Table of Contents:

Academic Physician & Scientist: Aligning Faculty for Improved Organizational Performance: Tools We Can Use to Effectively Head Cats (November 2006)…..…………………………………………………………………………………………… By: David J. Bachrach, FACMPE/FACHE Annual Performance Evaluations with a Positive Twist (September 2008).……………………………… By: Judith Kapustin Katz, EdD, Roberta E. Sonnino, MD, and Page S. Morahan, PhD Are You a Future-Oriented Faculty Member? (June/July 2009)...................................................... By: R. Kevin Grigsby, DSW, Wiley W. Souba, MD, ScD, MBA, and David Hefner, MPA Are You Really a Team Player? (July/August 2006)......................................................................... By: R. Kevin Grigsby, DSW Committee, Task Force, Team: What’s the Difference? Why Does It Matter? (January 2008)....... By: R. Kevin Grigsby, DSW Find a Functional Mentor (January 2009)……………………………………………………………………………. By: Luanne E. Thorndyke, MD, Maryellen E. Gusic, MD, and Robert J. Milner, PhD Five Potential Pitfalls for Junior Faculty at Academic Health Centers (May 2004)……………………. By: R. Kevin Grigsby, DSW Five Ways to Fail as a New Leader in Academic Medicine (January 2010)……………………………….. By: R. Kevin Grigsby, DSW Investing in a Postdoc for Your Lab (June 2008)……………………………………………………………......... By: R. Kevin Grigsby Managing Organizational Pain in Academic Health Centers (January 2006)……………………………. By: R. Kevin Grigsby, DSW Retain or Replace: The True Costs of Unintended Faculty Departures and How to Minimize Them (March 2005)…………………………………………………………………………………………………………. By: DavidJ. Bachrach, FACMPE/FACHE Strategies for Successful Faculty Retention (September 2005)…………..……………………………………. By: Deborah C.K. Wenger The Deadly Trap of Gossip: A Pitfall for Junior Faculty (January 2007)………………………………….. By: R. Kevin Grigsby, DSW The Fine Art of Apology: When, Why, and How to Say ‘I’m Sorry’ (June 2007)…..……………………. By: R. Kevin Grigsby, DSW The Need for Succession Planning (April 2005)…………………………………………………………………… By: Luanne Thorndyke, MD, and R. Kevin Grigsby, DSW

What Is Team Coaching, and Why Use Co-Coaches? (March 2009)….............................................. By: Judith Kapustin Katz, EdD, Sally Rosen, MD, MFS, and Page Morahan, PhD You’ve Been Offered The Chair...But Do You Know Enough to Take It? (November/December 2008)………………………………………………………………………………………………………………………………… By: David J Bachrach, FACMPE/FACHE

Creating order, direction, andprogress in academic medicalcenters (AMCs) has often been

likened to the process of “herdingcats”—cats being highly independentand disinclined to take direction or becompliant. That being said, deans,chairs, and hospital leaders have no choicebut to harness the incredible power of theirfaculty in order to move their organizationsforward. But how does one do so when tra-ditional methods (often those used in thecorporate world) seem not to work? Thereis a way, but it takes structure and disci-pline—and the adoption of tools that makethis possible.

Leadership of AMCs and their compo-nents requires copious amounts of hardwork. Effective leaders are successfulbecause they have developed an under-standing of, and a facility in the use of, thosetools that make this difficult work possible.

This article will describe a package oftools that the leaders of AMCs and their fac-ulty can use to achieve success in the pur-suit of the organization’s mission and therealization of its vision. When properlyapplied, these tools will allow their organi-zations to thrive, not merely survive—andwill likely reduce the burnout rate for deansand hospital CEOs.

First, It’s About the PeopleJim Collins, in his book, Good to Great,1

offers several constructs that distinguishgreat institutions from lesser ones. First andforemost is that great organizations select

the right people to be “on the bus,” in theright seats and roles, and they get thewrong people off the bus because theycan be toxic and undermine the efforts ofothers. Collins goes on to offer otherimportant elements, such as the“Hedgehog Concept” (focus on what you

are passionate about; do that better thenanyone else, and be sure that it also drivesyour economic/resource engine); and the“Flywheel Concept” (have discipline in allyou do—disciplined thought, disciplinedpeople, and disciplined action; continue tobuild mass and momentum in pursuit ofthat “breakthrough moment” when theorganization ‘takes off’).

Challenges When LeadingProfessionals

Medical education trains physicians to beindependent thinkers, take initiative andminimize risk, and often to look for “perfect”outcomes (it does not value mistakes). Incontrast, an organization’s success requirescollaboration and timely decision makingwith less than perfect information, andallows for midcourse corrections or even theabandonment of a project that appears not tobe achieving desired outcomes.

Tools for Aligning Faculty and Improving Organization

Effectiveness Medical schools often fail to put in place thestructures and mechanisms that make itpossible, even relatively easy, to achieve fac-ulty performance consistent with organiza-tion objectives. Some attempt to get the jobdone with partial processes, frequentlypoorly timed, that are often awkwardly andinconsistently implemented. There are alter-natives. Here is one model that has all of theelements for success (see Figure 1).

Part 1: Creating a Culture of Effectiveness

The successful organization embraces the

4 Academic Physician & Scientist ■ November/December 2006

Aligning Faculty for Improved Organization Performance:

Tools We Can Use to Effectively Herd Cats B Y D AV I D J . B A C H R A C H , F A C M P E / F A C H E

C A R E E RWatch

David J. Bachrach has more than 34 years of expe-rience in academic medicine administration and

provides leadership coaching to physicians in academicmedical centers and teaching hospitals. He may bereached at (303) 497-0844 or www.PhysXCoach.com.

Figure 1. Tools for Aligning Faculty.

Academic Physician & Scientist ■ November/December 2006 5

concept of community: an assembly of peo-ple bound together by a common mission,vision, and values. All faculty know andembrace why we exist, where we are going,and the rules by which we travel. This is com-municated to candidates for positions, aswell as reinforced on a regular basis with allmembers of the community. We don’t invitepeople to join our community if they cannotcommit to such principles—and we invitethose within the community to leave if theycannot adhere to these principles.

We clearly define and effectively com-municate the organization’s mission, vision,and values. We openly discuss examples ofgood—and bad—behaviors. Each has itsconsequences. We always do the right thing;we take the “high road”; and we acknowl-edge good deeds and accomplishments.

When recruiting, we vet candidates forknowledge and skill, and we embrace andpursue diversity, but we also consider a can-didate’s “fit” within our community. Wedon’t invite people into the community whowill not share our values.2 There are timelyand definitive consequences for transgress-ing these principles; we do not tolerate suchbehaviors, and people understand that.

Faculty know what’s expected of them.They have a well-developed positiondescription that describes these expecta-tions. There is a linkage to the organization’sstrategic plan—faculty know their role rela-tive to the strategic objectives and can tietheir activities back to those that have beendetermined to be important to the successof the institution.

Recently recruited faculty can turn to awell-thought-out offer letter that unambigu-ously states expectations (and includesmany of the documents referenced here) ofthe individual during his or her initialyear(s). There are clear goals—measurableand reportable expectations for rolling 12-to 18-month periods.

These faculty have a clearly defined rolewithin the organization: their duties, respon-sibilities. and deliverables are expressed inrelationship to those around them (organiza-tion chart). They know how and by whatmeans those above and around them expectto be communicated with, and how often(personal statement).

They know the consequences of theirperformance: the awards, rewards, and like-ly consequences should outcomes not mea-

sure up to expectations. They are givenaccess to resources that are sufficient forthem to achieve what is expected of them.These are in the form of a well-articulatedand clearly funded start-up package, as wellas ongoing resources sufficient to sustain theacademic and clinical service expectationsto which they will be held. There is a well-defined and easily accessed mechanism foradjusting resources based upon a changingenvironment and arising opportunities.

Part 2: Introducing Faculty andKey Staff to the Culture

The organization has a robust orientationprogram that transcends the usual introduc-tion to the faculty handbook and sign-up forbenefits. It continues throughout the initial90 to 120 days and involves not just didac-tic presentations but also dialogue with thosewho will be resources to the new facultythroughout the duration of their time at theinstitution. At the end of the process, newfaculty know how to navigate the systemusing well-developed information sourcingtools and know whom to go to for answers.

There is a well-reasoned and monitoredmentoring program. All faculty are expectedto be both mentors and mentees—provid-ing support to those who can benefit fromtheir wisdom, knowledge and experience,and receiving guidance from those who canoffer such support to them. Healthy com-munities maintain an environment that fos-ters mentorship from all who will benefit.

