- Email: [email protected]
Who’s the boss?
COMMENT AND CONTROVERSY Edited by Stephen P. Stone, MD
Who’s the Boss? RONNI WOLF, MD LAWRENCE CHARLES PARISH, MD The very best instructor for students may have no conception of the higher lines of work in his branch, and contrariwise, how many brilliant investigators have been wretched teachers?“ [Sir William Osler, Teaching and Thinking, 1895, Reprinted in Aequanimitas, with Other Addresses to Medical Students, Nurses, and practitioners of Medicine, 3rd ed. Philadelphia: Blakiston’s Son; 1932 p. 128]. ”To discover and teach are distinct functions; they are also distinct gifts, and are not commonly found united in the same person.“ [John Henry, Cardinal Newman 18011890 on the Scope and Nature of University Education, Preface.
M
edicine, once considered an art, has become a multidisciplined science thanks to the enormous strides in knowledge and understanding that have been taken over the past century. Insights into the pathogenesis of diseases at a molecular level, developments of new therapeutic agents, discoveries of biologic and immunologic therapeutics that target cytokines and cells, dissemination of knowledge at the speed of light, technologic advances in sophisticated equipment and procedures —all these giant leaps in progress have made it unrealistic to expect that there are mortals who possess all the capabilities of being outstanding physicians, top-notch scientific researchers, men/women of superior intelligence, brilliant teachers, and first-class administrators. If there are no such superleaders among us, who, then, is best suited to lead an academic department of dermatology? We decided to collect the opinions of leading dermatologists to define the consensus opinion of who should be the boss.
Materials and Methods A short, closed (multiple choice) questionnaire was distributed through e-mail to leaders in dermatology. Included in the survey were the Editors, Assistant Editors, and Members of the Editorial Board of the Journal of the American Academy of Dermatology, the Board of From the Dermatology Unit, Kaplan Medical Center, Rechovot, Israel; and the Department of Dermatology and Cutaneous Biology, and the Jefferson Center for International Dermatology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania. Address correspondence to Ronni Wolf, MD, Dermatology Unit, Kaplan Medical Center, 76100 Rechovot, Israel. E-mail address: [email protected] © 2003 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010
Directors and Officers of the American Academy of Dermatology, the Editors, Assistant Editors, Members of the Editorial Board, Advisory Board and International Advisory Committee of the Archives of Dermatology, and the Editors and Editorial Board of Clinics in Dermatology. In all, we had a list of 160 physicians for potential inclusion in the survey. We could not reach 35 of them. The participants were asked to rate the importance of nine characteristics of an individual most suitable to be head of an academic department of dermatology on a 5-point scale: 5 ⫽ most important, 4 ⫽ very important, 3 ⫽ important, 2 ⫽ essentially unimportant, 1 ⫽ completely unimportant. A score of 5 points could be assigned to only one characteristic, and scores of 1 to 4 could be used often as they wished. The choices we gave were as follows: A. a distinguished scientist, clinical/patient-oriented; B. a distinguished scientist, pure researcher, basic science; C. a clinician who has published and conducted clinical research; D. an administrator and a leader who knows how to exercise authority and supervise the staff; E. a physician who excels in personal and physician/patient relationships; F. an educator; G. an individual distinguished in public relations; H. a prestigious member of the profession; and I. other.
Results Fifty-nine of the 125 physicians who received our e-mail responded (response rate of 47.2%). Their responses are displayed in the Table.
Discussion Currently, a position in academic medical departments (including appointments for head of department) is awarded mostly, if not solely, on the basis of the scientific curriculum of the candidates and the number and size of grants they had received. Those who have spent most of their time and energy dissecting mice or operating sophisticated equipment in laboratories have a better chance of becoming new heads of academic departments than those who devoted their time to clinical practice, to treating patients and to teaching students. The responses of the present survey testify to the fact 0738-081X/03/$–see front matter doi:10.1016/S0738-081X(03)00017-8
Clinics in Dermatology
336 COMMENT AND CONTROVERSY
Table 1.
Question A C D E F H B G I
Responses Sorted by Descending Numbers of Points Total Number of Points
Number of Times Scored 5 Points
244 213 202 185 175 150 144 128 25
26 11 10 2 3 1 1 0 5
that the leaders in our discipline are at odds with this state of affairs. Most responders thought that the head of an academic department of dermatology should be a distinguished scientist, clinical/patient-oriented (answer A). The next important qualities our responders wanted for a chairman were a clinician who has published and conducted clinical research and an administrator and a leader who knows how to exercise authority and supervise the staff (answers C and D). Almost
Y
2003;21:335-6
all of them ranked a distinguished scientist, pure researcher, basic science in last place. Noteworthy, because we also allowed open-ended answers (ie, I ⫽ other) the responder had, for all intents and purposes, unlimited choices. Only 5 out of 59 responders (8.5%) took the opportunity to do so. It appears that most of the responders consider the most suitable individual for head of department to be an outstanding scientist, but one who is clinically oriented and who has published and conducted clinical research. They appear not to favor the brilliant researchers who spend their best years in the laboratory, producing high-quality papers and whose curricula vitae enhance their chances in the competition for prestigious positions, but who are ”outsiders“ when it comes to caring for patients in the clinical setting. The academic community should be encouraged to study this apparent dichotomy between the expressed preferences of the leadership group reported here and the current state. It may well be that the methods of ”choosing the new boss⬙ are outdated and even inimical to the advancement of our specialty.
