Article In Brief
Neurology chairs share their insights about what it takes to be hired—and succeed—as chair of a neurology department.
Multiple sclerosis specialist Alissa Willis, MD, was not looking to be a department chair when the University of Mississippi Medical Center (UMMC)—her alma mater—recruited her. But she was prepared for the position.
During her six years at the Mellen Center for Multiple Sclerosis at Cleveland Clinic, Dr. Willis was a clinician educator focused primarily on patient care and education, including administration and curriculum development. But she had seized opportunities to serve as quality officer, learning how institutions prioritize and implement quality initiatives, and later as medical director.
“That was a great way to learn the logistics of running a clinic and the challenges associated with that,” said Dr. Willis, an associate professor at UMMC. “That gave me the opportunity to get familiar with budgeting and reading finance reports.”
Getting a range of experiences, many of which are far removed from a subspecialist's medical training, is an essential qualification to succeed as the chair of a neurology department, according to S. Andrew Josephson, MD, FAAN, chair of the AAN Academic Neurology Committee's Department Chair Subcommittee.
“When you're a department chair, you can't just focus on that one thing you're good at or that one mission that you're known for,” said Dr. Josephson, professor and chair of the neurology department at Weill Institute for Neurosciences at the University of California San Francisco. “You are responsible for everyone who supports all of the missions of the institution, and you must make sure that you're excited about supporting all of these missions and that you want to think creatively about how to improve them.”
A. Gordon Smith, MD, FAAN, professor and chair of the department of neurology at Virginia Commonwealth University, encourages leadership-minded neurologists to aspire to chair positions.
“All too often, people who would be outstanding chairs are dissuaded from doing it because they see it as being a really tough job,” he said. “But being department chair is fulfilling in that you are supporting an entire team of people, and the impact you can have is extraordinary because of that.”
“As a department chair, you're not just responding to things that are going on internally within the department, but you're also responding to external requests and pressures. So if there is an initiative from the dean's office that comes with the short deadline, you're responsible for turning on a dime and meeting that deadline.”—DR. ALISSA WILLIS
In interviews with Neurology Today, Dr. Smith and other current neurology chairs shared their insights about what it takes to be hired—and succeed—as chair of a neurology department.
Who Are America's Neurology Chairs?
A recent analysis of 131 chairs at neurology programs certified by the Accreditation Council for Graduate Medical Education provided a demographic snapshot as of March 2021. The analysis, conducted by Kajol K. Patel and Parth A. Patel, medical students at the Medical College of Georgia, found that nearly 85 percent of chairs were male. On average, they were 60.5 years old and had been appointed to their jobs at age 52.
More than 20 percent had earned a PhD, and another 21 percent held a master's degree. The majority of the department heads—73 of 131—received significant National Institutes of Health funding during their careers.
That analysis should not suggest that either extensive research achievements or a degree in addition to the MD are prerequisites for becoming a department head, the chairs told Neurology Today.
Robert Holloway, MD, MPH, FAAN, professor and chair of neurology at the University of Rochester Medical Center, has both an impressive research record and a master's degree. Having served as department chair for more than a decade, he said neither is essential.
The only commonality about neurology chairs, in Dr. Holloway's view, is that they are recognized for high-quality patient care. “You have to be a well-respected, committed clinician who cares deeply about patients and their families,” he said. “Depending on the department, a master clinician or an educator can have the toolset to become a really good chair of a department.”
Dr. Willis considered pursuing a master's-level degree, but her mentors advised that gaining a range of experiences was a better use of her time and energy.
Dr. Josephson concurred with that advice. “The job of a chair nowadays is much more diverse than it has ever been. We must have a deep understanding of finance, research, education, clinical care, diversity, global health, [and] public health,” he said. “There's probably no one who, going about their usual day as a neurologist, gains all of those experiences and comes with all of that perspective.”
While a master's-level management degree might provide some of that education, a more targeted approach is to identify the gaps in your knowledge and experience that need to be filled and look for ways to fill them.
