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The neurosurgeon as chairman of surgery
92
Surg Neurol
1989;31:92-5
The Neurosurgeon
as Chairman of Surgery
A. John Popp, M.D. Henry and Sally Schaffer Albany, New York
Chairman
of Surgery,
Professor
and Head-Division
As for Nathan, well, 1 intend to get even (of course). 1 am part of a conspiracy to teach him what it is like to have to play God to a group of fractious humans, to have far more responsibility than you have power.
We’re going to make him departmental God Game by Andrew
chairman. M. Greeley
Greeley’s opinion about departmental stewardship may ring a note of truth for some. However, the opportunity to serve for the past 2 years as acting chairman and, subsequently, as Chairman of the Department of Surgery at Albany Medical College has left me with an optimistic view of this challenging responsibility. Presently, only a handful of neurosurgeons in the United States serve as chairmen of university-based multispecialty surgical departments. This article examines this infrequent phenomenon and shares my perception of the generic responsibilities and problems faced not only by neurosurgeons but by anyone assuming this position. Dr. Eben Alexander, Jr., the editor of this journal, asked me to prepare this topic nearly a year ago. The assignment was completed promptly, but the manuscript was filed to allow aging-for both the text and the author. The intervening period, as expected, has produced an evolution of my initial view of departmental leadership, but the changes were not as significant as 1 had anticipated.
The Searcb
Process
Surgical specialties in most medical schools are either conjoined in a single department or exist as separate departments. In the latter instance, the search for a new chairman proceeds unimpeded by consideration of specialty because candidates are always selected from members of the respective discipline. Identification of a suit-
AddreJJ reprint requests to: A. John Popp, M.D., Division of Neurosurgery, Albany Medical College, Albany, New York 12208. Received August 1, 1988; accepted August 24, 1988.
0 1989 by Elsevier Science Publishing Co., Inc
of Neurosurgery,
Albany
Medical
College,
able leader for the multispecialty department is more problematic. By precedence, leadership of this constituency has been provided most frequently by a genera1 surgeon. This choice seemed natural because early surgical specialists first considered themselves “genera1 surgeons” and the specialties were viewed as a continuum, both in training and practice, with genera1 surgery. Generally, neurosurgeons do not pursue candidacy for the chair of a multispecialty surgical department outside their institution. Thus, appointment of a neurosurgeon to the chair invariably occurs when, given institutional imperatives, the search process identifies a neurosurgeon as the most suitable internal candidate. This occurred once before at Albany Medical College when Eldridge Campbell, division head of neurosurgery, was selected as Department Chairman and served with distinction from 1946 until his untimely death in 1956. Despite other historie examples and growing numbers of neurosurgeons serving as department chairmen, the appointment of a neurosurgeon to the chair evokes varied responses (Figure 1). Within the institution, the selection of a neurosurgeon generally is supported when the candidate is perceived as being the most qualified. However, a few nonneurosurgical colleagues from across the country have expressed consternation because of the appointment of a neurosurgeon to the Chair of the Department of Surgery. This emotion appears to reflect concern about the impact of this selection on genera1 surgery in the institution: the supposition being that specialty chairmen bring with them a bias for their own specialty and a restricted view of the field of surgery. However, even if true, this opinion would be equally applicable to any chairman of a multispecialty department of surgery, whatever the area of expertise. In fact, chairmen from surgical subspecialties may have a broader view of the field because of mandated training in general surgery prior to entering specialty residency. In my own instance, the 4 years spent in genera1 surgery before entering a neurosurgical residency gives me an understanding of genera1 surgery which could not be matched by a genera1 surgeon’s experience in my specialty. 0090.3019/89/$3.50
Neurosurgeon
Surg Neuroi 1989;31:92-5
as Chairman
Figure 1. Initial impression of ethers about neuvosurgeonlcbairman.
