hat qualities and skills are essential to leaders? The most highly regarded authors on leadership put on the top of the list the skills of listening, communicating, managing tensions, developing and enabling others, using feedback and introspection, and taking risks (2—4). A recent study of the major leadership challenges confronting U.S. medical school deans found that they considered open, candid communication to be the most effective means of addressing their most complex problems (5).

Because of a combination of training and temperament, psychiatrists, compared with all other physician specialists, might particularly excel in these skills. Yet they are not overrepresented in academic medicine’s leadership. How might psychiatrists better parlay these particular strengths to play a more exemplary role? This article frames this challenge and offers a number of strategies.

For academic medicine in general and psychiatry as well, the need for strong leaders has never been clearer. Academic health centers must navigate in the face of a great deal of turmoil, competition, and uncertainty regarding funding sources and shifting priorities. Moreover, the complexities of each of the missions—basic, clinical, translational research, clinical excellence, and several levels of medical education—keep compounding. Not only do department chairs and deans require leadership skills, all physicians have increasingly challenging staff and financial management responsibilities. The public expects physicians to be leaders, especially those working in teaching hospitals.

Given that they are the role models for the next generation and those with the greatest opportunities for influence within their communities, it makes sense to focus particularly on the skills of full-time faculty. Since faculty clearly do not arrive with all of the leadership and professional development skills they will require, medical schools ought to offer them the full range of supports, especially given rising demands on faculty to generate revenues, accelerating competition for grant funding, and the explosions in biomedical knowledge which educators must master (6).

Yet, in contrast to corporate investment in their employees, no academic health center currently has a comprehensive faculty development system (7). Most schools offer some faculty development services and some chairs have implemented their own structures, but too often faculty are left to their own devices with regard to career management and acquiring new skills. Some obtain effective mentoring, but large percentages do not (8).

Another argument for more substantial and centralized faculty development resources is that, with faculty appointments increasingly resembling independent practice in terms of clinical load, these appointments are becoming less attractive to physicians, however much they may prefer an intellectually challenging environment. Over the course of their training, residents are exhibiting diminishing interest in joining the academic life (9). The widening income gap between independent practice and medical school salaries in most specialties may be a factor in that today’s medical school graduates have both higher debt and greater preferences for more free time than did their predecessors (10).

Young persons now can anticipate five or more decades of active professional life. Taking a longer view of their options and health, the younger generations seek a balance between work and life, but they see few examples of this among faculty. Messages that physicians must be "married to medicine" remain prevalent, that is, never needing extended or even episodic time away, especially during their twenties and thirties. The continuing tyranny of the assumption that total immersion is necessary, that it is "either career or family," interferes with creative exploration of less-than-full-time alternatives. With the rising proportion of women entering the profession, medicine will continue to lose access to an enormous quantity of talent if the traditional full-time model remains the only path to leadership roles.

Another concerning indicator that academic health centers must pay more attention to the supply of faculty and their qualifications as role models comes from a well-designed study of faculty at four U.S. medical schools (11). It found that 20% had significant levels of depressive symptoms, with even higher levels in younger faculty. The greater the faculty’s perception of financial instability at their institution, the greater the levels of work strain, depression, and anxiety reported. Over 20% reported thinking often of early retirement. Even if they do not retire early, Baby Boomer faculty are graying and will soon begin retiring. With many schools under pressure to expand class sizes, will there be a sufficient supply of faculty, especially of those who are academically productive and whom students view as excellent role models?

Academic health centers’ lack of attention to human resources is not only shortsighted, it is expensive. The costs of faculty turnover have been estimated to be 5% of academic health center budgets (not including costs of lost opportunity, lost referrals, overload on other faculty, and reduced productivity and morale). Another study found that the costs of recruiting and training faculty are over 1.5 times the first year’s salary (12). Since individual faculty success, as measured by productivity and retention, is key to organizational success, now, more than ever, protecting this investment makes financial sense.

Leadership and faculty development depend on creating a supportive ecology that enables individuals to reach their professional potential. What can psychiatry do to more actively nurture leadership skills in its practitioners and trainees? And how can psychiatrists capitalize on their talents to steer improvements that would benefit academic medicine in general?

Certainly there are no quick fixes or shortcuts that will "grow" more leaders; a long-term perspective is necessary in this work. Promising avenues include the following:

With leadership challenges accelerating, it is risky to assume that the "cream" will continue to "rise to the top" ready and skilled for tomorrow’s demanding leadership roles. If psychiatry does not act to ensure the vitality of its leadership pipeline, it risks not attracting and retaining the requisite talent to continue to advance in education, research, and patient care. Moreover, psychiatrists are uniquely suited to lead improvements at their academic health centers that will enhance faculty and leadership development across the board.

In addition to improving faculty development programs at the medical school level, strategies to more proactively develop leadership talent include: flexible career options so that young physicians do not have to choose between an academic career and their family responsibilities; peer and collaborative group mentoring among junior faculty and trainees; supportive coaching of senior faculty to more effectively mentor "across differences"; career development seminars targeted at residents; succession planning; and internal leadership development programs.