ARTICLE IN BRIEF:
Increasingly, neurologists are assuming positions as deans in academic medical centers. In this story, they discuss their career pathways, their unique challenges, and their role overall in making an impact on health care and medical education.
Relatively few neurologists and neuroscientists sit in the offices of deans and associate deans of medical schools. Gerald Fischbach, MD, a physician-scientist who previously headed the National Institute of Neurological Disorders and Stroke (NINDS), served as dean of Columbia University College of Physicians and Surgeons from 2001 to 2006; and Alzheimer's expert Steven DeKosky, MD, FAAN, served as dean of the University of Virginia School of Medicine from 2008 to 2012. One of the few women to serve as a dean, Lois Nora, MD, JD, MBA, was president and dean of medicine at Northeast Ohio Medical University from 2002 to 2010.
The only neurologist currently in the role of medical school dean is S. Claiborne Johnston, MD, PhD, who is dean, vice president for medical affairs, and Frank and Charmaine Denius Distinguished Dean's Chair in Medical Leadership at the University of Texas at Austin's Dell Medical School.
A handful of other neurologists also lead the research, clinical, or medical education enterprises at various medical schools as associate or senior associate deans. Neurology Today spoke with several of these leaders about how they achieved their positions, the roles they play, and what part neurology has in their work as deans.
A Natural Fit
Neurologists are particularly suited for the dean's office, Dr. Johnston believes, for a variety of reasons. “First, we are a nice bridge between primary and specialty care,” he said. “Yes, we are specialists, but we provide primary care to certain types of patients, such as those with epilepsy or the elderly with Parkinson's disease. We become the doctor that is central to their care. Because of that, we speak both languages, and we end up with a lot of knowledge about general medicine. We're not so subspecialized that we don't know about antihypertensives or anticoagulation. And although we are a cognitive specialty, we work closely with procedural specialists, and that allows us to understand both sides. Also, because we focus on cognition and the brain, that serves us well in these roles. A lot of the job in any deanship is management, which means managing brains, as imperfect as they are.”
One of the things that surprised Dr. Johnston as he grew into the role of dean was just how much of a public figure he had become. “People start to laugh at your jokes whether they're funny or not,” he said. “The degree to which that happens surprised me. There's a degree of loneliness about it. I try to push in the other direction. For example, we have a first-name-only policy. Everyone calls me by my first name and I do the same with them. There's no reason to put the dean on a pedestal.”
The Education Mission
At Baylor College of Medicine in Texas, the education mission is under the purview of not one but two deans with a neurology background. Joseph S. Kass, MD, JD, FAAN, professor of neurology, psychiatry & behavioral sciences, and medical ethics & health policy, serves as associate dean of student affairs; while J. Clay Goodman, MD, FAAN, professor of pathology & Immunology and neurology, is associate dean for undergraduate medical education.
Dr. Goodman said that it's probably a coincidence that the two associate dean positions charged with overseeing the journey of medical students are currently both filled by neurologists, but maybe not entirely. Baylor's particular commitment to the neurosciences stretches back to the mid-1970s, when the school inaugurated a 15-week course on the nervous system as part of its foundational sciences curriculum.
“It's larger and more intense than you'll find in most medical schools at this level,” said Dr. Goodman, who has directed the class for the past two years. “It's a very clinically oriented course, focused on clinical localization, differential diagnosis, and therapeutics.”
Dr. Goodman oversees the medical school's 18-month basic science curriculum, which has been significantly integrated since the 1980s. “We were a bit ahead of our time in that regard,” he said. “For example, in the first six months, the students take one large basic science course that covers the traditional disciplines of gross anatomy, histology, biochemistry, and physiology.” (He actually ran that course up until this year, as well.)
Dr. Goodman said he felt his experience teaching and holding various leadership positions had prepared him well for the job as associate dean, a title he has held since 2005. He had served as program director for the neuropathology training program and assumed leadership roles at the AAN on the Education Committee and as chair of the Neurology Residency In-service Training Examination (RITE) subcommittee. He had also served in leadership roles at the American Board of Psychiatry and Neurology (ABPN). “I think the background I got from the Academy and the ABPN, where I serve on the board, informed me a lot about future trends in medical education and assessment of students, residents, and ultimately practitioners,” Dr. Goodman said.
Visibility as a Mentor
Dr. Kass, who came to the dean's office more recently, agrees that the trajectory to his current position, although not planned, seems a logical one in retrospect. As a lawyer who changed careers to pursue medicine, he was older than many in his graduating class. “I was the first neurologist in my department to go through what was then our new teachers' fellowship program for those interested in becoming clinician-educators,” he said. “I developed a reputation as a teacher and, in 2008, became a mentor in Baylor's Learning Community Program, a network of clinical faculty advisors for medical students. That's almost like being a mini-dean, I would say.”
