Academic Chairmen Research Articles

Level-I Orthopaedic Trauma Care: A Model for Longevity

Affiliation with a level-I trauma center imposes a heavy burden on any orthopaedic practice. This burden is manifested in the required trauma call; the issues centered on providing appropriate, timely care for trauma patients; and, finally, in the financial disincentive to providing trauma care1,2. These issues are expanded in terms of the required commitments to achieve success, including institutional support, support from the academic department chairman, and dedication from all members of the orthopaedic practice2-5. Although certainly not unique, the system developed at our medical center has demonstrated efficient, high-level care for patients with musculoskeletal injury. It has improved our ability to generate revenue for the department, and it has prevented “burnout” or turnover of the musculoskeletal traumatologists. We describe this model as an example of a system that has worked well in a level-I academic trauma center. Elaboration on the difficulties associated with level-I trauma care is required to fully appreciate the success of our program. Required trauma call places considerable demands on individual orthopaedic surgeons. Trauma and injury occur throughout the day with no respect for work, family, or sleep schedules. Often the injuries require immediate evaluation and prompt surgical intervention. In light of a busy practice, the disruption caused by the need to provide immediate trauma care can result in the cancellation of elective surgeries or office visits. It can further disrupt already compromised family time. Off-hours care may drain the physician for the next day, as well as potentially compromise the outcome for the patient6,7. Finally, patients with nonemergent conditions who move to the “add-on” schedule the following day further extend the time commitment for trauma call and the frustration related to trauma care. To expand on these issues, the effect of trauma care …

Personal observations on the cultural evolution in academic surgery

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.

Vascular Centers: Perspective of an Academic Chairman

Vascular Centers: Perspective of an Academic Chairman

Message from the Academic IPC Chairman

Message from the Academic IPC Chairman

The Changing Role and Responsibilities of a Chairman—Letters

To the Editor.— Dr Brent's article on academic chairmen (Pediatrics. 1992;90:50-57) was terrific—insightful, helpful, and much needed. If I may be so bold as to add one further insight and suggestion: When chairmen of academic departments are selected, invariably it seems to be done by the "weight of the c.v." approach. An outstanding researcher does not necessarily make an outstanding chairman. (In fact, one could argue that there are skills needed for bench or clinical research that are antithetical to those needed to chair an academic department.)

A characterization of the imminent leadership transition in academic family medicine

Of the 106 identified chairmen of academic departments, divisions, or sections of family medicine in the United States in 1990, 97 (92%) responded to a survey designed to characterize the current chairmen of family medicine and estimate requirements for future chairmen. Even though 43% had occupied the chair for less than five years, over half, not limited to older chairmen, intended to leave within five years. Reasons for leaving varied, including being required to leave, career choice, personal reasons, and especially dissatisfaction with the job. Only half of current chairmen identified one or more qualified applicants for chairmanship within their own departments. The formal training and experience of these potential chairmen strongly resembled the training and experience of current chairmen, especially the fact that they had little training or experience in research. In the 1990s, the demand for academic chairmen of family medicine is likely to be large, the competition for capable candidates keen, and the challenges great for new chairmen, who will probably be young, residency-trained family physicians with relatively limited academic experience.

The Southern Surgical Association: The First 100 Years 1887-1987

Mark Ravitch wrote the ultimate review of a surgical organization with his monumental two-volume A Century of Surgery 1880-1980 , the history of the American Surgical Now Bob Sparkman and associates have nearly equaled it with the 1989 publication of their one-volume, 533-page story of the Southern Surgical Association (SSA). book begins with a well-researched, detailed chapter on the origin and early development of the SSA by the centennial year president, John L. Sawyers. He points out that from the very beginning in Birmingham, Ala, founder W E. B. Davis invited men of great eminence from the entire country to join the Association. This tradition has continued. Today, about one fourth of the membership resides outside of the South. These recognized surgical leaders, who number among them many academic chairmen, contribute greatly to the enduring strength of The Southern. custom still prevails of holding the annual meeting at

Undergraduate medical education in obstetrics and gynaecology in the USA and Canada, 1985

Many factors have led to a movement from the emphasis of the 1960s and 1970s on departmental expansion towards an emphasis on cost-effective undergraduate medical education emphasizing the 'art' as well as the 'science' of medicine. In January 1985 a questionnaire was sent under the auspices of the Undergraduate Education Committee of the Association of Professors of Obstetrics and Gynecology to all chairmen of departments of obstetrics and gynecology in the USA and Canada seeking their opinions about these trends and information about the educational programmes in their departments. The information from this study indicates that the chairmen are aware of and responding to this new direction in medical education. A stabilization of teaching staff and clerkship sizes and the emphasis on clinical as well as cognitive evaluation, despite recognition of the cost of the former, shows active interventions towards these ends. An emphasis on education in 'basic' as compared to 'subspecialty' areas which is independent of the subspecialty of the academic chairman also supports this trend.

Response and critique

This paper is being published when there is concerned discussion about the relationship of psychiatry to the community mental health movement. The number of psychiatrists in CMHCs has dropped considerably. Some would say that the CMHCs are pushing psychiatrists out while others would point the finger in the opposite direction, suggesting that psychiatrists are abandoning the CMHCs. In any case, the matter is important enough for the American Psychiatric Association and the National Council of Community Mental Health Centers to be planning a national meeting on the topic. If psychiatrists continue to diminish in numbers in CMHCs or if they are only to be part-time prescription signers, there is little point in trying to train more of them for such careers. If they are to have more significant involvement, it is essential to explore the relationships between academic programs and CMHCs. The concerns on each side reflect more than suspicion by the CMHCs that the academic programs will rip them off and by the academic chairmen that the resident will be used for service instead of being educated. The problems reflect the current criticisms of the CMHCs, namely that they have changed from the original health services model to a social activist model, that they have adopted anti-medical attitudes relegating psychiatrists to signing prescriptions or insurance forms, and that they have given undue emphasis to unproven prevention programs while neglecting the seriously mentally ill. Such criticisms are of intense concern to those of us who early identified the CMHC as the basic delivery system for the public sector and who have advocated a model of community mental health as developed in the mid 1960's. To have a successful relationship between an academic program and a CMHC there must be an underlying assumption that the CMHC movement will continue (hopefully more like the original than the present model) and that it will involve psychiatrists in appropriate numbers and professionally meaningful roles. If so, all psychiatrists ought to get a significant clinical experience in such a center. The issue is not one of "control"--academic departments have long been placing students in clinical settings which they don't control. A basic issue in the relationship is that the CMHC must recognize that the reason for a student being assigned to any clinical setting is to learn--not just to give service. Whether the

An Academic Chairman Looks at Governance

(1972). An Academic Chairman Looks at Governance. Change: The Magazine of Higher Learning: Vol. 4, No. 7, pp. 24-29.