ASSESSING THE POSTION: WHAT I HAVE LEARNED True Confessions of an Itinerant Chair

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ASSESSING THE POSTION WHAT I HAVE LEARNEDTrue
Confessions of an Itinerant Chair

• Raymond C. Roy, Ph.D., M.D.
• Professor Chair of Anesthesiology
• Wake Forest University School of Medicine
• Winston-Salem, NC, USA
• rroy_at_wfubmc.edu

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PRE-CHAIR HISTORY
Years School Comments
66-71 Duke PhD (Inorganic Chemistry)
71-74 Tulane MD
75-78 Penn GME
78-92 WFU Instructor to Professor Chairs Tom Irving, Frank James
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PERSONAL BACKGROUND

• 1970 Father-in-law medical role model
• loved internal medicine, loved his job
• 1971 PhD lessons
• some problems take months to years to solve
• lab research ? clinical research ? clinical work
• 1978 1st time acknowledged goal
• when PGY2, told Visiting Professor Ted Eger
  aspired to chair academic anesthesia department
• surprised myself

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PERSONAL BACKGROUND

• 1980s magical experience as part of team
  building top 10 academic department
• critical mass of colleagues with high
  expectations
• all trained in programs with strong academic
  culture
• most recruited by unheralded Chair, Tom Irving
• 9 of us became academic chairs
• Butterworth, Gravlee, James, Johnston, McLesky,
  Prielipp, Prough, Roy, Stullken
• smooth succession Tom Irving to Frank James

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PERSONAL BACKGROUND

• 1987-92 Vice chair lessons
• no actually means not now or not as
  presented
• yes more likely if problem and solution(s)
  identified
• mission-based budgeting hoax
• academic costs (research, teaching, faculty
  development, administration) gt academic revenues
  (endowments, annual funds, Medicare, grants)
• culture critical department members must be
  willing to use clinical revenues to support
  academics and to accept lower salary in exchange
  for time resources
• desired salary ratio privateacademic lt 2

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CHAIR HISTORY
Place Time Starting age, yrs Faculty My grade of my chair performance
MUSC 92-96 48 20 B
UVA 96-98 52 30 C-
WFU 98-now 54 50 A-
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MUSC 1992-96

• Replaced liked chair of gt 20 yrs
• retired completely
• zeroed accounts with exit bonus to each
  partner
• Strong dean who was strong mentor
• Critical mass of faculty members with academic
  potential
• Weak package
• Salary department 100
• 2 chair training courses (AAMC, Harvard)

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MUSC 1992-96

• Cultivated surgery chair as ally
• Quickly addressed his OR concerns
• His star NIH-funded researcher mentored us
• Consultant for 360o appraisal in 2nd year
• Vice chair issues

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Dean as Mentor What I Now Expect from a Dean

• Clear goals markers of success
• Provided for non-clinical activities when
  reasonable plan submitted
• Accessible for one-on-one discussions
• explained ? negotiating with my own (i.e.,
  departmental) versus negotiating for new
• accurate assessments honest appraisals
• placing my stamp on MUSC anesthesia by staying
  vs. using MUSC as stepping stone
• 1992 promised wife I would apply for WFU Chair
  (return to Winston-Salem) if position available
  before I turned 55

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Why did I leave MUSC for UVA?

• MUSC departmental plateau
• academically almost as far along as I felt it
  could be with people and resources available
• my 4 yrs still the best 4 academic yrs in their
  history
• consolidating phase of grow, consolidate, grow
  cycle
• new chair had no immediate problems to address
• succession reasonable in-house candidates
• Personal issues
• needed more academics (UVA gt MUSC)
• thought Frank James would retire at WFU at age 65
  (not 62 when he did) when I would be 57

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UVA 1996-98

• Replaced respected feared chair of gt 20 yrs
• golden parachute gt 1 million (over several yrs)
• special office space
• Ineffective dean
• too interested in his own research, inaccessible,
  ignored clinical mission
• Excellent faculty
• Weak package
• Distinquished Chair gt 50 salary

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UVA 1996-98

• On my own for 1st time
• had not yet solved administrative structure
• not yet mature enough to self-mentor
• found maintaining strong department insufficient
  goal, i.e., needed to work toward something
• chronic pain clinic
• unsuccessful attempt to convert -losing classic
  model to entrepreneurial model
• energy sapping culture clash

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Why did I leave UVA for WFU?

