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Invited Commentaries

The Inevitable Interim: Transitional Leaders in Academic Medicine

Merritt, Chris MD, MPH, MHPE; Clyne, Brian MD, MHL

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doi: 10.1097/ACM.0000000000002945
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Transitional or interim leadership is increasingly common in academic medicine. High turnover among academic health care leaders (e.g., medical school deans, department chairs, program directors, nurse managers, clerkship directors) is well described.1–3 The average tenure of academic chairs has been steadily decreasing since the 1990s.4 Among residency program directors across specialties, the average tenure is 7 years, with a 12%–14% annual turnover rate.5 The average tenure of U.S. medical school deans is only 6 years, and as many as 1 in 6 are serving in interim roles.6 This Invited Commentary calls attention to the growing phenomenon of interim leadership, temporary leadership during which a permanent leader is sought, in academic medicine and the gap in intentional, formal leadership training of future health care leaders.

We consider interim leadership from 3 perspectives—the organization, the appointing authority, and the interim leader. We highlight the strategic importance of interim periods and the need for succession planning within academic medicine organizations. Based on our personal experiences (one as interim residency program director and one as interim department chair), as well as existing literature,7,8 we offer a 4-stage framework for interim leadership and strategies for success at each stage. Lastly, we attest to the fundamental challenge facing interim leaders—providing stability during periods of significant change. We hope this will serve as a resource for future interim leaders, those responsible for appointing them, and the organizations they are called upon to lead.

The Organization

The precipitating event for transition to an interim leader is the departure of an existing leader. The root cause of this departure often predicts the immediate responses of the organization and individuals. A leader stepping down amidst financial troubles results in much more uncertainty than a smooth transition during times of prosperity. Regardless of the cause, predictable organizational responses include fear, loss, and a sense of instability. At the individual level, there may be concern about the impact of a leadership change on one’s position, influence, level of support, or status. The circumstances surrounding the departure of the outgoing leader can also influence the selection and experiences of an interim leader. For example, a retirement or promotion may be associated with a well-thought-out succession plan. In these cases, interim leaders often have adequate support and time to prepare for the transition. Abrupt or unforeseen leadership changes without a succession plan, however, can leave a temporary void and heighten organizational distress. If a leader is forced out or fired unexpectedly, the resulting chaos and confusion may be crippling. Such dramatic departures offer little time for interim appointees to prepare. These situations are more challenging if the organization has not adequately prepared its future interim leaders.

The Appointing Authority

An important perspective to consider during leadership transitions is that of the “appointing authority,” the individual or group charged with selecting the interim and/or permanent candidates. This entity identifies the qualities and characteristics sought in the interim leader and determines the selection process and timeline. The expected timeline to fill the permanent role has an important impact on the interim leader’s experience. Depending on the leadership role, selecting the permanent leader may be a short, efficient process or may involve a national search led by a large committee of stakeholders. If the interim period is to be brief, then the appointee will have fewer expectations. If it is to be longer (a year or more), the appointee will have more responsibility to move the organization forward and the opportunity to create meaningful change.

An early decision for the appointing authority is whether to select an internal or external candidate. Internal interim leaders may have the advantages of experience, operational knowledge, and respect of their peers. Often, there is a selection process among several internal candidates. Internal candidates may be chosen strategically to represent a certain point of view or to advance a specific agenda. The appointing authority may choose to look externally for more diverse, qualified, or experienced candidates. External candidates may also be considered in deeply troubled organizations in need of a major turnaround or restructuring. Transitional periods are also opportune moments to increase gender and/or ethnic diversity within the leadership ranks.9

During the selection process, the appointing authority should describe the expectations, responsibilities, and resources available to the interim leader. The process for decision making and the reporting structure must also be clearly explained. Unless the anticipated tenure is very brief, appointing authorities should resist oversimplifying the role to that of “caretaker,” as interim leaders face high-stakes decisions with long-term consequences. The appointing body must articulate its level of support for change during the interim period, as too often interim leaders may not grasp the extent (or limits) of their authority to act decisively or implement change.