Who’s the Boss? RONNI WOLF, MD LAWRENCE CHARLES PARISH, MD The very best instructor for students may have no conception of the higher lines of work in his branch, and contrariwise, how many brilliant investigators have been wretched teachers?“ [Sir William Osler, Teaching and Thinking, 1895, Reprinted in Aequanimitas, with Other Addresses to Medical Students, Nurses, and practitioners of Medicine, 3rd ed. Philadelphia: Blakiston’s Son; 1932 p. 128]. ”To discover and teach are distinct functions; they are also distinct gifts, and are not commonly found united in the same person.“ [John Henry, Cardinal Newman 18011890 on the Scope and Nature of University Education, Preface.
M
edicine, once considered an art, has become a multidisciplined science thanks to the enormous strides in knowledge and understanding that have been taken over the past century. Insights into the pathogenesis of diseases at a molecular level, developments of new therapeutic agents, discoveries of biologic and immunologic therapeutics that target cytokines and cells, dissemination of knowledge at the speed of light, technologic advances in sophisticated equipment and procedures —all these giant leaps in progress have made it unrealistic to expect that there are mortals who possess all the capabilities of being outstanding physicians, top-notch scientific researchers, men/women of superior intelligence, brilliant teachers, and first-class administrators. If there are no such superleaders among us, who, then, is best suited to lead an academic department of dermatology? We decided to collect the opinions of leading dermatologists to define the consensus opinion of who should be the boss.
Materials and Methods A short, closed (multiple choice) questionnaire was distributed through e-mail to leaders in dermatology. Included in the survey were the Editors, Assistant Editors, and Members of the Editorial Board of the Journal of the American Academy of Dermatology, the Board of From the Dermatology Unit, Kaplan Medical Center, Rechovot, Israel; and the Department of Dermatology and Cutaneous Biology, and the Jefferson Center for International Dermatology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania. Address correspondence to Ronni Wolf, MD, Dermatology Unit, Kaplan Medical Center, 76100 Rechovot, Israel. E-mail address: [email protected] © 2003 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010
Directors and Officers of the American Academy of Dermatology, the Editors, Assistant Editors, Members of the Editorial Board, Advisory Board and International Advisory Committee of the Archives of Dermatology, and the Editors and Editorial Board of Clinics in Dermatology. In all, we had a list of 160 physicians for potential inclusion in the survey. We could not reach 35 of them. The participants were asked to rate the importance of nine characteristics of an individual most suitable to be head of an academic department of dermatology on a 5-point scale: 5 ⫽ most important, 4 ⫽ very important, 3 ⫽ important, 2 ⫽ essentially unimportant, 1 ⫽ completely unimportant. A score of 5 points could be assigned to only one characteristic, and scores of 1 to 4 could be used often as they wished. The choices we gave were as follows: A. a distinguished scientist, clinical/patient-oriented; B. a distinguished scientist, pure researcher, basic science; C. a clinician who has published and conducted clinical research; D. an administrator and a leader who knows how to exercise authority and supervise the staff; E. a physician who excels in personal and physician/patient relationships; F. an educator; G. an individual distinguished in public relations; H. a prestigious member of the profession; and I. other.
Results Fifty-nine of the 125 physicians who received our e-mail responded (response rate of 47.2%). Their responses are displayed in the Table.
Discussion Currently, a position in academic medical departments (including appointments for head of department) is awarded mostly, if not solely, on the basis of the scientific curriculum of the candidates and the number and size of grants they had received. Those who have spent most of their time and energy dissecting mice or operating sophisticated equipment in laboratories have a better chance of becoming new heads of academic departments than those who devoted their time to clinical practice, to treating patients and to teaching students. The responses of the present survey testify to the fact 0738-081X/03/$–see front matter doi:10.1016/S0738-081X(03)00017-8
Clinics in Dermatology
336 COMMENT AND CONTROVERSY
Table 1.
Question A C D E F H B G I
Responses Sorted by Descending Numbers of Points Total Number of Points
Number of Times Scored 5 Points
244 213 202 185 175 150 144 128 25
26 11 10 2 3 1 1 0 5
that the leaders in our discipline are at odds with this state of affairs. Most responders thought that the head of an academic department of dermatology should be a distinguished scientist, clinical/patient-oriented (answer A). The next important qualities our responders wanted for a chairman were a clinician who has published and conducted clinical research and an administrator and a leader who knows how to exercise authority and supervise the staff (answers C and D). Almost
Y
2003;21:335-6
all of them ranked a distinguished scientist, pure researcher, basic science in last place. Noteworthy, because we also allowed open-ended answers (ie, I ⫽ other) the responder had, for all intents and purposes, unlimited choices. Only 5 out of 59 responders (8.5%) took the opportunity to do so. It appears that most of the responders consider the most suitable individual for head of department to be an outstanding scientist, but one who is clinically oriented and who has published and conducted clinical research. They appear not to favor the brilliant researchers who spend their best years in the laboratory, producing high-quality papers and whose curricula vitae enhance their chances in the competition for prestigious positions, but who are ”outsiders“ when it comes to caring for patients in the clinical setting. The academic community should be encouraged to study this apparent dichotomy between the expressed preferences of the leadership group reported here and the current state. It may well be that the methods of ”choosing the new boss⬙ are outdated and even inimical to the advancement of our specialty.