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Letters to the Editor

Academic Medicine and the Quandary of Term Limits

Balon, Richard MD

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doi: 10.1097/ACM.0000000000003770
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To the Editor:

In his Invited Commentary on term limits in academic medical centers (AMCs), Dr. Austin1 outlines advantages and disadvantages of term limits for academic leaders and concludes that although there are strong arguments both for and against term limits, the potential benefits of term limits may “outweigh the downside for some institutions.” There are more aspects to explore within the issue of term limits at AMCs, though.

Dr. Austin is correct in using the phrase “some departments,” as not every department may have a pool of able, willing, and competent members who can step into leadership positions every few years and bringing in a new leader may not always be suitable. Dr. Austin also suggests that term limits may help current leaders exit gracefully. Possibly. However, what about a dynamic and effective leader appointed at the age of 40? Should he/she depart after 2 terms at the top of her/his leadership abilities?

The main weakness in Dr. Austin’s argument, however, is the omission that AMCs already have a mechanism to enact term limits—the 5-year review. In this process, medical schools, departments, and their leadership are reviewed every 5 years, internally (faculty driven) and externally (outside experts). Faculty usually have a powerful voice in this process. The AMCs, based on review, decide whether the dean, chair, or other leaders get reappointed for another term. It is like the term limit mechanism Senator Mitch McConnell said exists in the U.S. Senate—“I would say we have term limits now. They’re called elections.”1 Or, in the case of AMCs, they are called 5-year reviews.

My home state of Michigan introduced term limits for legislators (3 terms for Michigan House, 2 terms for Michigan Senate) in 1992.2 Almost 3 decades later, I realize that term limits, as Dr. Austin mentions about other places, have not brought about any substantive positive change. They have brought, however, unwanted effects, such as increased power of lobbyists and nepotism. Thus, we now have calls to abolish term limits in Michigan.

Every coin has 2 sides, and every regulation has plusses and minuses that should be carefully examined before implementation. It is important to remember that no one solution fits all, and thus individual circumstances and factors should be taken into consideration at each AMC.


1. Austin JP. Is academic medicine ready for term limits? Acad Med. 2020;95:180–183.
2. Michigan Legislature. Constitution of Michigan of 1963: Article IV: Section 54: Limitations on terms of office of state legislators. Effective December 19, 1992. Accessed September 23, 2020.
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