of its investment. Institutions build structures, invest in expensive equipment, and hire personnel to support the success of these individuals. These fixed costs will remain even when individuals leave and take grants or clinical volume with them. Institutions must then scramble to find faculty who are capable of providing the economic engine to support this infrastructure. Deans acknowledged that the loss of an institution's rock stars may have psychological consequences on the health center and the local community. They anticipated transient negative publicity at the time of the departure. The reaction of faculty to the loss of a rock star may be mixed. Some faculty, even those who were most vocal about their perceptions of unjust preferential treatment of the individual, may view the departure as evidence that the institution is incapable of greatness. Others may worry that the institution's unwillingness to support a highly talented faculty member (albeit one with high demands) may bode poorly for its willingness to continue to support a more average faculty member. Still others may view the departure with a sense of relief and optimism, believing that the departure of the star performer will mean more money to invest in those who remain. Finally, if the rock star has engaged in behavior counter to the culture of the institution, some may feel a sense of pride that the institution has held fast to its values and allowed the rock star to depart.
Business experts have focused on identifying strategies for maintaining institutional stature and success despite departure of superstar employees. Bendapudi and Leone5 outline three of those strategies: (1) Don't let customers become attached to only one employee, (2) develop steady performers alongside superstars, and (3) don't let employee turnover catch customers by surprise. These strategies are equally applicable to academic health centers, where the customer is anyone following the career of the rock star.
This study provides preliminary data about the existence and characteristics of the entity we have described as the academic medical center rock star. Given that respondents were most representative of public medical schools, the results may not be entirely applicable to private institutions. Additionally, the short survey length did not allow for an in-depth assessment of the spectrum of faculty members who meet our definition. Also, this instrument attempted to characterize the perceptions of deans only about this subset of faculty. Subsequent investigations should target a wider constituency (not only deans but usual faculty and star performers themselves) with a more in-depth instrument to fully characterize the personal and professional heterogeneity of this subset of highly valuable faculty. Finally, an additional possible limitation is that we did not ascertain whether all the responses to the survey came from the deans themselves; some may have come from persons delegated by the dean to respond.
The presence of rock stars in an institution illustrates the tricky balance between the institution's values and resources and the benefits the star brings. On the one hand, they are bright, hard-working, productive faculty who enhance the institution's reputation and visibility. On the other, they can sometimes be seen as relatively weak in social intelligence, self-awareness, and collaborative skills. Balancing this results-values equation is more art than science. Indeed, the findings of this study are consistent with those of a previous study that demonstrated that the complex challenges that confront our academic medical centers have contributed to the development of a dynamic tension that exists between humanistic core values and performance-based values.10 An inherent part of a dean's work is to manage that tension and to know when and how to prioritize one set of values over another. Rock stars test this leadership space for deans and others and will likely continue to do so well into the future.
The study protocol was reviewed and approved by the Ohio State University behavioral science research review board.