That role as a mentor also brought him to the attention of the former associate dean for student affairs, who recruited him as her assistant dean in the spring of 2015. (At the time, he was also directing the neurology residency program.) A year later when she stepped down from the position, Dr. Kass took on his current role, reporting directly to the College of Medicine's dean.
“Student affairs in most institutions does everything except design the curriculum,” he said. “We deal with student career choices, wellness, student progression through the curriculum, their achievements, and their failures. We are in charge of our learning communities program, academic support, and all the student government, student honor council, and the student promotions committee.”
A critical part of student affairs is specialty choices and career planning. In this role Dr. Kass tries to overcome some of the profession's biases toward procedural specialties, he said. “I'm fighting a culture where the idea is that a happy life is a subspecialty surgery life, so if you get a good Step score and good grades, you should go into otolaryngology or dermatology or ophthalmology. I know there's a dearth of neurologists, and I want to encourage people to pursue neurology if they're at all interested. When I see younger students with an interest in neurology, I do what I can to promote that interest and make sure they're shadowing the right people.”
Dr. Goodman does the same in his role. “As the foundational dean, I am relatively neutral as far as the courses, but obviously as course director of neuroscience in foundations, the students know I'm a neurologist. I don't conceal the fact that it's an exciting field,” he said. “Particularly in the nervous-system course, we try to excite the students about neurology, and I think we're reasonably successful at that. We've had usually two to four students a year go into neurology, and sometimes as many as 12.”
The Research Mission
At the University of New Mexico, the research mission for its school of medicine is under the direction of a neurologist, Corey Ford, MD, PhD, professor of neurology and senior associate dean for research. “As with many career evolutions, you best know how you got there when you look backward,” he said of the position he assumed in 2006.
“I didn't join the institution or work toward the idea of becoming a dean in the research mission for the school of medicine. But I had served along the way on various committees: I chaired the pharmacy and therapeutics committee, I served on the science advisory council for the previous associate dean for research, and I directed our research-imaging center. Serving in those positions and others gave me insight into the efforts that make the institution run, and everything that happens behind the scenes to provide infrastructure and support for the medical center's missions.”
In his role Dr. Ford oversees the Biomedical Sciences Graduate Program and is involved in broad areas such as research compliance, animal care, conflict-of-interest policies, biosafety, and the Institutional Review Board (IRB). “I was also particularly interested in helping to develop our signature research programs, of which we have six,” Dr. Ford said. “They focus on critical health problems and encompass broad disciplines to break down the silos of departments and centers that can be focused on narrow areas and provide platforms for collaboration.”
One of those programs is focused on brain and behavioral health, and Dr. Ford believes his background gave him particular acumen for growing that program into a full center providing training, infrastructure, implementation, and computational tools to the research faculty. “As a neurologist, I knew all the pieces we had, and the institution was committed to developing them, so it was a great confluence of my training and interests with the institution's,” Dr. Ford said.
The Balancing Act
Taking on a dean's responsibilities requires an exquisite balancing act in an already busy academic career. “It's not something to dabble in,” Dr. Goodman said. “It takes support from your chair and a serious commitment to doing the work.
“Everybody has to make their own decisions about how to manage it,” Dr. Ford said. As an assistant dean for research in 2007, his role was allotted 25 percent of his time; as a senior associate dean, that increased to 50 percent. Another 10 percent of his time is assigned to directing the MD/PhD program. “The remainder of my time I divide between clinical work and my research,” Dr. Ford said, “but most of it goes to clinical research. I still go to clinic, but that effort has shrunk over the years to about 10 to 15 percent of my time.”
And while a dean may appear to hold a substantial amount of power, Dr. Johnston said appearances can be deceiving. “In some instances you have a lot of freedom and power to do things, but in some instances you have none. Yes, you get to make decisions about things like the budget, but the reality is that you are constrained in so many different ways that the ability to make those decisions is substantially restricted before you make them. In some ways, you carry the weight of the decisions without always being able to make them freely.”
For those considering deanships, these neurologist-deans agree, pursuing the job out of notions of prestige or power, or because it's the next logical step on a chain of promotions, is not recommended. Candidates should pursue such posts only if they have a clear vision and a passion to create something better than what is already in place.
“People want to follow an idea that's bigger than you as an individual, and bigger even than your institution,” Dr. Johnston said. “If you want to make changes in health care or medical education or the way the research enterprise is run, and you think that can best be accomplished in a leadership post at a medical school, then being a dean could be for you.”
Editor's Note: Neurology Today aims to include a diverse range of perspectives in our reports including both men and women specialty leaders in the field. For this story, we found a paucity of women who currently serve as deans. A 2018 analysis in Academic Medicine — by pediatric neurologist, Nina F. Schor, MD, the deputy director of the National Institute of Neurological Disorders and Stroke — found that as of 2016, 15 percent of deans and interim deans were women, and the prevalence of women in decanal positions decreases with ascending professional rank (p < .05).