Not only does such a process accelerateknowledge acquisition and skill develop-ment, but it also fosters the bonds that giveorganization strength and resilience to workeffectively during challenging times.

Part 3: Evaluation and FeedbackIt is difficult to motivate faculty without stan-dardized measures of performance.Identifying metrics that measure meaningfulfactors is a critical element in the process.Measurements over time and comparing tobenchmark standards of best-performingpeers are two ways to look at data. Facultythus know the criteria by which their perfor-mance will be measured and the time framewithin which deliverables are expected.

There are instruments to measure perfor-mance on a real time or near-real time basis.Critical success factors are presented as a“dashboard,” a tool that provides measur-able and reportable data to those who canact on this information in a timely fashion toaffect outcomes.3

Part 4: Awards and Rewards We acknowledge successes with recognitionand rewards. We celebrate our colleagues’successes. We provide certificates andplaques. We publicly fete them, and whilesome may suggest that it is crude and crass,the fact is that most people respond well toeconomic rewards. Such rewards may comein the form of increased personal compen-sation, but may also come in the form ofincreased resources (discretionary funds,space, equipment, travel, additional supportstaff and/or trainees) provided in support oftheir academic quest.

We use economic rewards to achievealignment. If alignment makes it possible forthe organization to travel faster and farther,both more efficiently and more effectively,then we can use financial rewards providedto parties who work together in a collabora-tive fashion to advance the organization’smission, help it more rapidly realize theorganization’s vision, and foster a strongerand more resilient enterprise.

We do this, in part, by “joining peopletogether at the hip.” We do not allow forevaluations, let alone incentive compensa-tion rewards, to be driven by one person’ssuccess at the expense or to the detriment ofanother’s, as to do so may lead to the organi-

“All faculty are expected to be both mentors and

mentees—providing support to those who can

benefit from their wisdom, knowledge and

experience, and receiving guidance from those

who can offer such support to them. Healthy

communities maintain an environment that

fosters mentorship from all who will benefit.”

Continued on page 9

Stanford Joins Schools BanningGifts from Drug Manufacturers

Under a new policy aimed at limiting theinfluence of the pharmaceutical industry onpatient care and physician education,Stanford University Medical Center will pro-hibit physicians from accepting any gifts, nomatter how small, from pharmaceuticalcompanies. Stanford thereby joins Yale andthe University of Pennsylvania in institutingthis policy.

The new policy, which became effective

October 1, also prohibits physicians fromaccepting free drug samples and from pub-lishing articles in medical journals that areghost-written by industry contractors.

The policy also applies to gifts fromsales representatives from makers of med-ical devices and other companies, not justpharmaceutical companies. Company rep-resentatives are barred from areas wherepatient treatment and physician educationoccur. Physicians buying medical equip-ment must report any financial relation-

ships with equipment suppliers and couldbe excluded from decision-making, theuniversity said.

The new policy does not cover consult-ing agreements between faculty membersand companies aimed at developing drugsor medical devices, which are governed byan existing conflict-of-interest policy.

Women Face Barriers to Hiring,Promotion at ResearchUniversities

A new report from the National Academiesfinds that women face barriers in hiring andpromotion in science and engineering atmajor research universities, concluding thateliminating such bias will require globalreform and decisive action by universityadministrators, professional societies, gov-ernment agencies, and Congress.❖ The report presents a wide range of rec-

ommendations, including the following:❖ Top levels of university administration

should provide clear leadership tochange the culture of their institutionesto recruit, retain, and promote womeninto faculty and leadership positions.

❖ University departments should berequired to provide evidence of fair,broad, and aggressive talent searches tofill departmental vacancies.

❖ Departments should be held accountablefor the equity of their search processesand outcomes.

❖ Universities should form a collaborativebody to develop standards for facultyrecruitment, retention, and promotion. ❖

Academic Physician & Scientist ■ November/December 2006 9

News & ViewsN E W S & Views

zation’s ultimate failure. Great benefits maycome from such techniques when the deanand the hospital CEO are in alignment.Tying their incentive compensationrewards together may be an effective meansof accomplishing organization objectives.

Similarly, incentive compensationplans that tie the success of the medicalschool’s chief administrative officer (busi-ness and finance) and practice plan direc-tor to the hospital’s CFO and managedcare/reimbursement contract officer canpromote similar collaboration. Such con-structs encourage these players to spendtime and energy working for commongoals rather then in efforts to divide a finite“pie.” We act on the performance of ourleaders in a timely and meaningful way.We reward success, not only with pay andrecognition, but often by giving increasedor additional responsibility; and we pun-ish poor performance by not rewarding iteconomically, and often by removingduties and responsibility.

ConclusionsFailing to apply or misusing tools toachieve progress often leaves organizationleaders frustrated, exhausted, and discour-aged. Similarly, it leaves the faculty con-

fused, angry, and disenfranchised. Whenapplied properly and skillfully, however, itis a beautiful thing to watch. The organi-zation travels forward rapidly and smooth-ly, outdistancing its competitors year afteryear, attracting and retaining the best andthe brightest to its ranks. ❖

Notes1. Collins J. Good to Great, Why Some Companies

Make the Leap …and Others Don’t. HarperCollins, 2001.

2. Bland C et al. The Research-ProductiveDepartment; Strategies from Departments ThatExcel. 2005.

3. Elger WR. Managing resources in a better way:a new financial management approach for theUniversity of Michigan Medical School. AcadMed 2006;81(4):301-305.

Career Watch

Continued from page 5

For an expanded version of this column, including additional tools,

visit the APS Web site atwww.acphysci.com.

COMING IN DECEMBERThe first all-electronic issue of APS, featuring a compilation of Career Watcharticles providing valuable information on giving your academic career a boost.

ATTENTION ALL DEPARTMENTS:This electronic issue of APS will include fully searchable ads.

Visit the APS Web site at www.acphysci.com for further details—and look for the special issue in December!

4 Academic Physician & Scientist ■ September 2008

In earlier columns we havediscussed the use of the for-mula PAR (Problem +

Action + Result) as a constructto determine accomplishmentsand, ultimately, competencies.1

Deconstructing the competen-cies yields a cluster of genericskills and traits, which can helpdetermine a career path. Theresults of PAR work can thenused as bullet points in executive sum-maries,2 and as the basis for “stories” ininterviews.3 Behavioral interviews specifi-cally beg for the “stories” that can be gener-ated from preparation that includes a reviewof one’s PARs.

Through the years, feedback from searchcommittee members and applicants forpositions has lauded the usefulness of anapplicant taking the time to do the PARwork. It has provided a strong basis fordetermining the extent to which one knowshe or she has the skill sets that are beingmarketed, and whether the opportunity is agood match with the skills one excels in andenjoys using.

Let’s take a moment to review the con-struct PAR as a method for competencyanalysis. Reflecting on your achievements,P asks that you determine if there was aproblem, issue, challenge, or opportunity tobe solved or resolved, and A asks for theaction or activities taken to do this. R standsfor the positive result, outcome, or benefit,phrased in as quantitative terms as possible.

An accomplishment statement begins withthe A and follows with the R. This canbecome a bullet point on an executive sum-mary2 and might read, “Chaired departmen-tal program review for re-accreditation, whichresulted in full accreditation for seven years.”

PAR Use ExpandedWith this summary of the PAR method, let’sconsider how it can be extended beyond

applying and interviewing for positions,into performance management.

“…the task of leadership is to align strengthsin ways that make weaknesses irrelevant.”

—Peter Drucker

What has become increasingly clear isthat determining competencies is also quitehelpful in preparing for annual performanceappraisal or review. Focusing on strengthsis increasingly acknowledged as an effectiveapproach to managing performanceappraisals and coaching employees for

change. Many experts todayrecommend strength- or asset-based approaches rather thana more traditional deficit- orproblem-based approach.4,5

Moreover, Torbeck andWrightson6 have advocatedfor determining promotioncriteria for family medicineresidents based on demon-strated competencies in a

variety of areas suggested by theAccreditation Council for Graduate MedicalEducation (ACGME). Their report providedguidelines for developing and demonstratingknowledge, skills, and attitudes.

Clifton and Harter give another rationalefor the focus on strengths, writing, “Whenpeople become aware of their talents,through measurement and feedback, theyhave a strong position from which to viewtheir potential. They can begin to enlargetheir awareness of their talents with knowl-edge and skills to develop strengths.”7

Information such as the above and feed-back from clients has led to our recommen-dation to use the PAR work approach inpreparing oneself for an annual evaluation.Reviewing PARs for the past year and decon-structing them as suggested1 provides onewith an understanding of his or her compe-tencies. Moreover, the PAR approachenables preparation of a performance reportthat is focused on results or outcomes, ratherthan being the all-too-common list of activi-ties conducted during the year.