NeurosurgeonlChairman: Career and Specialty
The Effect on Personal
How does a neurosurgeon’s life change when he becomes department chairman? This question requires intense reflection before assuming departmental leadership, because being chairman requires unstinting participation. It is doubtful that even the most prescient candidate can begin to understand the magnitude of the job. Simply stated, being a department chairman is demanding and the responsibility inevitably produces a significant impact on an individual’s professional and personal life. An important goal of a new chairman should be to maintain his own professional identity. The prototypical academie surgeon strives for recognition in research, education, and practice, but many have found that simultaneous excellente in al1 three areas is difficult. The added administrative responsibilities of the chair exacerbate this problem (Figure 2 A and B). Improvement of personal and organizational efficiency may reduce time pressures somewhat; further help can come from added support staff and delegation of responsibilities to reliable colleagues. Despite these strategies, the increased administrative burden wil1 leave less time for teaching, practice, and research. It is difficult to prioritize these activities because each is a necessary component of one’s career. However, 1 believe, on balance, that it is difficult to maintain leadership and credibility as chairman if one ceases to practice clinical neurosurgery because of the incessant demand of administrative tasks. If the neurosurgeon/chairman continues to be head of neurosurgery as well, the ability to devote adequate attention to the activities of his specialty may be im-
93
the
peded. In addition, assuming responsibility for an entire department requires a broadening of one’s thinking. One can no longer consider what is best for neurosurgery alone; the implications of an action must be evaluated for its impact on the entire department and institution. Consideration should be given to recruiting a new division head of neurosurgery. This step allows administrative representation at the divisional leve1 and may lessen the perception that decisions partial to neurosurgery are based on favoritism and not propriety. Unfortunately, this appointment gives rise to a paradox in which the department chairman’s own specialty is under the leadership of a subordinate. Were the chairman subsequently to resign or lose the position, a not uncommon occurrence in this day of often brief tenure, his position in the specialty division would be uncertain. Perhaps the solution to this problem lies in the appointment of an interim head of neurosurgery during the chairman’s tenure, but identifying such an individual is difficult.
A Chairman’s Responsibility to Department and Institution As the department’s chief administrative officer, the chairman assumes ultimate responsibility for al1 departmental activities. Despite an often intimidating skein of meetings to fulfill this charge, the importante of administrative duties is often unrecognized by colleagues and frequently underemphasized by chairmen themselves. In a recent Delphic dialogue among clinical and basic science chairmen at my institution, only 4 of 15 listed administrative activities as one of their major roles; yet
94
Surg Neurol
POPP
1989;31:92-5
greatest nurturing. An initial goal of chairmen should be to create an environment that promotes a sense of inquiry and facilitates attainment of the goals of an academic department. This includes removing the exigencies of the “business” of medicine from faculty surgeons by hiring a management staff to oversee such necessary functions as billing, collections, and personnel management. Physicians should continue to review these activities but, freed of concerns for which they are poorly trained, the professional members of the department should have more time to focus on their careers in academic surgery. In this milieu, the able chairman can best display leadership by valuing and stimulating excellente, whether it be by the master surgeon, the dedicated teacher, or the innovative surgeon/scientist. Recruitment and retention of faculty to populate this environment are never-ending and time-consuming, but by careful selection and mentoring of new department members, the chairman can ensure the quality of patient care and can perpetuate a successful department. External forces shaping medicine have become distressingly complex. Folse { 11 writes critically of the tendency of many in academie circles to become “sleeping dogs” as the swirl of change engulfs US. Although his remarks concern surgical education, they could have easily included other areas of health care. As leaders in academie medicine, chairmen must actively participate in the dialogue and decision making that invariably accompany institutional change. Despite the tedium of
Figure Eigure 2. (A) The stable thee-legged stool of teacbing, research, and patient care representing the necessary components offaculty inuolvement in medical education. (From: Alexander E Jr: Perspectiue on neurosurgery, presidential address. J Neurosurg 1967;27:189-206. Vsed by permission of tbe author and the Joumal of Neurosurgery.) (B) Instability introduced by adding administratiue duties. (From: Alexander E Jr: Perspective on neurosurgery, presidentialaddress. J Neurosurg 1967;27:189-206. Vsed by permission of the autbor and tbe Journal of Neurosurgety.)