The Interim Leader

Being offered a leadership role—even temporarily—is a flattering proposition. It is tempting for a candidate to agree before carefully analyzing the benefits and pitfalls. On the positive side, an interim role is an excellent platform from which to learn about the nature of leadership, forge relationships, and experience the emotional and psychological impacts of leadership. Internal candidates who know the organizational structure and politics may see an opportunity to create positive change. Perhaps the greatest advantage of serving as an interim leader is the opportunity to “try on” a role to determine if its demands and responsibilities are a good fit. With appropriate reflection, interim leaders can address personal leadership gaps in preparation for future roles. We recommend approaching interim opportunities with a growth mindset.

Candidates must also consider the drawbacks, specifically how the interim role will impact current activities. New demands easily displace ongoing research, clinical, or teaching responsibilities and may distract from one’s career path. Interim leaders may be asked to serve on short notice with limited room for negotiation. A significant challenge (that we both experienced) is being considered for the permanent position while serving in the interim capacity. The competing demands of prior roles, new interim responsibilities, and the application process for the permanent role can be overwhelming. Given the often-limited mandate and resources provided to interim leaders, it may not always be the best platform from which to demonstrate one’s abilities and qualifications. It may in fact be, but there is associated risk. An interim leader’s successes may be judged to predict future excellence, but failure to move an organization beyond the status quo may be viewed as equally predictive.

A Framework for Interim Leadership

For those considering or preparing for an interim role, we propose a framework with 4 distinct phases: (1) expectations and exploration, (2) adjusting expectations, (3) accommodation, and (4) phasing out (Figure 1).

Figure 1
Figure 1:
A schematic of interim leadership progression. Interim leadership often progresses through a series of 4 distinct phases, each characterized by a set of organizational and interpersonal dynamics and supported by a series of contributing factors. The interim period is set in motion by a precipitating leadership change event and ends with the onboarding of a permanent leader. A successful interim period is bookended by succession planning within an organization.

Phase 1: Expectations and exploration

Expectations start high, with great enthusiasm on the part of both the interim leader and the organization. In this phase, the new interim leader is orienting to the details of the role and learning about the organization’s various units and functions. During “expectations and exploration,” we recommend solidifying relationships with the executive team, clarifying roles, and establishing lines of reporting. The interim leader must also evaluate his or her level of support from various constituencies and build coalitions. We advise meeting with members from all levels of the organization to increase situational awareness and set communication norms. Early on, some stakeholders will seek favor for closely held personal interests. We recommend examining these requests objectively and maintaining the established process for allocating resources. During this phase, the interim leader must address any immediate crises facing the organization. Humility is an important asset, as the leader will need to seek the guidance and counsel of many others—all while conveying stability and confidence. This is no small task.

Phase 2: Adjusting expectations

As day-to-day responsibilities become clear, the interim leader refines his or her goals and sets priorities. If it has not been done previously, an analysis of the organization’s strengths, weaknesses, opportunities, and threats will provide the interim leader with a deeper understanding of the organization and guide decisions. In this phase, the leader must effectively communicate his or her vision and expectations to the organization. It is tempting for the interim leader to take on decidedly simpler tasks that will yield quick wins, rather than addressing larger systemic challenges. Indeed, identifying early opportunities for success is a reasonable strategy. If he or she pushes aside complex problems indefinitely, however, a sense of drift or apathy may develop within the organization. At minimum, the interim leader must articulate a plan to address longer-term projects and consider how his or her actions will impact the organization’s future. During this phase, the interim leader may be applying and interviewing for the permanent role. Those who seek the permanent role walk a fine line; one must demonstrate ability, decisiveness, and action but may not have the full institutional mandate to make needed changes.