Moving from PAR to CAR forPerformance Management

To focus on goals for the coming year, we findit helpful to substitute C for P and use theacronym CAR. Challenges, problems, oppor-tunities, or issues can be set, with details of theAction to be taken and the Results expected.This acronym, CAR, implies forward move-ment and is thus distinguished from past

Annual Performance Evaluations with a Positive Twist B Y J U D I T H K A P U S T I N K AT Z , E d D , R O B E R TA E . S O N N I N O , M D ,A N D P A G E S . M O R A H A N , P h D

C A R E E RWatch

Judith Kapustin Katz, EdD, and Page S. Morahan, PhD, work with scientistsand faculty to provide strategic planning for rewarding careers. They are

independent consultants and members of the Executive Leadership inAcademic Medicine (ELAM) Leadership Program Consulting Alliance. ContactDr. Katz at 601-664-4785 or katzknect@aol.com; contact Dr. Morahan at215-947-6542 or psmorahan@att.net. Roberta E. Sonnino, MD, isAssociate Dean for Faculty Affairs at University of Minnesota Medical Schoolin Minneapolis. Contact Dr. Sonnino at 612-624-5442 or rsonnino@umn.edu.

Judith Kapustin Katz: “We believe that theuse of the PAR process in performanceappraisal adds a much-needed dimensionto the traditional faculty–chair meeting.”

Academic Physician & Scientist ■ September 2008 5

accomplishments. In our framework, the PARthen becomes a focus on Past Problems,opportunities, issues, or challenges and CARon Current/ future challenges, opportuni-ties, issues, or problems.

One to several CARs can be written foreach area to be appraised—such as teach-ing, research, service, and scholarship. Theamount of detail and degree of “stretch” inthe goals is up to you and your supervisor todetermine—whether your CAR is a high-performance Porsche or a reliable and effi-cient Prius.

Here are a couple of examples that depictthe basic format:❖ Scholarship:

❖ Challenge—Submit two articles forpublication.

❖ Action—Complete data collectionand draft manuscripts for intrade-partmental review.

❖ Results—Submit articles to theJournal of XXX by April 1.

❖ Teaching:❖ Challenge—Develop integrated cur-

riculum for pathology course.❖ Action—Collect and review curricu-

lum from several other institutions;convene small task force to discussand draft proposal.

❖ Result—Submit new curriculum todepartment chair by April 30.

These statements are written in the pre-sent tense, are grounded in your history, rep-resent a preferred future, and move towardpositive accomplishments and change thatyou desire for your career. The statementsalso help you identify aspects of your workthat ultimately will make you feel goodabout yourself. Finally, the work of construct-ing your CARs helps to define areas on whichto focus in the following year as you do youryearly reflection, with questions such as: Howmuch of my current position allows me to usethe skills that I enjoy? Are there ways that Ican build more of this into my current job?

We believe that the use of the PAR processin performance appraisal adds a much-need-ed dimension to the traditional faculty–chairmeeting. The process enables faculty andtheir supervisors to identify, and then toacknowledge, faculty members’ concreteresults-oriented contributions to the school—traditional peer-reviewed publications andgrants, clinical service, or teaching—as well asnontraditional contributions that advance

the missions of the school. As recently high-lighted by an AAMC Consensus Meeting ondocumenting and evaluating contributionsin education, there is a great need for medicalschools to develop methods that documentand value contributions such as advising,mentoring, directing courses, and the like.8

Some internal CV report templates allowfor short verbiage to describe such contri-butions, and we suggest that more schoolscould usefully adopt this process as anoptional component of the annual review.Formal inclusion would benefit all parties:❖ The faculty member gets credit for a task

well done, yet not easily added to a tra-ditional CV, and takes personal satisfac-tion in the accomplishment. Furthermore,the deconstruction allows the facultymember to identify skills and strengthsthat can be developed further.

❖ The department benefits from facultywillingness to take on projects thatotherwise would not be considered worththeir time and effort (“What do I get outof doing this?”).

❖ The school, which always benefits fromthe success of its faculty, will identify apool of talented individuals with specif-ic skills that may be invited to participatein important processes that enhance theschool’s mission.This change in performance appraisal will

require a shift to focus on how to document

the outcomes, rather than just listing theactivities in which a faculty member isinvolved. For example, it is not sufficient tonote that one served on the IRB committee;for this to be used as an accomplishment,the faculty member must focus on what wasaccomplished that year. This requires con-sidering elements such as: Was the processstreamlined so that time from applicationsubmission to approval was shortened?Were there improved explanations of whatwas needed in IRB applications, so thatfewer resubmissions were required?

This recommended approach for usingPAR for past accomplishments and CARfor current and future challenges aligns withthe values of “appreciative inquiry.” Onemodel uses the appreciative approach todetermine strategic objectives by analyzingStrengths and Opportunities, Action, andResult.9 The CAR focus is thus strength-based, and one is being valued for contribu-tions as well as potential. Your annualreview becomes a valuation rather than anevaluation—built on strengths rather thandeficits. ❖

References 1. Katz JK, Morahan PS. Dissecting accomplish-

ments as a career compass. Academic Physician &Scientist October 2006: 4–5 .

2. Morahan PS, Katz JK. How to use the executivesummary when applying for positions. AcademicPhysician & Scientist February 2005:2–3.

3. Morahan PS, Katz JK. We’d like to have an initialinterview with you! Academic Physician &Scientist October 2005:2–3.

4. Buckingham M, Clifton DO. Now, Discover YourStrengths. New York: Free Press, 2001.

5. Orem SL, Binkert J, Clancy AL. AppreciativeCoaching: A Positive Process for Change. SanFrancisco: Jossey-Bass, 2007.

6. Torbeck L, Wrightson AS. A method for definingcompetency-based promotion criteria for familymedicine residents. Acad Med 2005;80(9):832–839.

7. Clifton DO, Harter JK. Investing in strengths.In Cameron KS, Dutton JE, Quinn RE, eds.Positive Organization Scholarship: Foundationsof a Discipline. San Francisco: Berrett-KoehlerPublishers, 2003: 111–121.

8. Simpson D, Finscher RM, Hafler J, Irby D,Richards B, Rosenfeld G, Viggiano T. Advancingeducators and education: defining the compo-nents and evidence of educational scholarship.Summary report and findings from AAMC groupon Educational Affairs Consensus Conference onEducational Scholarship. Washington, DC:AAMC, 2007: 1–15.

9. Stavros J, Hinrichs G. SOARing to high andengaging performance: An appreciative approachto strategy. AI Practitioner, August 2007.

Roberta E. Sonnino: “This change inperformance appraisal will require a shiftto focus on how to document the outcomes,rather than just listing the activities inwhich a faculty member is involved.”

4 Academic Physician & Scientist ■ June/July 2009

Lately, you notice that your departmentchair is under mounting pressure toincrease revenue through clinical

productivity, increase extramural researchfunding, and maintain or reduce the costs ofteaching, even as class size expands. Differ-ent demands are now being placed on you,creating a dilemma: The core component ofwhat differentiates academic medicine andmakes it unique—scholarship—is beingdiluted and, at times, neglected, and you arebeginning to question your career choice.The professional literature in academicmedicine describes changes in organization-al structure, leadership, and culture.1,2

What has not been explored is the questionof whether a different “model” of facultymember is needed. This is a good timefor faculty members to ask: Am I a “future-oriented” faculty member? Do I possessthe key ingredients—values, skills, andcommitment—necessary for future successin academic medicine?

A New ModelThe prevailing culture in academic medi-cine is often described as individualistic,autonomous, scholarly, expert-centered,competitive, focused, high-achieving, andhierarchical.3 It is not surprising, therefore,that many faculty members are highly com-petitive, high-achieving individuals whostrive for autonomy in narrow areas ofexpertise and scholarship. These individualsare comfortable in hierarchical systems, typ-ically having done well in similar systemsthroughout their careers. Senior facultymembers are likely to have been rewardedfor individual achievement and expect tosee the same in the faculty who succeedthem in the world of academic medicine.

The Current DilemmaTo paraphrase Spencer Johnson (a physi-cian), someone moved the cheese.4 Thequalities and characteristics that led to suc-cess in the past are becoming less relevant

in the changed environment. If you wantto be a successful faculty member in thecoming years, you should be sure you areequipped to deal with the changed envi-ronment and newly emerging culture ofacademic medicine.5 A different behavioralrepertoire and skill set will likely berequired.6 But upgraded skills alone areonly a part of required changes in behavior.If you want to truly adopt an orientationtoward the future of academic medicine,other changes will be necessary.