as much as 50% of a chairman’s time may be spent on administrative duties. Because the methodology for administrative problem solving can be quite different from that used in clinical situations, chairmen must be able to “wear different hats” and use techniques which change depending on the circumstances (Figure 3). It is the task of the chairman to fulfill the mission of the department by development and management of key resources including space, revenue, and personnel. The professional members of the department are the most essential of these three resources and require the
3. In tbe baberdasbey.
Neurosurgeon
Surg Neurol 1989;31:92-5
as Chairman
Figure
meetings, effective communication on a regular basis is fundamental to successful organizations in a rapidly changing environment. In this context, some view the chairman as being trapped in an awkward position with his constituents and fellow surgeons on one hand and administrative counterparts on the other. Instead, 1 believe that a chairman should view the job as being a “communications expert.” In this pivotal position, a chairman must amplify and translate the needs of the department into language that is understandable by those governing the institution; at the same time, chairmen must interpret and communicate institutional policy and strategie goals to their departmental colleagues (Figure 4). With greater emphasis on outpatient evaluation and treatment, many university medical centers have become, in essence, surgical hospitals with much of the institution’s support derived from the enterprises of the department of surgery. Thus, it is important that the strategie plan of the department and institution be in harmony and that the department of surgery participate in policymaking as an integral part of an institution. To accomplish this, the modern department chairman must be a team player, always keeping the best interests of the department and institution in sight. Chairmen must continue to be their department’s advocate, but long
4. The communications
95
expert.
gone are the days when a department could function in relative isolation without concordante with the rest of the institution. In large institutions, cohesiveness is difficult to develop and maintain. Collaborative undertakings with basic science departments should be fostered to facilitate innovative research. Other collaborative agreements within the institution, and with government, community, and industry, are also essential linkages; the department chairman must have an appreciation for their significante and be willing to play an active role in their development. By shaping and positioning the department to be responsive to the changing environment, chairmen begin to meet their prime mandate: to evolve, enhance, and maintain an effective department of surgery.
Presented in part as the Schaffer Lecture, November 12, 1987. The author acknowledges, with gratitude, support by the H. Schaffer Foundation and the expert secretarial assistance of Debra Wasserbach.
Reference 1. Folse R. Sleeping tion 1987;4:3.
dog or roaring
giant.
Focus on Surgical
Educa-
Surg Neurol
1989;31:92-5
The Neurosurgeon
as Chairman of Surgery
A. John Popp, M.D. Henry and Sally Schaffer Albany, New York
Chairman
of Surgery,
Professor
and Head-Division
As for Nathan, well, 1 intend to get even (of course). 1 am part of a conspiracy to teach him what it is like to have to play God to a group of fractious humans, to have far more responsibility than you have power.
We’re going to make him departmental God Game by Andrew
chairman. M. Greeley
Greeley’s opinion about departmental stewardship may ring a note of truth for some. However, the opportunity to serve for the past 2 years as acting chairman and, subsequently, as Chairman of the Department of Surgery at Albany Medical College has left me with an optimistic view of this challenging responsibility. Presently, only a handful of neurosurgeons in the United States serve as chairmen of university-based multispecialty surgical departments. This article examines this infrequent phenomenon and shares my perception of the generic responsibilities and problems faced not only by neurosurgeons but by anyone assuming this position. Dr. Eben Alexander, Jr., the editor of this journal, asked me to prepare this topic nearly a year ago. The assignment was completed promptly, but the manuscript was filed to allow aging-for both the text and the author. The intervening period, as expected, has produced an evolution of my initial view of departmental leadership, but the changes were not as significant as 1 had anticipated.
The Searcb
Process
Surgical specialties in most medical schools are either conjoined in a single department or exist as separate departments. In the latter instance, the search for a new chairman proceeds unimpeded by consideration of specialty because candidates are always selected from members of the respective discipline. Identification of a suit-
AddreJJ reprint requests to: A. John Popp, M.D., Division of Neurosurgery, Albany Medical College, Albany, New York 12208. Received August 1, 1988; accepted August 24, 1988.