“For me, it was taking a series of courses and, more importantly, immersing myself in a diversity of activities and volunteerism both here at my institution and nationally through the AAN and other organizations,” Dr. Josephson said.
Seek Out Leadership Training
Leadership is perhaps the most important role of an academic chair in medicine, but newly appointed department heads often have limited experience in leadership, according to David Greer, MD, FAAN, chair of neurology at Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center.
That's why Dr. Greer, also a professor of neurology at Boston University, wrote Successful Leadership in Academic Medicine, published by Cambridge University Press last year. Dr. Greer was named chair at Boston University in 2017 after seven years as vice chair of neurology at Yale University School of Medicine.
At Yale, he learned the benefit of working with a professional coach, and he negotiated funding for a chair coach as part of his employment package at Boston University. His coach periodically conducts a “360 review”—a performance evaluation that gathers feedback from a wide range of individuals with whom Dr. Greer interacts.
“That is extraordinarily helpful because you can get information about yourself and your leadership style,” he said. “What are the blind spots for Dave Greer? That is the single most important question to ask because, if you don't get that perspective from others, you are not going to be able to take your leadership to the next level.”
Early in his career, Dr. Smith received this advice: If you are interested in a specific position, get to know the person in that position in your own organization and other organizations you respect.
He took that advice during his years as vice chair for research in the neurology department at the University of Utah. That helped him understand what the chair position involved and gave him experience working with system-level leaders.
“I had standing meetings with several members of the health system's senior leadership team, and that gave me a sense of how the chair and the department were being judged by their leadership,” said Dr. Smith, the Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research in Neurology.
He also completed a leadership program offered at University of Utah's business school. “That was helpful because it gave me basic competency in accounting and finance and marketing,” he said. “And it gave me some of the basic vocabulary to use to communicate with folks who are more administratively or financially focused.”
Dr. Holloway encourages neurologists to acquire leadership skills throughout their careers. During a sabbatical years before he was appointed chair, he took a two-week course for physician leaders in academic medical centers offered by the Harvard T.H. Chan School of Public Health.
He recommends the AAN leadership development programs, such as the Emerging Leaders Program and Transforming Leaders Program. Dr. Willis points to leadership courses offered by the Association of American Medical Colleges.
The Academy's new Diversity Leadership Program is specifically designed to help physicians from marginalized groups fulfill their greatest potential.
The program includes interactive workshops, a group project to address a strategic issue, the opportunity to present the project to the AAN Board of Directors--and individual coaching that allows participants to design a path for career advancement.
Vanessa Cooper, MD, assistant professor of clinical neurology at Yale School of Medicine and associate director of diversity and inclusion education for its neurology residency program, said the Diversity Leadership program is intense—and worthwhile.
“It's so fulfilling because the individual coaching really does push you to the next level of your career and pursue things that you may not have seen yourself doing without that encouragement,” she said.
Dr. Greer suggests his book, specifically targeted at physicians who aspire to leadership roles, and a periodical not focused on academic medicine. “The Harvard Business Review is a really fantastic resource for anybody going into leadership,” he said.
Look for the Right Fit
Having helped several neurology departments discuss potential chair candidates, Dr. Josephson sees that the type of individuals eligible for consideration has grown considerably in recent years.
“Different institutions are looking for different types of people,” he said. “That may reflect a specific emphasis of an institution or perhaps the department that, when selecting a new chair, wants to focus on to grow or to improve.”
“There are some things I don't have time to do any more, but one of the neat things about being chair is that you're a real mentor and advocate for more junior people to take on these leadership roles. And I don't think there's anything more satisfying than seeing that happen.”—DR. S. ANDREW JOSEPHSON
That's what made Dr. Willis the right person to chair the UMMC neurology department. Over the years, medical students showed declining interest in neurology, and in 2019, none of the four residency slots were filled.