Characteristics of the Future-Oriented Faculty

Future-oriented faculty members are similarto present-day faculty in several ways. Mosthave developed an ability to postpone grati-fication as they work toward future goals thatare often in the distant future. Most are deeplycommitted to helping others and generatingnew knowledge in the service of improvingthe human condition. However, there aresignificant differences between today’s facul-ty and the future-oriented faculty.

First, the future-oriented faculty memberis much more likely to be female and/orto be from an underrepresented minority.These individuals will probably have experi-ence working in teams with collegial orcollaborative members. If the person istrained as a scientist, he or she will quitepossibly be oriented toward the conduct oftranslational or clinical research, and assuch, more comfortable with team science.The future-oriented faculty will be less con-cerned about the accumulation of knowl-edge and more oriented toward the practical

application of that knowledge—in otherwords, it will be competency-centered ratherthan knowledge-centered. (For a table com-paring traditional and future-oriented facul-ty, see the expanded version of this article atwww.acphysci.com.)

The ChangingOrganizational Culture

Academic medicine is under pressure to sus-tain itself in the face of declining reimburse-ment, rising levels of uncompensated care, adecreasing NIH budget when adjusted forinflation, and ever-increasing costs of laborand supplies. The need for tighter alignmentbetween the health system and the physicianpractice plan is becoming increasingly appar-ent, given the need to partner in supportingsalaries, invest jointly in capital expenditures,and implement business strategy. In theresearch enterprise, extramural grant fund-ing is necessary, but not sufficient, to sup-port research. One analysis found the needto subsidize 17% of academic medicalcenters’ research funding in 2003 with clin-ical enterprise dollars or endowment inter-est and gifts providing the additionalrevenue needed to support research.7

Becoming Future-OrientedIn order to be successful in the transition toa future orientation, you should create acustomized career development plan that iscarefully planned, linked to measurablegoals, monitored routinely, and reinforcedby effective feedback and coaching.8

In order to protect the integrity of theacademic medical center, the unifyingtheme of the new community of future-oriented faculty must be scholarship.Keeping academic medicine anchored inscholarship has several advantages. First,all faculty will contribute to scholarship.Newer reward systems will have to acknowl-edge team contributions to science and totechnology, commercialization, and licens-ing. Second, the litmus test of scholarship

Are You a Future-Oriented FacultyMember?B Y R . K E V I N G R I G S B Y, D S W, W I L E Y W. S O U B A , M D , S c D , M B A ,A N D D AV I D H E F N E R , M P A

C A R E E RWatch

R.Kevin Grigsby, DSW, is Senior Directorof Organizational Leadership Develop-

ment at the AAMC. E-mail: kgrigsby@aamc.org. Wiley W. Souba, MD, ScD, MBA,is Dean of Ohio State University College ofMedicine. David Hefner, MPA, is President ofUniversity of Chicago Medical Center.

rather than independence, supportingwork-life balance, and ending the relianceon individualistic rewards are likely to beother key features of successful academicmedical centers in the coming years.

If you are a faculty member who wantsto be successful in the future, anticipate andprepare for it. Adopt an orientation to thefuture, align your workplace behavioraccordingly, and relish the fact that you area part of creating the future of academicmedicine. ❖

References1. Barrett DJ. The evolving organizational structure

of academic health structures: the case of theUniversity of Florida. Acad Med 2008;83:804–808.

2. Kirch DG, Grigsby RK, Zolko W, Moskowitz J,Hefner DS, Souba WW, Carubia JM, Baron SD.Reinventing the academic health center. AcadMed 2005;80:980–989.

3. Kirch DG. Culture and the courage to change.Washington, DC: AAMC. AAMC President’sAddress, 2007.

4. Johnson S. Who Moved my Cheese? New York:G.P. Putnam’s Sons, 1998.

5. Shuck JM. Personal observations on the culturalevolution in surgery. Am J Surg 2002;183:345–348.

6. Grigsby RK, Hefner DS, Souba WW, Kirch DG.The future-oriented department chair. Acad Med2004;79:571–577.

7. Moses H, Dorsey ER, Matheson DH, Their SO.Financial anatomy of biomedical research. JAMA2005;294:1333–1342.

8. Staveley-O’Carroll K, Pan M, Meier A, Han D,McFadden D, Souba W. Developing the youngacademic surgeon. J Surg Res 2004;118:109–113.

9. Boyer EL. Scholarship Reconsidered: Priorities of theProfessorate. Princeton, NJ: Carnegie Foundationfor the Advancement of Teaching, 1990.

10. Bickel J, Brown AJ. Generation X: Implicationsfor faculty recruitment and development inacademic health centers. Acad Med 2005;80:205–210.

11. Dufort F, Maheux B. When female medicalstudents are the majority: Do numbers reallymake a difference? J Amer Med Women’s Assoc1195;50(1):4–6.

12. Howell LP, Servis G, Bonham A. Multi genera-tional challenges in academic medicine: UCDavis’s responses. Acad Med 2005;80:527–532.

13. Paik JE. The feminization of medicine. JAMA2000;283:666.

14. Ceci SJ, Williams WM. Why aren’t more womenin science? Washington, DC: APA Press, 2007.

Academic Physician & Scientist ■ June/July 2009 5

will be simple: Does the scholarship, viaknowledge creation or transfer, add value tothe people we serve in academic medicine?Finally, collective scholarship will help toattract new faculty and will serve as the“glue” that retains and sustains faculty. Theorganization’s mission—improving people’slives through scholarship—remains its mostfundamental reason for existence, one thatgoes far beyond generating a margin. Thismission is one that will resonate extremelywell with the various stakeholders the insti-tution must engage.

Although scholarship remains at the coreof all the missions—teaching, research,patient care, and service—there is less timeavailable to both clinicians and researchersto engage in the process of creating newknowledge and innovating. Ernest Boyerproposed a broad definition of scholarship—one that went beyond emphasizing pure dis-covery to one that included “integration,application, and teaching.”9 This broad defi-nition of scholarship applies aptly in acade-mic health. To a degree, evidence of thesechanges is all around us as greater emphasisis placed on clinical and translational scienceand less on basic science research. In effect,the question of value from funding agencies(NIH and others) has changed from “Whathave you discovered?” to “What have youcured?” The emerging organizational cultureof academic medicine now requires a paral-lel-processing applied research model—and afaculty with the requisite skills to conductapplied research.

Likewise, intellectual pursuits havebecome more transdisciplinary and lessinsular. In the past, individualism prevailed,as a largely male workforce defined them-selves through work. Physicians now enter-ing the workforce are different, however, asthey seek a work environment that valuesfamily and other quality-of-life issues.10

Some of this change may be the result ofthe changing demographics in medicine, asmore than 50% of medical students arefemale, effectively reshaping the medicalworkforce. Some authors argue that in andof itself, this shift in demographics mayresult in more emphasis on humanistic, psy-chosocial and other softer factors in healthcare.11,12 The “feminization” of medicine13

and the controversies about the dearth ofwomen in science14 are likely to becomemanifest in the near future.

In terms of recruiting future-orientedfaculty members, Bickel and Brown suggestthat generational differences will requirenovel recruitment and development strate-gies.10 Much of the challenge of recruiting,retaining, and sustaining the future-orientedfaculty member involves the ability to pro-mote scholarship at the same time as askingclinicians and scientists to maximize revenue,ensure efficient use of resources, and “right-size” the entire enterprise. In the past, manyof the rewards to faculty members originat-ed “within” the individual faculty memberrather than from within the organization. Inthe future, the cultural expectation will needto focus on “we” (collective success) ratherthan on “me” (individual success). Althoughthis may sound contradictory, it is not. Thecrucial element within the organization is tocreate a culture that rewards collaborationand simultaneously promotes the vitality ofthe individual faculty member.

Academic medical centers will be chal-lenged to change their organizational cultureswiftly enough to recruit and subsequentlyretain future-oriented faculty. A future-ori-ented organizational culture is likely to bemanifested as collaborative, transparent,outcomes-focused, mutually accountable,team-based, service-oriented, and patient-centered.3 Rewarding interdependence

R. Kevin Grigsby, DSW: “In order to besuccessful in the transition to a futureorientation, you should create a customizedcareer development plan that is carefullyplanned, linked to measurable goals,monitored routinely, and reinforced byeffective feedback and coaching.”