Phase 3: Accommodation

After managing the tumultuous early adjustment period and then charting a course of action, the third phase becomes a crucial strategic window for the interim leader to act in service of the mission. This is when well-organized teams excel and organizations experience the greatest opportunity to demonstrate progress and achieve results. The effective leader focuses on motivating and engaging others, knowing that while the interim period is temporary, much of the team will remain. Future success depends on the team’s involvement and enthusiasm. To be effective at this stage, the interim leader should continue to set expectations and reinforce collaboration. It is also important to regularly revisit and/or revise the working priorities, communicating these to the community at large as goals are met or priorities change. If the organization is not reaching its potential or is performing poorly, it is tempting for the interim leader to revert to “placeholder” status rather than seeking forward progress. The desire to initiate large-scale or long-term change becomes tempered by accommodation to the pragmatic rather than the aspirational. The interim leader feels the temporary nature of the role acutely at this point, prompting calculations about what can truly be done now versus what is better left for a permanent hire.

Phase 4: Phasing out

The final phase is marked by the selection of a new permanent leader. Regardless of the individual selected, the interim leader plays a critical role in guiding the organization during this time. If the interim leader is not selected, it is important to communicate a clear timeline for the transfer of responsibilities. An intentional change in language—speaking in concluding terms—will signal the beginning of the process. Collaboration with the incoming permanent leader is essential for continuity, as the interim leader can offer unique insights and serve in an advisory role.

For the outgoing interim leader, this is an opportunity to reflect on the experience and consider future career steps. The end of the interim period can be an emotionally difficult time, bringing a sense of loss or leaving a vacuum in one’s professional life. Identifying new opportunities (some made possible by the interim experience) is at once a challenge and a luxury. If the interim leader is selected for the permanent leadership role, there may not be an obvious transition point. Nonetheless, it is important for this individual to acknowledge the moment when he or she will act with the full authority of the role. Transitioning from the interim to the permanent role frequently requires some organizational restructuring as prior responsibilities are assigned to other personnel.

Other Factors Influencing Interim Success

Organizations can prepare to thrive during times of transition by identifying and cultivating leadership potential. Developing internal candidates through programming on communication skills, time management, organizational finance, personnel management, strategic planning, operations, and technology can benefit potential leaders before they are called to serve. Former interim leaders in academic medicine have identified several themes important for success: empowerment, personal development, communication, strategic planning, and limits and balance (Figure 1).10 Interim leaders must be empowered to be genuine leaders but must also empower those around them through delegation and team building. Leadership development is an ongoing process that requires deliberate practice, with mentorship and personal reflection. Frequent, transparent communication with stakeholders will ensure that the interim leader understands goals and expectations. Effective short- and long-term strategic planning linked to the mission will provide clear direction for the organization. Finally, interim leaders must be made aware of the limits of their mandate and be flexible to balance new roles with existing relationships. These themes transcend the interim period and are applicable to all types of formal and informal leadership roles.


Interim leadership must be considered from several important perspectives, including those of the appointing authority, potential candidates, and the frontline members of the organization. Interim leaders must have a clear understanding of their role from the appointing authority. We believe that interim leaders are most effective when empowered to act decisively. For the benefit of the organizations they serve, interim leaders must avoid relegation to “placeholder” status at all costs.

Regardless of the “success” of an interim leader in being offered the permanent position, or even if the interim leader seeks the permanent role, the experience will have a lasting impact on the individual. As difficult as it may seem, interim leaders should strive to separate their performance and responsibility to the organization from any personal desire to secure a permanent leadership position. Potential interim leaders should approach the role as a learning opportunity rather than a strategic career move.

Interim leaders in academic medicine are being appointed more frequently and serving for longer periods of time than they have in the past. To ensure that they are well prepared, we advocate for the intentional, formal training of future health care leaders. Programs should include leadership and management concepts, health care finance, and principles of organizational behavior. Proper succession planning through targeted faculty development can help organizations thrive during transition periods. Turnover is inevitable, so we must all prepare to make these interim periods positive and productive.


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