• Promise to my wife in 1992
• despite promise, initially said no to WFU
• Equivalent academic culture
• UVA department reasonably stable
• no projects that required me to be there to
  finish
• succession excellent in-house candidates

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WFU 1998-2005

• Replaced respected chair
• Sabbatical ? GME Dean ? retired completely
• Good package
• AIMS, patient simulation lab, discretionary fund
• Salary 50 hospital, 50 dept
• Comfortable with WFU administrative structure
• more able to make decisions and act than at UVA
• stronger relationship with leaders than at UVA
• self-mentoring

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WFU STRONG ACADEMICS

• Top 5
• 1 of about 20 who claim to be top 5
• Goal 1 Anesthesia Teaching Residency
• Top 10 in publications
• gt 100/yr x 5 yrs
• 18th in NIH funding
• 2,306,080, MD (5) gt PhD (3)
• Medical students
• Mandatory 3rd yr week, elective 4th yr month
• 18/108 entered anesthesia in 05

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WFU STRONG ACADEMICS

• Strong Faculty
• ASA refresher course lecturers 7 (04), 6 (05)
• ABA 8 oral examiners 2 former directors
• New Editor of Anesthesiology (Eisenach)
• APSF Newsletter Editorial Office
• Active external and internal websites
• Outside OR clinical strengths
• One LD unit in area (7000 deliveries), PICU,
  adult ICU, TEE for residents, regional anesthesia
  acute pain, successful private practice chronic
  pain model, preoperative assessment center (70-80
  patients/day)

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Examples of Opportunities at WFU

• Faculty
• other chair hires vs. new hires, s,
  specialization
• Contracting
• 3rd party payers, practice plan, hospital
• Chronic pain clinic
• Successful privatization (strong resident
  rotation, strong fellowship)
• CRNA issues
• Hospital employs, helps residency (enables
  regional anesthesia rotation, decrease call
  burden, relief for conferences/breaks)

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Examples of Opportunities at WFU

• Regional combined with acute pain
• Sedation by non-anesthesiologists
• Pediatric (pediatric intensivists), ER,
  Endoscopy, cardiology, procedure rooms (CRNAs)
• trainees
• ?ing residents
• ?ing fellows
• Anesthesia Information Management System

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Examples of Opportunities at WFU

• Preoperative Assessment Clinic
• Quality practice improvement
• Pay for performance
• Practice improvement (MOCA)
• Evidence-based practice
• Faculty development
• Academic medical center administration
• Evidenced-based practice
• Simulation-based CME

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REASONS NOT TO SEEK ACADEMIC CHAIR

• Personal prestige
• faster track to full professor
• launch pad for personal projects
• Money
• Escape
• restlessness or disgruntlement
• working too hard
• tired of clinical work or call
• loss of confidence in clinical ability

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Personal Qualities that Make It Hard to Succeed
as Chair

• Inability to make tough decisions
• fear of criticism, bad publicity, being blamed
  for failure
• Act in untimely manner
• act too late because fear uncertainty or
  criticism
• act impulsively with too little planning or
  information
• Inability to confront people
• who are performing below standards, blocking
  efforts
• Inability to accept pace of change
• cannot accept current system while creating
  higher standard one

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Personal Qualities that Make It Hard to Succeed
as Chair

• Do not know when or what to compromise
• Easily depressed or discouraged
• require a lot of positive feedback
• Cannot accept interest hierarchy corporate gt
  department gt personal
• Jealous or arrogant
• take credit from rather than give credit to the
  people you appoint, fear competition
• Impatient, prone to anger, thin skinned

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EMOTIONAL INTELLIGENCE

• Sine qua non for leadership
• You can have 1st class training, incisive mind,
  endless supply of good ideas, but still not be
  good leader
• Self-awareness, self-regulation, motivation,
  empathy, social skill
• Understanding your own other peoples emotional
  makeup well enough to move people in direction of
  accomplishing departments institutions goals.

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REASONS TO SEEK ACADEMIC CHAIR

• Believe in the academic missions
• Enjoy being part of a winning team
• Like being involved in big projects
• Feel joy in enabling, facilitating, mentoring the
  success of others

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WHAT DO I THINK DEANS EXPECT?

• Corporate gt department view
• within limits
• Clear vision and plan for department
• within context of institutions strategic plan
  resources
• Problem solvers, not problem dumpers
• Collegiality, professionalism, energy enthusiasm

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How high do you or your faculty members climb the
C (See) ladder to help solve problems?

• Closer implements debriefs
• Constructer devises solution
• Cogitater clearly defines problem
• Coper Works around problem
• Criticizer defines what is wrong
• Complainer aware something not right

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SUGGESTIONS

• Recognize academics is chair with 4 legs
• clinical, teaching, research, administration
• poor administration can topple chair
• Most important job is recruiting high C people
  and delegating well
• double threats more likely than triple or
  quadruple
• Strive to make yourself non-essential
• create a department that functions well without
  you
• identify and mentor potential successors
• You could become disabled acutely

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SUGGESTIONS

• Expect to be judged on what your department and
  its members do
• not on what you do personally
• outside projects can be distractions
• be careful what you say yes to do
• Do not underestimate power of passive aggressive
  behavior
• need bottom-up buy-in for orders, projects
• youre not a leader if cannot convince anyone to
  follow you.

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SUGGESTIONS

• Strive for clarity
• in identifying and presenting problems and
  solutions
• Avoid bad-mouthing
• create a culture that will make it more
  difficult to address the reason in the future
• To speak ill of others is a dishonest way of
  praising ourselves. Will Durant
• Work with for people you like, respect, trust
• Do not make the job so important that youll do
  anything to get it or keep it

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Personal Notes

• When you become chair at a place where you were a
  faculty member, your relationship with former
  colleagues is no longer an equal one
• You might have to discipline or fire them
• At dinner, do not sit down first at a table.
  Wait and sit next to someone