Personal observations on the cultural evolution in academic surgery

Abstract

Background: The changing environment in academic medical centers has had a major effect on the recruitment and the demographic characteristics of leadership positions in academic surgery. Categorization of “cultures” from the business model has been extrapolated into the academic surgical model. Methods: The types of cultures in organizations according to Cameron and Quinnn at a school of management can be classified into four: clan culture, adhocracy culture, hierarchy, and market-driven culture. In addition, academic surgical chairmen were surveyed in 1981 and also 20 years later, 2001, by the author. This was done in an effort to determine whether there is a difference in the type of person being attracted to such positions and if there is demographic difference in academic chairmen over the two decades. Results: The organizational profile of academic departments in 1980 is perceived to be more clan and adhocracy in type and less hierarchical and market driven. That has reversed itself dramatically two decades later with much of the energy of a department and structure based on hierarchy and the market. Also, in terms of the chairman, the mean age at the time of appointment in 1981 was 44 years and the mean age at time of appointment in 2001 was 49 years. In 1981 the years in grade was 9.4 years and in 201 it is 7.1 years. The new chairman is now older and will not serve as long as his/her predecessor. Conclusions: There clearly has been a cultural evolution in academic surgery over the past two decades. The chairman has different priorities than chairmen 20 years ago. The success of an academic department will depend upon the adaptation to this cultural evolution and the understanding of the chairman as to what the job really is.