Evolving competencies for chairs of departments of family medicine.

Abstract

The rapidly changing environments of academic health centers (AHCs) are demanding adaptation to new roles for Chairs of Departments of Family Medicine (DFMs). Over a decade ago, the Association of American Medical Colleges identified 3 overarching areas of skills for Department Chairs: (1) managing conflict, (2) performance evaluation, and (3) managing diversity.1 Grigsby described the need for a “future-oriented” Chair with ability to shift the focus from personal to others’ success, to develop realistic business plans, to be resilient, and to be a team leader.2 In 2013 Kastor asserted that the job of the Chair of a Department is now something new: that of a change agent, with loss of autonomy over budgetary management, and with more business responsibilities than the traditional focus on academic advancement.3 In addition to the roles of promoting diversity, managing conflict, and performance evaluation, the skills of leadership and change management are increasingly important to Family Medicine Chairs. Largely subspecialty-based AHCs have not historically embraced substantial roles for primary care disciplines. Even the smaller, community-based medical schools have often not included the primary care departments in significant economic decisions related to medical practice. In recent years, however, with the movement from volume- to value-based health care, AHCs and smaller medical school practice plans are calling on family medicine to develop new primary care networks on which they need to survive economically in the new world of health care delivery. The leaders of DFMs, and in particular the Chairs, are being asked to lead significant change within environments that are often resistant to such change. The Association of Departments of Family Medicine (ADFM), witnessing substantial turnover in Chairs over the past few years, has identified the development of new chairs as a high strategic priority. As ADFM’s Leadership Development Committee began to consider key competencies for Chairs, it became apparent that a number of the competencies needed by Chairs are also competencies of successful senior leaders within DFMs, many of whom may someday find themselves in a chair role. Through an iterative process, whereby input on key competencies has been received from participants of various ADFM leadership development sessions, an evolving set of competencies for Chairs of DFMs has emerged. Four major areas of competencies have been defined: Leadership (eg, strategic planning, building a team, leading/managing change) Administrative/management (eg, finances, human relations) Personal development and management (eg, understanding your role, managing calendar, resiliency, and self-care) Managing external relationships (eg, understanding where the department fits into institutional culture, external entities) In planning a preconference for new chairs, senior leaders and ADFM fellows at the 2015 ADFM Annual meeting, registrants ranked Leadership as the competency area of highest need. Of the 8 specific competency areas under the heading of “Leadership,” the preconference participants identified 3 as most important for their development: (1) building and sustaining a leadership team (including working effectively with an administrator partner); (2) leading and managing change (including having a framework and tools around meeting design, delegation, and group decision-making); and (3) understanding and changing department culture (including legacy issues). As ADFM continues to explicate the evolving list of competencies for chairs, we will work closely with other partners, such as the Society of Teachers of Family Medicine (STFM) through the Leading Change Curriculum initiative. We will use our list of competencies to guide training development in our own ADFM Fellowship, in our work with ADFM member chairs and in working with senior leaders in DFMs. The ADFM Leadership Development committee is also tying key resources to the competencies and will be housing these resources on an open-access site so that all who are interested can view them. The current version of the competencies can be found at: http://adfm.org/Members/NewChairs. Change is calling those of us in academic family medicine to respond not only to departmental needs but to much broader system needs. Chairs of DFMs must be equipped to answer this call through leading at many institutional levels while leading their own faculty and departments through uncertain times. An important element of facing these challenges is understanding family medicine’s position of power and relevance within the larger environmental context. As challenged recently, Chairs of Family Medicine must find meaning in answer to a fundamental question: “Are we institutional leaders who happen to be family physicians, or are we family physicians who happen to work at academic health centers?”4