For an expanded version of thisarticle, including a table comparing

traditional and future-oriented faculty,visit the APS Web site at

www.acphysci.com.

It seems that everyone is talking aboutteams these days. The popular businessliterature is brimming with books and

articles about teams. Although teams havebeen used in academic health centers(AHCs) in the past, AHCs have begun toembrace the use of teams as a new way ofaddressing “old problems.” The NIHRoadmap is explicit in describing the expect-ed use of “research teams of the future.”1

The days of the isolated but dedicated scien-tist toiling away in the lab accompanied onlyby a faithful assistant (undoubtedly a post-doctoral fellow) are already long gone inmost AHCs.

Although nearly everyone has somefamiliarity with teams and teamwork, it hasbeen my experience that most people don’tknow about or understand what it means tobe a member of a real team. Your future suc-cess may depend on your ability to be a realteam player. Many readers may already be apart of a team (or will be). How can you tellif you are really a team player?

Teams Are Different Many team members may be members inname only. Although they may be partici-pating in a group called a “team,” theapproach may be no different than that of acommittee, task force, or other work groupcharged with completing a task or tasks.Real teams are different. A team is a smallgroup of people with complementary skills whoare committed to a common purpose, perfor-mance goals, and approach for which theyhold themselves mutually accountable.2

Teams differ from other groups in manyways. Shared leadership, members holdingeach other accountable, embracing conflict,measuring performance, and creating col-lective work products are only a few of thesalient differences between real teams andother work groups.

Different Behaviors Are Necessary

Real teams require a different behavioralrepertoire. One cannot expect success if the

approach to team membership is the sameas the approach to other work group activ-ities. Successful teamwork demands behav-ior conducive to meeting the common pur-pose of the team, setting and reaching per-formance goals, and creating collectivework products. Real team players need todetermine if they are on target. Thisrequires team members to assess their ownbehavior and to modify it to meet the needsof the team.

Self-KnowledgeTeam members have complementary skills.In fact, selection of team members shouldbe based on the unique skills and perspec-tive each of the members brings to thetable. All team members should be fullycognizant of why they have been selectedfor the team and of the expectations ofthem as members of this team. Individualsneed to ask of themselves: Am I bringingwhat is needed? Are my skills up to date? Ifyou don’t have the skills, it may be best todecline to participate. If your skills are outof date, you should sharpen them in orderto bring your best to the team. After all, theother members are depending on you. Inturn, teams need to assess whether or notthe members bring the necessary skills orperspective to the team.

Another important aspect of self-knowl-edge is related to temperament. Whilelearning about temperament may precedejoining a team, many teams engage in a peri-od of assessment at the outset of their for-mation. Administration of the Myers-BriggsType Indicator or similar measure offersvaluable information that can be very help-ful in building good relationships amongstthe team members as they learn to commu-nicate, build trust, and work together.

CommitmentReal team members demonstrate commit-ment to the team through their behavior. Areal team player makes a commitment tothe goals of the team—and honors thatcommitment consistently. Attending teammeetings, arriving on time, and coming

prepared are clear demonstrations of com-mitment. Too often, I’ve encountered per-sons who repeatedly announce “I’m a teamplayer,” but attend meetings only sporadi-cally, arrive late, or fail to have completedtasks integral to achieving team goals.

Commitment to the team process isimportant, too. Rather than approachingteam membership with a “What’s in it forme?” attitude, real team players recognizethe question must be rephrased to “What’sin it for us?” This approach requires not onlya full commitment to the team goals, butalso a continued focus on results.

BraveryEffective teams demand trusting relation-ships amongst team members. While thephrase “trust has to be earned” has sometruth, one has to take the risk other teammembers are skillful, conscientious, andcommitted to the goals of the team. This canbe very challenging to the “rugged individu-alist” who typically espouses a perspectiveof “if you want it done right, do it yourself.”Trust builds over time, especially as otherteam members demonstrate their skills and“deliver” as expected. However, some levelof trust must exist from the outset or theteam will never have a chance to grow intrust. Many teams engage in trust-buildingexercises early on in order to establish asmuch trust as possible.

Real team players are unafraid of conflict.Team members exhibit maturity and braveryin addressing conflict openly, especially if theorganizational culture is one where ignoring,denying, or avoiding conflicts represent thestatus quo. All teams will experience con-flict—it should be expected. Teams dealwith conflict openly, recognizing that con-flict often prompts creativity, which results in

4 Academic Physician & Scientist ■ July/August 2006

Are You Really a Team Player?B Y R . K E V I N G R I G S B Y, D S W

C A R E E RWatch

R.Kevin Grigsby, DSW, is Vice Dean forFaculty and Administrative Affairs at Penn

State College of Medicine in Hershey, PA. E-mail:kgrigsby@psu.edu.

Academic Physician & Scientist ■ July/August 2006 5

collective work products that reflect the wis-dom of the entire team. Patrick Lencioniargues that “fear of conflict” represents onetype of team dysfunction.3 Real team playershave the confidence, maturity, and patienceto actively engage in eliminating, reducing,or managing team conflicts. Development ofskills related to resolving, reducing, or man-aging conflict may require specific trainingfor the entire team.

Listening SkillsKnowing when to keep one’s mouth shut isa virtue. Nowhere is this more evident thanin the work of teams. Real team players lis-ten keenly to other team members and oftenelicit more information from others (“tell memore about . . .”) in order to be certain thespeaker’s message is received accurately.Good listeners ask open-ended questions(“What is your perspective on the prob-lem?”) and often take time to “state the obvi-ous” by summarizing the message. Askingother team members if the summary isaccurate and if not, where the inaccuraciesexist allows the group to build consensus.Finally, good listeners recognize that theirperceptions and opinions may not be asimportant or as good as the perceptions andopinion of the team.

Consensus BuildingReal team players respect and honor thewisdom of teams. Just as truly listening toothers is an attribute of real team players,communicating with other team membersin a manner that builds consensus is animportant skill demonstrated by real teamplayers. Taking an adversarial position and“digging in heels” is unlikely to lead theteam to creating better work products. Realteam players understand the outcome orproduct may not be as they initially envi-sioned. Building a coalition or bloc of votesin support of one’s position may lead to a“win” on the part of the individual.Unfortunately, however, this is often at theexpense of the team. In other words, realteam players subordinate their own desiredoutcome in deference to the desired or pre-ferred outcome of the team.

Shared LeadershipReal team players are able to share lead-

ership according to the task at hand.Leadership roles are shared and “move

around” the team according to which mem-ber’s skills and perspective are best suitedtaking the lead. One person might be for-mally designated as “team leader,” but this istypically limited to securing a location forteam meetings and other logistical tasks.Shared leadership requires knowing whento “step up” to assume a leadership role andwhen to “step aside” to allow another teammember to assume leadership.

DisciplineReal team players are disciplined. They arerelentless in pursuit of the team’s goals anddon’t give up easily. Discipline is veryimportant in the formative stage of teamdevelopment as it is often protracted, espe-cially as compared to the other workgroups. It takes time to build trust and toestablish consensus. At times, teams mayrequire the assistance of an expert from out-side of the team to facilitate trust and buildteam cohesiveness. Real team players havethe discipline to “stick with” the team as itforms, as it weathers “storms” of intrateamconflict, and as it establishes norms inbecoming a team that truly performs.4

AccountabilityReal team players hold the team and

themselves accountable. In AHCs, there isan inherent conflict in holding teams

accountable, as rewards and recognition arepredicated upon individual performance.Subordinating personal success in deferenceto the success of the team is a new skill formany persons in AHCs. Real team playershave the confidence to acknowledge per-sonal shortcomings and to take action toacquire the skills needed to best serve theteam. Truly accountable team players solicitsupport—and criticism—of other teammembers individually and collectively inorder to improve personal and team perfor-mance.5

Summary Self-knowledge, commitment, bravery, andgood listening skills are some of the behav-iors required of real team players. Eventhose persons who seem to have a naturalaffinity for teamwork need to developthese skills to maximize team performance.As these skills are developed, disciplineand shared leadership build team consen-sus. Real team players are unafraid of hold-ing themselves accountable as individualsand as a team. Not everyone is a team play-er. As such, it should be expected thatsome persons would not be able to be apart of a team. In these cases, allowingthem to be productive in their own way ofworking is preferable to trying to forcethem to fit into a team. Participation as ateam member who is not really committedto the team “holds back” the progress ofthe team.

