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Letters to the Editor

In Reply to Balon

Austin, Jared P. MD

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doi: 10.1097/ACM.0000000000003774
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I appreciate Dr. Balon’s comments on my Invited Commentary. Indeed, 5-year reviews (and annual and semi-annual reviews, for that matter) serve an important function for academic medical centers (AMCs) that employ them. Leaders are assessed within multiple domains, both internally and externally, and provided opportunity for growth and improvement. However, since those performing these reviews do not, in and of themselves, typically have hiring or firing power, these reviews do not ensure that subpar leaders will be removed or replaced. Those decisions rest in other hands, such as university presidents, deans, and governing boards. These individuals may use reviews to inform their decisions, but are not bound by them. Therefore, the mechanism of 5-year reviews does not, as the author suggests, occupy equal footing to political elections for producing leadership changes.

Furthermore, despite the presence of such review mechanisms within AMCs, leadership within these organizations has remained largely concentrated in the hands of White men.1 Clearly, this mechanism is insufficient to diversify leadership, and may, depending upon how reviews are conducted, even reinforce inequitable power sharing and entrenched leadership. Term limits provide an unbiased, fully transparent means by which leadership transitions occur. It is true that some talented young leaders will be removed from their leadership positions whilst in the prime of their careers, but such leaders should have no problem transitioning to other areas of leadership. At the same time, the next talented up-and-coming young leader may be given an opportunity to lead, thus spreading out the opportunity for leadership to a larger pool of individuals.

With the murder of George Floyd by Minneapolis police in May 2020, the issue of structural racism is finally at the forefront of national discourse. AMCs would be wise to take this opportunity to examine the means by which leadership is determined within their organizations and devise mechanisms to ensure equity, transparency, and diversity. Though many tools exist, term limits, paired with fair and transparent selection processes that prioritize diversity, may offer one such option.


1. Association of American Medical Colleges. Diversity in medicine: Facts and figures 2019. Accessed September 23, 2020.
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