The American Association of Chairs of Departments of Psychiatry (AACDP) includes all chairs of departments of psychiatry in U.S. and Canadian medical schools. One of the four major missions of this group is “strengthening its membership by enhancing the skills and effectiveness of its leaders.” As such, the group provides an orientation once a year to new, acting, or interim chairs, arranges a senior mentor for those new chairs who request one, and provides the novice chair with a Tool Kit for New Chairs, edited by Stuart Munro, M.D., and published by the AACDP in 2004 (1).

Attendees at the orientation session are informed of the various leadership conferences available through the American Association of Medical Colleges, the Harvard School of Public Health, and others. In addition, they are made aware of pertinent reference materials (2–6) that they might find useful in their everyday activities.

For the past several years, Stuart Munro, several other chairs, and I have chaired the orientation session for new chairs. In addition to various other presentations that are held within the allotted time, I have presented the group with what I call the “Ten Commandments for the Successful Chair,” although I always facetiously mention that they are not carved in stone. I will list each of these and comment briefly upon them.

In general, the longevity of a chair’s term in office is determined largely by his ability to keep his budget balanced and to maintain a modest reserve account. Thus, it is imperative that the new chair realizes very quickly whether this is, in fact, feasible. If not, then he or she must press for changes in the financial infrastructure of the institution in order to make it possible for the department of psychiatry to break even or accrue a small excess. In my experience, it is not wise to maintain a huge positive balance as this leaves one susceptible to budget cuts and/or the assignment of additional costs to one’s department.

Since most of us have not had extensive training in business, finance, or accounting, the budget challenge generally requires hiring an expert and, ultimately, trusted business manager. This individual should assist with business development, contract/grants management, and ensure that accounts get paid in a timely manner. Some departments are responsible for their own billing and collections; others are not. In either case, the business manager must keep careful watch on the accounts receivable and expenditures.

I personally feel it is always important to realize that the chair serves not only at the pleasure of the dean, but at the pleasure of the faculty of the department. Though this does not mean that you are engaged in a popularity contest, it does mean that you should see service and faculty development as a major part of your mission. Key elements to consider here are ways to develop your junior faculty and provide them with mentorship and guidance as they begin their academic careers. Furthermore, one often has the challenging task of attempting to reenergize those individuals who have “burned out” somewhere along the line. Last but not least, each and every faculty member needs his or her accomplishments acknowledged. There needs to be a reward system in place within the department which includes clear standards for promotion. Furthermore, the department chair must market the department, its many programs, as well as individual faculty members.

The successful department chair learns to select key individuals for his leadership team, delegate authority to these individuals with appropriate timelines, and then let them do their work. Most capable individuals detest having their work micromanaged, yet may need to be asked to report periodically on their progress.

The chair of the department should set the vision for the next 5 years, putting it into a realistic strategic plan, and then ensure its implementation. While there are certain situations which require hands-on management, the chair needs to reserve plenty of time to allow this leadership function to evolve.

Since the chair can get totally focused on finances at times, it is important to remind yourself and your faculty of the key missions of the medical school: teaching, training, research, and clinical service. Life in the academic medical center can and does provide multiple distractions, so it is important for the chair to reiterate the mission and refocus the faculty on the tasks at hand.

Though the chair certainly should be serving his or her faculty and department, it is just as important that some time be reserved for one’s own projects. This might include maintaining a research laboratory or developing new skills. The latter might include taking additional courses in leadership, organizational behavior, or business, but might also include learning more about some of the new subspecialties of psychiatry that you have not necessarily had time to explore.

Note that it is most important for the chair and key members of the department of psychiatry to be involved in a number of important committees, not just with the school of medicine, but with the affiliate hospitals as well. Furthermore, it might be most beneficial for members of the department to be involved in local groups, such as the National Alliance on Mental Illness (NAMI), the local mental health association, family services, or child welfare agencies.

One must have an adequate number of staff trained to serve the faculty to whom they are assigned. A variety of skills are necessary in the modern department of psychiatry, and one should endeavor to have all of these bases covered.

Though it is not necessary to have large numbers of committees within the department, it is important to have key committees to help ensure that there are good lines of communication and a clear set of expectations regarding various responsibilities. The department chair should make sure that each committee has a clearly defined charge and is given appropriate deadlines for particular projects.

The demands on the modern-day department of psychiatry have increased dramatically over the past 5 to 10 years. In addition to the financial pressures created by managed care, the demands of the new medical school curriculum which utilizes small group teaching (and thus is more dependent upon faculty time) have increased the demands upon departments of psychiatry. However, most of our departments have relatively large numbers of volunteer faculty members who have expressed their interest and desire to be active participants in our teaching programs and often jump at the opportunity to do so. Though it may take some clear-cut orientation and retraining for some of the individuals, they are nevertheless a key source of manpower which can be effectively utilized.

Another imperative for the modern-day chairman of the department of psychiatry is to be able to network effectively within the school of medicine, health sciences center, university, community, region, nation, etc. This includes, of course, the communication of the department’s mission and values, but it also includes the communication of expectations to one’s volunteer faculty, alumni, faculty, residents, staff, and superiors. A number of departments have newsletters that are circulated internally, while others send newsletters to their alumni and/or to various others in the field. This can be an effective way of keeping people informed of the positive developments within your department and can effectively help expand the department’s reputation. Other means of accomplishing this can be through the use of continuing medical education programs. This allows you to select topics that put the strengths of your department in the limelight and allows you to showcase the “stars” within your department. Not only will those in attendance at your program be positively affected by this activity, but those who have received brochures announcing your program, and have taken the time to read them, will be similarly impressed. Again, this is a great way to network and to market various programs and individuals within your department.

Sooner or later, as a department chair you will be asked to assist with the development activities of the university. Various sources of funding can be identified. These often will include alumni, grateful patients, foundations, as well as other avenues of support. Endowed accounts can fund professorships or chairs which buy protected time for people to do research or to teach, while endowed lectureships provide wonderful opportunities to bring guest speakers to your department to supplement your educational activities.

Last but certainly not least, it is important for the chair to wear the hat of social coordinator from time to time. It is useful to have social functions in order to mark the usual occasions of the academic calendar. Thus, a welcoming party for new residents and trainees in late June or early July is often part of the routine. In addition, many departments will host some sort of holiday reception in mid to late December and then have some sort of graduation ceremony in late May or early June for those residents, fellows, and other trainees moving on after completing their training. When executed properly, these sorts of activities can really help gel the department socially as well as boost morale. In addition, it gives you the opportunity to invite various dignitaries from the medical school, affiliated hospitals, state office of mental health, or other such institutions to your functions. It is also important to include your volunteer faculty, especially those who have been active in your teaching or research programs.

In summary, these “commandments” are meant as useful guidelines for the novice chair and, of course, must be applied to one’s local situation. Over the years they have had some utility for those who have attended our AACDP orientation sessions. In fact, they have continued to serve me well in my chairmanship over the past 20 years.