For those of us privileged to be membersof high-performing teams, it is hard to imag-ine working in any other way. The benefitsof having team members who are real teamplayers are easily seen and measuredthrough high quality collective work prod-ucts. The benefits of high-performing teamsfar outweigh the investment of time andenergy in training real team players. ❖

References1. http://nihroadmap.nih.gov/researchteams/index.

asp, Accessed May 15, 2006.2. Katzenbach JR, Smith DK. The Wisdom of Teams.

Boston: Harvard Business School Press, 1993.3. Lencioni P. The Five Dysfunctions of a Team. San

Francisco: Jossey-Bass, 2002.4. Tuckman BW. Developmental sequence in small

groups. Psychological Bulletin 1965;63:384-399.5. Katzenbach JR, Smith DK. The discipline of teams.

Harvard Business Review 1993;71:111-120.

“Shared leadership, members holding eachother accountable, embracing conflict,measuring performance, and creatingcollective work products are only a few ofthe salient differences between real teamsand other work groups.”

Faculty members new to medicalschools and centers face many chal-lenges as they try to learn about orga-

nizational culture. Faculty members whohave been around the school and centers fora more lengthy period of time can be sur-prised when they find that they hold long-standing misinterpretations of the “mean-ing” of some aspect of the culture. Thenuances of any organization complicate ourworking with other persons who may havea different understanding of “the way thingswork are around here,”1 leading us to “workat working together.”

Sooner or later, all of us participate asmembers of work groups—a group of indi-viduals assigned to work together toward anoutcome. Specific types of work groups maybe better tools, depending on the work to bedone. Knowing which tool to use can bevery helpful in understanding what isexpected of the work group and in success-fully completing the work. Unfortunately,most of us have never really been taughthow to best use the tools called committees,task forces, and teams.

Why Does It Matter?Too often, meetings result in too much talk-ing and not enough doing. Knowing thetype of work group helps to clarify whatneeds to be done and can lead to more spe-cific conversations covering “what needs tobe talked about.” Jeffrey Pfeffer and RobertSutton describe the pitfall of the “smart-talktrap,” where groups confuse talking aboutsomething with doing something.2 There aremany bright persons in medical schools andmedical centers who often have a lot to sayabout a topic—but as Peter Drucker sug-gests, being bright is no substitute forknowledge.3 Likewise, knowledge is nosubstitute for action. Our behavioral reper-toire should be adjusted according to thetype of work group, as they all require dif-ferent approaches and different behavior.The descriptions that follow offer some

insight to the differences—and similari-ties—of these three types of work groups.

CommitteesCommittees, the most formal of these typesof work groups, are groups of personsappointed or selected to perform a functionon behalf of a larger group. In a sense, thelarger body entrusts a smaller subset ofmembers to do something for them.

Often defined in organizational by-lawsor statutes, committees serve very specificfunctions within organizations. Typically,they are headed by a committee chair andare composed of individuals representingdifferent points of view (junior or senior fac-ulty), different organizational components(departments or divisions), or different con-stituencies (female basic scientists or post-doctoral scholars). Every medical school hascommittees, often required by regulatorybodies such as LCME, JCAHO, or theDepartment of Health and Human Services.

Some committees are enduring, as theyhave no fixed endpoint. Others may be adhoc committees, appointed with a well-defined charge and deadline, after which thecommittee will cease to exist.

Task ForcesTask forces are work groups typically com-prising experts in specified areas of knowl-edge or practice. Task forces are small groupsof people—and resources—brought togeth-er to accomplish a specific objective, withthe expectation that the group will disbandwhen the objective has been completed.

Whereas committees are typicallydefined in organizational by-laws, charters,

or other formal documents, task forces arecreated on an “as needed” basis. The impe-tus for the creation of a task force is oftenthe result of some event, often unexpectedor unanticipated, causing the need for anorganization to acquire knowledge as tohow to best respond to the event, relatedevents, or to a similar situation. One differ-ence between task forces and committees isthe assignment of “forces and resources.”4

That is, personnel and materials needed toenhance the chance for success of the taskforce are put to work simultaneously. Taskforce work products are collective andaddress the specific charge to the group.

TeamsA team is a group of persons linked togeth-er for a common purpose. For the mostpart, teams consist of persons with comple-mentary skills organized to function cooper-atively as a group. Katzenbach and Smithhave written extensively about teams andoffer the following definition:

A team is a small number of peoplewith complementary skills who are com-mitted to a common purpose, perfor-mance goals, and approach for whichthey are mutually accountable.5

In a previous Career Watch article inAcademic Physician & Scientist, I made thepoint that “while nearly everyone has somefamiliarity with teams and teamwork, it hasbeen my experience that most persons don’treally know about or understand what itmeans to be a member of a real team.”6

High-performing teams are made up ofdiverse members who agree on a purpose;establish a set of ground rules for workingwith one another; understand their respec-tive roles on the team; acknowledge, expectand value conflict; and produce high-quali-ty collective work products. Teams rarelyvote, relying on working toward consensusas the preferred model for decision making.Members are selected based on skill set orperspective, rather than as representing

4 Academic Physician & Scientist ■ January 2008

Committee, Task Force, Team:What’s the Difference? Why Does It Matter?B Y R . K E V I N G R I G S B Y, D S W

C A R E E RWatch

R.Kevin Grigsby, DSW, is Vice Dean forFaculty and Administrative Affairs at

Penn State College of Medicine and MiltonS. Hershey Medical Center in Hershey, PA.E-mail: kgrigsby@psu.edu.

Academic Physician & Scientist ■ January 2008 5

some component or constituency of theorganization. Although there may be a des-ignated leader, leadership moves frommember to member based on the topic ortask assigned and the member’s skills.Successful teamwork requires members tobehave in ways allowing work toward a col-lective product.

An Example from Academic Medicine

A common academic function is the processof recognition and reward by promotionthrough the professorial ranks. Committees,task forces, and teams might all have a role inthe promotion process, as shown below.

The CommitteeMost of us are familiar with the role of thepromotion committee, although it may belabeled differently in different organizations.The creation of the committee is a result ofthe college or university by-laws, statutes, orpolicies and is required in every academicdepartment and college within the universi-ty. By definition, the committee is responsi-ble for rendering decisions. The group ofsenior faculty members, led by an appointedor elected chairperson, review carefully pre-pared dossiers of faculty being consideredfor promotion and discuss or deliberateabout the qualifications and performance ofcandidates. Committees most often render adecision by voting. Following the vote, thecommittee chair prepares a letter or lettersrevealing the outcome of the committeevote. In many systems, those letters becomea part of the dossier.

The Task Force Say that during recent promotion commit-tee deliberations, members noticed a pre-cipitous decline in the quality of dossierssubmitted on behalf of junior faculty mem-bers. Many promotion committee membersfeel that the declining quality of dossiers isevidence of the need for change.

In response, a task force composed ofexperts in the areas of faculty development,academic promotion, and university promo-tion policies is appointed to explore optionsfor improving the process for developingjunior faculty members. The charge to thetask force is to review policies and programsat other medical schools and to report onhow your school can have state-of-the-art

faculty development services by the begin-ning of the next promotion cycle. The taskforce report will need to include a strategy,operational plan, and related budget.

The Team Assume that recent deliberations by the col-lege promotion committee found a precipi-tous decline in the quality of dossiers sub-mitted on behalf of junior faculty members.In turn, a review of faculty hiring revealed ahigh turnover rate for junior faculty mem-bers. Exit interview findings indicate thatjunior faculty members do not feel support-ed by department chairs and senior faculty,and dossiers of junior faculty membersreflect a decline in scholarly productivity.

Based on a report from the task force onfaculty development and promotion, a“career enhancement team” is formed tosupport junior faculty. The team consists ofphysicians with skills in the area of mentor-ing, basic scientists who have a track recordof successfully mentoring junior faculty,junior faculty members involved in the pro-motion process, senior faculty memberswith a historical view of promotion of facul-ty over time, an expert in employment ben-efits and policies, a human resourcesdepartment member, and other facultymembers who are well-published in the areaof faculty development.

Team members agree to hold each otheraccountable, to embrace conflict and make itwork for the team, and to produce a pro-gram plan, design, and budget (a collective

work product) within the next 90 days. Asinterdependent team players, the memberssubordinate their individual desired out-comes as they work toward consensus as tothe best approaches to supporting junior fac-ulty members in pursuit of promotion. Theteam creates and implements a state-of-the-art faculty development service before thebeginning of the next promotion cycle. Thereport from the task force provides the strat-egy, operational plan, and related budget.