0 1989 by Elsevier Science Publishing Co., Inc
of Neurosurgery,
Albany
Medical
College,
able leader for the multispecialty department is more problematic. By precedence, leadership of this constituency has been provided most frequently by a genera1 surgeon. This choice seemed natural because early surgical specialists first considered themselves “genera1 surgeons” and the specialties were viewed as a continuum, both in training and practice, with genera1 surgery. Generally, neurosurgeons do not pursue candidacy for the chair of a multispecialty surgical department outside their institution. Thus, appointment of a neurosurgeon to the chair invariably occurs when, given institutional imperatives, the search process identifies a neurosurgeon as the most suitable internal candidate. This occurred once before at Albany Medical College when Eldridge Campbell, division head of neurosurgery, was selected as Department Chairman and served with distinction from 1946 until his untimely death in 1956. Despite other historie examples and growing numbers of neurosurgeons serving as department chairmen, the appointment of a neurosurgeon to the chair evokes varied responses (Figure 1). Within the institution, the selection of a neurosurgeon generally is supported when the candidate is perceived as being the most qualified. However, a few nonneurosurgical colleagues from across the country have expressed consternation because of the appointment of a neurosurgeon to the Chair of the Department of Surgery. This emotion appears to reflect concern about the impact of this selection on genera1 surgery in the institution: the supposition being that specialty chairmen bring with them a bias for their own specialty and a restricted view of the field of surgery. However, even if true, this opinion would be equally applicable to any chairman of a multispecialty department of surgery, whatever the area of expertise. In fact, chairmen from surgical subspecialties may have a broader view of the field because of mandated training in general surgery prior to entering specialty residency. In my own instance, the 4 years spent in genera1 surgery before entering a neurosurgical residency gives me an understanding of genera1 surgery which could not be matched by a genera1 surgeon’s experience in my specialty. 0090.3019/89/$3.50
Neurosurgeon
Surg Neuroi 1989;31:92-5
as Chairman
Figure 1. Initial impression of ethers about neuvosurgeonlcbairman.
NeurosurgeonlChairman: Career and Specialty
The Effect on Personal
How does a neurosurgeon’s life change when he becomes department chairman? This question requires intense reflection before assuming departmental leadership, because being chairman requires unstinting participation. It is doubtful that even the most prescient candidate can begin to understand the magnitude of the job. Simply stated, being a department chairman is demanding and the responsibility inevitably produces a significant impact on an individual’s professional and personal life. An important goal of a new chairman should be to maintain his own professional identity. The prototypical academie surgeon strives for recognition in research, education, and practice, but many have found that simultaneous excellente in al1 three areas is difficult. The added administrative responsibilities of the chair exacerbate this problem (Figure 2 A and B). Improvement of personal and organizational efficiency may reduce time pressures somewhat; further help can come from added support staff and delegation of responsibilities to reliable colleagues. Despite these strategies, the increased administrative burden wil1 leave less time for teaching, practice, and research. It is difficult to prioritize these activities because each is a necessary component of one’s career. However, 1 believe, on balance, that it is difficult to maintain leadership and credibility as chairman if one ceases to practice clinical neurosurgery because of the incessant demand of administrative tasks. If the neurosurgeon/chairman continues to be head of neurosurgery as well, the ability to devote adequate attention to the activities of his specialty may be im-
93
the
peded. In addition, assuming responsibility for an entire department requires a broadening of one’s thinking. One can no longer consider what is best for neurosurgery alone; the implications of an action must be evaluated for its impact on the entire department and institution. Consideration should be given to recruiting a new division head of neurosurgery. This step allows administrative representation at the divisional leve1 and may lessen the perception that decisions partial to neurosurgery are based on favoritism and not propriety. Unfortunately, this appointment gives rise to a paradox in which the department chairman’s own specialty is under the leadership of a subordinate. Were the chairman subsequently to resign or lose the position, a not uncommon occurrence in this day of often brief tenure, his position in the specialty division would be uncertain. Perhaps the solution to this problem lies in the appointment of an interim head of neurosurgery during the chairman’s tenure, but identifying such an individual is difficult.
