“No guru, no method, no teacher.” (1)
Many new chairs don’t have experience leading an academic department. They may have been leaders in the clinical, educational, or research components of a department, but generally not all three. If they have, it is unlikely that they also have been responsible for managing an entire departmental budget, reporting to the dean, and shaping the department’s relationship with the medical school and the community at large. The role is complex and challenging, but can be made less daunting through access to helpful information and resources, and the counsel of current and previous chairs.
Most medical specialties have an association of academic chairs that, more or less, resembles psychiatry’s association of academic chairs. The web site of the American Association of Medical Colleges (AAMC) lists eight member organizations in the Council of Academic Societies that are identified specifically as societies or associations of chairs of clinical departments (anesthesiology, emergency medicine, family medicine, obstetrics and gynecology, pediatrics, psychiatry, radiology, and surgery). These and other chair groups tend to meet in conjunction with larger gatherings within the specialty, such as the annual meeting of the American Psychiatric Association (APA) or meetings of organizations that represent the field of medicine at large. Examples of the latter include the annual meetings of the American Medical Association (AMA) and the AAMC.
All eight of the previously cited chair groups offer orientation sessions to newly appointed, acting, and interim chairs. In some cases, the organizations supplement the orientation sessions with a document. Several years ago, the American Association of Chairs of Departments of Psychiatry (AACDP) identified the need for a manual or “tool kit” designed to help a new chair get started. The creation of such a document was wishfully discussed over the course of several biennial meetings. Finally, in 2003, then President Joel Silverman (Virginia Commonwealth University) tasked a group with the responsibility for generating the product.
The group soon realized that AACDP had been outpaced by a close relative, the American Association of Directors of Psychiatric Residency Training (AADPRT). In 2003, AADPRT members Timothy Mueller, Mary McCarthy, and Bruce Levy, along with Executive Administrator, Lucille Meinsler, produced an excellent orientation manual for new members in their organization (2). This document served as a good model as the AACDP Tool Kit was developed. Similarities in format and component parts will be discernable to the keen observer. Summaries of the various sections of the AACDP Tool Kit are presented below.
John Racy, the venerable psychiatric educator at the University of Arizona, has said that while all animals have a past, only humans have a history (3). Kenneth Altshuler (University of Texas, Southwestern Medical Center), who served as president of AACDP from 1990 to 1991, contributed the Tool Kit’s section on the history of the organization. He writes that, until the mid-1960s the organization was essentially an eating club. Mickey Stunkard (University of Pennsylvania) drafted the first constitution in 1965. The first dues were established in 1967 at $25 per year.
James Joyce describes the experience of remembering figures from our past in his short story, “The Dead,” from his Dubliners collection (4). “One by one” writes Joyce, “they were all becoming shades.” The experience of reviewing the early succession of presidents of AACDP is akin to visiting a sports Hall of Fame shrine through a black and white documentary film. John Romano (Rochester) became the organization’s first president in 1963. He was succeeded, in order, over the next 3 years by Larry Kolb (Columbia), Mickey Stunkard, and Ray Waggoner (University of Michigan). Of the 38 presidents, nine (Kolb, Waggoner, Ewald Busse, Daniel Freedman, John Talbott, Paul Fink, Herb Pardes, Jerry Wiener, and Allan Tasman) also have served as president of the American Psychiatric Association (APA). Four schools (Columbia, Dartmouth, Michigan, and Texas Southwestern) have been represented more than once, with Dartmouth having three in the group. The organization has yet to elect a woman as president, despite the fact that five of the previous 21 APA presidents have been women.
AACDP members identified the following list of responsibilities of a department chair. While the list is not in order of significance, the first item, managing departmental finances, was at the top of almost every chair’s list:
AACDP members also identified a number of key issues facing a department chair. They are as follows:
AACDP has for many years encouraged new chairs to select a senior colleague to provide mentorship, advice and guidance. The suggestion was made that both the mentor and the new chair take the opportunity during the first 12 to 18 months to visit each other’s departments and to hold informal conversations via phone or e-mail as often as necessary. During his presidency (2000 to 2002), Dan Winstead (Tulane University) developed a list of chairs willing to serve as mentors to chairs that are new to the role. Thus, a new chair can select from a list of potential mentors, perhaps choosing on the basis of similar characteristics (size, setting, research versus clinical focus). Informal feedback regarding the program has been positive.
In 2001, a fellow organization known as the Administrators in Academic Psychiatry (AAP) collaborated with AACDP to survey departments of psychiatry around the country regarding their finances and business plans (5). Radmila Bogdanich (administrator, Southern Illinois University) served as the project coordinator. While only 51 of 125 departments responded, the results are of some value in comparing one’s home institution to similar and different departmental business plans around the nation. Still, the low response rate has prompted the AACDP and AAP to consider a second round of surveying in the near future. The two organizations frequently meet jointly for a component of their fall meetings.
Of the schools that responded, 71% identified themselves as public and 29% as private. Of course, the funding mosaic is more complicated than this. In fact, a wide variety of sources of support for base salaries of faculty members were identified. Of the departments that responded to the survey, 72% identified a faculty practice plan, 72% grants and contracts other than state, 64% hospital contracts, 62% university support, 52% state grants and contracts, 36% endowments and gifts, 30% “other,” and 28% Veterans Administration.
Outpatient clinical services were the activity most likely to be identified as making a profit (29% of respondents), followed by clinical trials, continuing education, and other research grants. Within the domain of profitable outpatient services, the most frequently identified profitable component was court testimony, followed in order by adult, child, geriatric, “other,” and developmental disabilities. While the average number of full-time equivalent compensated faculty across all responding departments was 43 (ranging from 5 to 200), departments reporting profitable outpatient services averaged only 28 full-time equivalent faculty members (ranging from 4 to 70).
Of the practice plans reported on, 100% involved participation by psychiatrists, 93% by psychologists, 46% by “mid-level providers,” and 13% by nurse practitioners. An annual limitation is placed on a participant’s total compensation by 43% of the programs with a faculty practice plan. On average, 71% of a faculty member’s total compensation is comprised of base salary (ranging from 2 to 100). Only 14% of reporting departments provide incentives for teaching based on a quantitative system (number of teaching hours, or trainees). By contrast, 70% of departments provide disincentives for faculty who are unwilling or unable to achieve their revenue targets. Also, 53% of reporting departments use forms of compensation other than base and incentive salary (e.g., discretionary funds, travel support) to reward faculty.
A listing of other resources described in the tool kit is provided in Appendix 1.
Creation of a document, such as this tool kit, binds together in a single package a set of information that other chairs have found helpful as they assumed leadership responsibilities for a department of psychiatry. The manual can be used to supplement orientation sessions at AACDP meetings, and can be given to new chairs who are unable to attend these sessions. However, certain limitations must be recognized. The document ages quickly and requires frequent updating to maintain integrity. Also, some of the critical moments of chairmanship, such as negotiation of salary and duties with the dean, may have passed already by the time the document makes its way into the hands of the new chair. Still, a tool kit that is limited and sometimes late may be better than no tool kit at all.