No One Said It Would Be Easy Undoubtedly, there are committees thatshould be task forces or teams, task forcesthat should be committees or teams, andteams that probably should be committeesor task forces. Even if the right type of groupis appointed and the members are clearabout the charge, there are plenty of oppor-tunities for becoming mired in the workitself. Teams are well suited for many of thecomplex, system-oriented problems we allencounter in medical schools and healthcenters. However, even if a team approach isappropriate, organizational change in med-ical schools and health centers can be slow.In recent times, there has been much greaterinterest in the team approach across a widerange of organizations. I believe we will seethis organizational form adopted more oftenin medical schools and medical centers aswe move into the future, but committeesand task forces still serve—and likely willserve—useful functions and should be usedas the “best tool for the job.” ❖

References1. Bower JL. The Will to Manage: Corporate Success

through Programmed Management. New York:McGraw-Hill, 1966.

2. Pfeffer J, Sutton RI. The smart-talk trap. HarvardBus Rev May–June 1999: 134–142.

3. Drucker PF. The Essential Drucker. New York:HarperCollins, 2003:220.

4. Webster’s II New Riverside University Dictionary.Boston: Houghton Mifflin, 1988.

5. Katzenbach JR, Smith DK. The Wisdom of Teams:Creating the High Performance Organization.Boston: Harvard Business School Press, 1993.

6. Grigsby RK. Are you really a team player?Academic Physician and Scientist. July–August2006: 4–5.

“Our behavioral repertoire should beadjusted according to the type of workgroup, as they all require differentapproaches and different behavior.”

For an expanded version of this article, including additional

discussion, see the APS Web site at www.acphysci.com.

4 Academic Physician & Scientist ■ January 2009

Are you having trouble finding thementoring that you need? Feelingisolated and alone? Don’t know

where to start or whom to ask? Functionalmentoring may be the answer.

Jane Brown, MD, has just been hired onthe clinician–educator track in the OB-GynDepartment of Big State University MedicalCenter. She has a busy practice in women’shealth, specializing in infertility, seeing patientsfour days a week, participating in the call sched-ule of the division on a rotating basis, and pre-cepting a resident clinic once a week. Her chairhas asked her to develop a new clinical rotationfor fourth-year medical students in reproductiveendocrinology. She has the clinical skills andthe content knowledge, but she has never creat-ed a curriculum before. What should Jane do?

This situation is typical of new facultyin a busy academic health center. Juniorfaculty, hired for their expertise in a clini-cal or research area, often have limitedunderstanding of the world of academicmedicine. Most lack the full array of skillsnecessary to excel as academicians. Someacademic health centers have begun tonurture junior faculty through profession-al development programs and mentoring.

Effective mentoring enhances bothindividual and institutional performance.Professional societies have also recognizedthe importance of networking and mentor-ing, and some have developed programsthat incorporate mentoring for professionalsocialization. Despite the increased empha-sis on faculty development and mentoring,are you feeling isolated and left to make iton your own?

At its heart, mentoring encompassesa supportive relationship and a teaching–learning process. In the fullest context, men-toring involves advising, coaching, rolemodeling, assessing, providing feedback, andsponsoring others. For the individual, men-toring provides skill development, professionalsocialization, and career counseling—ideally leading to faculty advancement andenhanced career satisfaction.1 Institutionsbenefit from the retention of native faculty

talent, enhanced productivity of faculty (bothprotégés and mentors), and continued engage-ment of faculty—leading to sustained insti-tutional vitality.2 Traditionally, mentoringrelationships develop through informalinteractions with other faculty members.However, junior faculty often struggle tofind mentors.2,3

How Can Dr. Brown Get the Help She Needs?

Functional mentoring is one solution.Functional mentoring occurs between a facul-ty member with specific needs and a mentorwith the specific skills and expertise to meetthose needs. They come together to focus ona project such as developing a course or cur-riculum, writing a grant, starting a new area ofresearch, or developing a new clinical service.The mentoring relationship develops as workon the project progresses. Functional mentor-ing lasts until the project is completed, butmay continue if both parties agree. It mayinvolve discussions beyond the project (suchas career counseling) and lead to further worktogether. Functional mentoring is a strategy to“jump-start” your search to obtain thementoring that you need—with or withoutthe assistance of a formal institutional men-toring program.

How Does One Find a Functional Mentor?

Start by identifying the issue or a projectthat is important for progress in your

academic career. Ask yourself the followingquestions:❖ What are the knowledge, skills, and

expertise that I need to be able to do thisproject or tackle this issue?

❖ What strengths do I bring to this project?❖ What are my areas of need?❖ What specific help do I need to be able

to complete this project?❖ What scholarly products (publications,

presentations) do I hope to generatefrom the project?Next, identify a senior person, prefer-

ably in your institution—but potentially atyour university, or within your professionnationally—who has the skills and abilityto fill the gaps that you have identified.You might ask your division chief or chairfor assistance in identifying an appropriateindividual. Search the faculty database atyour institution and the university. Lookin the membership directory and withinthe organizational leadership of yourregional and national professional organi-zations. The faculty affairs/faculty devel-opment dean at your institution may beanother resource to help you identify anappropriate individual.

In Jane Brown’s case, her goal is to developa new course in reproductive endocrinology.She needs a mentor with specific expertise ineducation and curriculum development. Janemight look at current course directors, mem-bers of curriulum committees, or othersinvolved in education within her institution.An education expert at another school or fromthe education committee of her professionalsociety may be the one to meet her needs.Jane’s mentor does not need to have expertisein ob-gyn or reproductive endocrinology; Janehas that content knowledge. She needs educa-tional expertise.

Think big! You may be surprised by theaffirmative response by a faculty “star” oracademic leader when you approach him orher with a focused, specific request for assis-tance. A word of caution, however: Be pre-pared when you approach the faculty member.A request for mentoring that is specific,

Find a Functional MentorB Y L U A N N E E . T H O R N D Y K E , M D , M A R Y E L L E N E . G U S I C , M D ,A N D R O B E R T J . M I L N E R , P h D

C A R E E RWatch

Luanne E. Thorndyke, MD (lthorndyke@hmc.psu.edu), is Associate Dean for

Professional Development and Professorof Medicine; Maryellen E. Gusic, MD (mgusic@hmc.psu.edu), is Associate Dean forClinical Education and Professor of Pediatrics;and Robert J. Milner, PhD (rmilner@hmc.psu.edu), is Director, Office of Post-DoctoralAffairs and Professor of Neural & BehavioralSciences at Pennsylvania State UniversityCollege of Medicine, Hershey, PA.

Academic Physician & Scientist ■ January 2009 5

focused, and time-limited is morelikely to be considered by busy seniorfaculty. Identify the time frame for theproject, the deadlines for task com-pletion (such as grant proposal dead-lines), and the time that you anticipatethat you will need from the facultymember.

Once you have secured an agree-ment from your new mentor, use thetime efficiently and wisely. Scheduleregular meetings, come prepared forthem, and be open to feedback andcritique. Respect the time and other commit-ments of your mentor by being diligent inyour work efforts and efficient in your com-munications. Utilize multiple forms of com-munication (e-mail, phone calls, lunch orcoffee breaks) to keep information flowingback and forth on a regular basis, especiallywhen your mentor is particularly busy, trav-eling, or located at a site other than yours.

Be sure to consider your goals for scholar-ship in discussing your project with yourmentor. Remember that academic work isnot complete until it is published and dissem-inated. You will be measured for advance-ment in the promotion and tenure process byyour record of scholarship. Opportunities forscholarship are not always obvious. Althoughit is straightforward to envision a paper orpapers generated from a bench or clinicalresearch project, projects in education orcommunity engagement may need more fore-thought to plan appropriate evaluation todemonstrate their impact. You may need towork with your mentor to identify opportu-nities for grant funding, and also for publica-tion and/or presentation of results.

In Jane’s case, for example, it is not suffi-cient for her to design and implement a newcourse; she must also evaluate the effective-ness of her approach and disseminate theresults. That evaluation will generate scholar-ship: a presentation at her national profes-sional meeting and ultimately a publication.Her mentor should be a rich source of advice,providing suggestions about where to present,where to submit, as well as critical reviewer ofpresentations and papers.