“My background as a clinician educator is what led the dean and vice chancellor to talk to me about potentially taking on the task of rebuilding,” she said. “To see it in the state that it was in 2019 was disheartening, and it became a personal mission to restore it and improve it beyond what I remembered from when I was a medical student and resident here.”
In the past two years, 10 medical students in each class have expressed interest in pursuing neurology careers, and all of UMMC's neurology residency slots have been filled with competitive candidates.
“The training that our recent graduates have received is better than what the graduates from a few years ago received, so I'm very proud of these young neurologists going out into practice and getting their careers started,” she said.
Embrace the Financial Administration Aspect
“If one has a disdain for finances or the higher administrative individuals within health care organizations, you better think twice about being a chair,” Dr. Holloway said.
Learning business fundamentals—how to read spreadsheets, make financial projections, write business plans, balance budgets, and so forth—is not technically difficult, but putting those skills to use in the context of an academic medical center is challenging, he said.
“You have to think more system-level, particularly now as health systems are merging and physicians are being acquired by hospitals and we have service lines that kind of cut across both inpatient and ambulatory,” Dr. Holloway said. “You have to really know how the funds flow and earn the trust of the stakeholders that you have to work with.”
Departments typically compete against one another for investments in their departments, so each chair must develop—and deliver on—business plans that build credibility and trust among their own faculty members as well as administrators and colleagues that allocate dollars.
“The business of medicine has really overtaken the job in [some] ways, and the financial aspects of the job can be extraordinarily pressure-filled,” Dr. Greer said. “So you spend a lot of your time negotiating with the hospital and the medical school and trying to do so in a positive way so that they feel like they're making a wise investment in your department.”
Indeed, financial acumen can increase a chair's influence within the organization. Dr. Smith runs a neurology department that is rapidly growing at a university that is evolving. “One of the things that I've found surprising is the extent to which we are part of the overall institutional evolution and culture change,” he said.
Is the Time Right for Your Career?
In Dr. Holloway's view, the primary satisfaction of being a chair is building a department that will thrive far into the future. That requires focusing less on your own career advancement than that of others.
“If one remains very self-interested in their own career, it's probably not the best time because this is a job in which you promote and sponsor others,” he said. “In this position, you look good when others around you look good, so the job is helping to shape the careers and programs of others.”
That requires a change in a neurologist's self-identity, Dr. Willis said. After years or perhaps decades of building one's reputation as a specialist, accepting a chair's position means becoming a generalist, familiar with and advocating for all areas of neurology and all missions of the department.
“That transition is something you need to be ready for,” she said. “Also, many faculty members function as individuals as they work to develop their own careers, but (as a chair), you are more focused on collaboration and making sure the team is successful.”
Chairs typically retain some of the teaching, patient care, and/or research activities that defined their career, but running a department requires flexibility over one's day-to-day schedule.
“As a department chair, you're not just responding to things that are going on internally within the department, but you're also responding to external requests and pressures,” Dr. Willis said. “So if there is an initiative from the dean's office that comes with the short deadline, you're responsible for turning on a dime and meeting that deadline.”
“You have to be a well-respected, committed clinician who cares deeply about patients and their families. Depending on the department, a master clinician or an educator can have the tool set to become a really good chair of a department.”—DR. ROBERT HOLLOWAY
“The business of medicine has really overtaken the job in [some] ways, and the financial aspects of the job can be extraordinarily pressure-filled. So you spend a lot of your time negotiating with the hospital and the medical school and trying to do so in a positive way so that they feel like they're making a wise investment in your department.”—DR. DAVID GREER
Dr. Josephson, whose department includes more than 250 faculty members, said it is unrealistic to think that some personal or professional interests will not have to fall by the wayside.
“These jobs are so large that there's no way to just add this to your portfolio of activities,” he said. “There are some things I don't have time to do any more, but one of the neat things about being chair is that you're a real mentor and advocate for more junior people to take on these leadership roles. And I don't think there's anything more satisfying than seeing that happen.”