A Chairman’s Responsibility to Department and Institution As the department’s chief administrative officer, the chairman assumes ultimate responsibility for al1 departmental activities. Despite an often intimidating skein of meetings to fulfill this charge, the importante of administrative duties is often unrecognized by colleagues and frequently underemphasized by chairmen themselves. In a recent Delphic dialogue among clinical and basic science chairmen at my institution, only 4 of 15 listed administrative activities as one of their major roles; yet
94
Surg Neurol
POPP
1989;31:92-5
greatest nurturing. An initial goal of chairmen should be to create an environment that promotes a sense of inquiry and facilitates attainment of the goals of an academic department. This includes removing the exigencies of the “business” of medicine from faculty surgeons by hiring a management staff to oversee such necessary functions as billing, collections, and personnel management. Physicians should continue to review these activities but, freed of concerns for which they are poorly trained, the professional members of the department should have more time to focus on their careers in academic surgery. In this milieu, the able chairman can best display leadership by valuing and stimulating excellente, whether it be by the master surgeon, the dedicated teacher, or the innovative surgeon/scientist. Recruitment and retention of faculty to populate this environment are never-ending and time-consuming, but by careful selection and mentoring of new department members, the chairman can ensure the quality of patient care and can perpetuate a successful department. External forces shaping medicine have become distressingly complex. Folse { 11 writes critically of the tendency of many in academie circles to become “sleeping dogs” as the swirl of change engulfs US. Although his remarks concern surgical education, they could have easily included other areas of health care. As leaders in academie medicine, chairmen must actively participate in the dialogue and decision making that invariably accompany institutional change. Despite the tedium of
Figure Eigure 2. (A) The stable thee-legged stool of teacbing, research, and patient care representing the necessary components offaculty inuolvement in medical education. (From: Alexander E Jr: Perspectiue on neurosurgery, presidential address. J Neurosurg 1967;27:189-206. Vsed by permission of tbe author and the Joumal of Neurosurgery.) (B) Instability introduced by adding administratiue duties. (From: Alexander E Jr: Perspective on neurosurgery, presidentialaddress. J Neurosurg 1967;27:189-206. Vsed by permission of the autbor and tbe Journal of Neurosurgety.)
as much as 50% of a chairman’s time may be spent on administrative duties. Because the methodology for administrative problem solving can be quite different from that used in clinical situations, chairmen must be able to “wear different hats” and use techniques which change depending on the circumstances (Figure 3). It is the task of the chairman to fulfill the mission of the department by development and management of key resources including space, revenue, and personnel. The professional members of the department are the most essential of these three resources and require the
3. In tbe baberdasbey.
Neurosurgeon
Surg Neurol 1989;31:92-5
as Chairman
Figure
meetings, effective communication on a regular basis is fundamental to successful organizations in a rapidly changing environment. In this context, some view the chairman as being trapped in an awkward position with his constituents and fellow surgeons on one hand and administrative counterparts on the other. Instead, 1 believe that a chairman should view the job as being a “communications expert.” In this pivotal position, a chairman must amplify and translate the needs of the department into language that is understandable by those governing the institution; at the same time, chairmen must interpret and communicate institutional policy and strategie goals to their departmental colleagues (Figure 4). With greater emphasis on outpatient evaluation and treatment, many university medical centers have become, in essence, surgical hospitals with much of the institution’s support derived from the enterprises of the department of surgery. Thus, it is important that the strategie plan of the department and institution be in harmony and that the department of surgery participate in policymaking as an integral part of an institution. To accomplish this, the modern department chairman must be a team player, always keeping the best interests of the department and institution in sight. Chairmen must continue to be their department’s advocate, but long
4. The communications
95
expert.
gone are the days when a department could function in relative isolation without concordante with the rest of the institution. In large institutions, cohesiveness is difficult to develop and maintain. Collaborative undertakings with basic science departments should be fostered to facilitate innovative research. Other collaborative agreements within the institution, and with government, community, and industry, are also essential linkages; the department chairman must have an appreciation for their significante and be willing to play an active role in their development. By shaping and positioning the department to be responsive to the changing environment, chairmen begin to meet their prime mandate: to evolve, enhance, and maintain an effective department of surgery.
Presented in part as the Schaffer Lecture, November 12, 1987. The author acknowledges, with gratitude, support by the H. Schaffer Foundation and the expert secretarial assistance of Debra Wasserbach.
Reference 1. Folse R. Sleeping tion 1987;4:3.
dog or roaring
giant.
Focus on Surgical
Educa-