Does Functional Mentoring Work?Can It Be Applied at the

Institutional Level?Functional mentoring has been incorpo-rated into a professional development

program at the Penn State College ofMedicine: the Junior Faculty DevelopmentProgram.4,5 The mentoring programcomplements a year-long course with a cur-riculum in career development, research,education, and clinical practice. Each partic-ipant undertakes an individual project thathe or she has identified and has receivedapproval from the chair to conduct. Thejunior faculty engage in a process to self-assess their (mentoring) needs and, afterutilizing the resources available at our insti-tution, identify a potential mentor. Just aswe have described with Jane Brown, partic-ipants determine the aspects of their projectsfor which they need guidance and identifysenior faculty who have the correspondingskills or expertise. Once the mentoringpairs are finalized, junior faculty identifythe goals for their projects, establish time-lines, and schedule meetings. The mentorprovides review, critique, and suggestionsfor the project. The mentor works with thejunior faculty member for the length ofthe course (approximately nine months),although some pairs have continued towork together to complete projects lastingmore than one year and on new or addi-tional projects.

In the last five years of the program,more than 125 junior faculty have completedprojects in research, education, and clinicalareas. In fact, the “Janes” in our programhave created 34 new curricula and coursesfor medical students, residents, and faculty

in the College of Medicine.Evaluations show continued high sat-isfaction with the program, and revealthat mentors had a significant impacton projects.4,5 Junior faculty reportthat the projects have a significantimpact on their career focus andpotential for advancement. In addi-tion, projects were new ventures thatmade a contribution to the institution.Many junior faculty report that men-toring extends beyond the focus of theproject—an unanticipated, yet desir-

able, outcome. Importantly, junior facultyhave developed the ability to establish andnavigate new mentoring relationships—animportant skill for their ongoing develop-ment and success.

Take Charge!So, don’t wait for that mythical, all-knowingmentor to find you; get moving! You need afunctional mentor! Think about a project ora task that you have been asked to do, onethat you would like to do, or one that youbelieve will advance your academic career.Identify your needs to make this project asuccess, and find a functional mentor tomeet those needs. Your efforts will pay offwith a tangible product at the end of theprocess—a completed and successful projectto add to your dossier and, in turn, advanceyour career. Finally, take time to celebratewith your mentor, and then move on to anew goal! ❖

References1. Sambunjak D, Straus SE, Marusic A. Mentoring in

academic medicine: a systematic review. JAMA2006;296:1103–1115.

2. Bland CJ, Seaquist E, Pacala JT, et al. One school’sstrategy to assess and improve the vitality of itsfaculty. Acad Med 2002;77:368–376.

3. Palepu A, Friedman RH, Barnett RC, et al. Juniorfaculty members’ mentoring relationships andtheir professional development in U.S. medicalschools. Acad Med 1998;73:318–323.

4. Thorndyke LE, Gusic ME, George JH, et al.Empowering junior faculty: Penn State’s facultydevelopment and mentoring program. Acad Med2006;81:668–673.

5. Thorndyke LE, Gusic ME, Milner JR. Functionalmentoring: a practical approach with multileveloutcomes. J Contin Educ Health Prof 2008;28:157–164.

For an expanded version of this column, visit the APS Web site

at www.acphysci.com.

Robert J. Milner, PhD, Luanne E. Thorndyke,MD, and Maryellen E. Gusic, MD (left toright): “In the fullest context, mentoringinvolves advising, coaching, role modeling,assessing, providing feedback, and sponsoringothers.”

2 Academic Physician & Scientist ■ December 2006

Are you at any early stage in yourcareer? Does the ticking of thetenure and promotion clock seem

to get louder with each passing week?Maybe you have started thinking aboutwhat you need to do to “climb the ladder” ofacademic promotion. If this sounds famil-iar, then this article may be helpful to you.

As a faculty affairs dean, I am responsi-ble for the oversight of the academicappointment, promotion, and tenureprocess in the College of Medicine at myuniversity. Every year, junior faculty mem-bers—those persons who have justreceived their first academic appoint-ment—join the ranks of our faculty. Typi-cally, this enthusiastic bunch is quicklyassimilated into the organization’s rank andfile without much fanfare.

My position as faculty affairs deanallows me to serve as a “participant observ-

er”; I can observe these individuals as theymove through the promotion (and tenure,if applicable) process. Based on what I havelearned from my own experience and inobserving what happens to others in thepromotion process, I have identified somecommon pitfalls of the junior faculty mem-ber. In the worst cases, these pitfalls mayaccount for a failure in the award of tenure.In less dire circumstances, delays in promo-tion may result.

No one warned me about these pitfallsduring my junior years—but someoneshould have! I hope I can help you byalerting you to the lurking dangers.

The pitfalls are: ❖ Too much service effort. ❖ Diffusion and confusion.❖ Lack of mentoring or guidance.❖ Exploitation by other faculty members.❖ Lack of discipline and perseverance.

Pitfall 1: Too Much Service EffortTo a newly arriving faculty member, it canfeel like quite an honor to be nominated toserve on an important committee. On theother hand, committee work is likely torequire many more hours than you will

Academic Physician & Scientist (ISSN 1093-1139), a comprehensive source for recruitment news and classified advertising in academic medicine, is published 10 times a year by Lippincott Williams & Wilkins (LWW), a global medical publisher, and is endorsed by the Association of American Medical Colleges (AAMC), which represents the 125 accredited U.S. medical schools; the 16 accredited Canadian medical schools; some 400 major teachinghospitals, including Veterans Administration medical centers; more than 105,000 faculty in 98 academic and scientific societies; and the nation's 66,000 medical students and 97,000 residents. Subscription is free to all members of the academic medical community residing in the United States. For all others,annual paid subscription rates are: $96, US individuals; $131, U.S. institutions; $122, non-US individuals; $168, non-US institutions. ©2006 Lippincott Williams & Wilkins. Printed in the U.S.A. Opinions expressed by the authors and advertisers are their own and not necessarily those of theAAMC or of LWW. Neither the AAMC nor LWW guarantees, warrants, or endorses any product, service, or claim made or advertised in this publication.

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ACADEMIC PHYSICIAN & SCIENTIST:The comprehensive source of professionalgrowth and development, recruitment, andcareer enrichment information for all acade-mic medicine faculty and administrators,from entry to senior levels.

EDITORIAL ADVISORY BOARD

David J. Bachrach, MBA, FACMPE/FACHEThe Physician Executive's Coach

Boulder, CO

Janet Bickel, MACareer Development and Executive Coach

Faculty Career & Diversity ConsultantFalls Church, VA

Rosemary B. Duda, MD, MPHAssociate Professor of Surgery,

Harvard Medical SchoolDirector, Center for Faculty Development,

Beth Israel Deaconess Medical CenterBoston, MA

R. Kevin Grigsby, DSWVice Dean for Faculty and

Administrative AffairsPenn State College of Medicine

Hershey, PA

Susan R. Johnson, MD, MSAssociate Provost for Faculty

University of IowaIowa City, IA

Page Morahan, PhDCo-Director, ELAM

Drexel University College of MedicinePhiladelphia, PA

Michael L. Rainey, PhDAssociate Dean, Academic Advising, Retired

SUNY, Stony Brook School of MedicineNew York, NY

Susan R. Rosenthal, MDAssistant Dean of Students

Clinical Professor of PediatricsRobert Wood Johnson Medical School

New Brunswick, NJ

Five Potential Pitfalls forJunior Faculty at AcademicHealth CentersB Y R . K E V I N G R I G S B Y, D S W

R.Kevin Grigsby, DSW, is Vice Dean forFaculty and Administrative Affairs at

Penn State College of Medicine in Hershey,PA. He may be reached at 717-531-3570 orat kgrigsby@psu.edu.

C A R E E RWatch

J u n i o r F a c u l t y

spend in the actual committee meeting. As anassistant professor, some service effort isimportant, as you want to demonstrate thatyou are a “team player” and committed to thedepartment and institutional missions. Toomany service obligations can interfere withestablishing a trajectory toward the successfulaward of tenure and/or promotion, particu-larly for women and minority group mem-bers. Junior faculty members who invest asmall portion of effort in service until they areawarded tenure or promoted seem to havefewer problems with demonstrating their val-ue to the institution.

Pitfall 2: Diffusion and ConfusionThe early stages of an academic career can bea dizzying experience. Arrival on an unfamil-iar campus, a lack of understanding of thecampus culture, and a teaching load that farsurpasses anything experienced as a teachingassistant (TA) can leave a junior faculty mem-ber with both feet planted firmly in the air.Typically, junior faculty members have only arudimentary understanding of what is expect-ed of them: teaching, research, and every-thing else. It seems logical that assisting juniorfaculty members with establishing the foun-dation upon which to build a career would bea core function of any medical school faculty

affairs office. Without guidance of some sort,the typical junior faculty member hasn’t a clueas to what is or isn’t a priority. Page Morahan,Jennifer Gold, and Janet Bickel argue that“while a consensus is emerging about thefunctions of a faculty affairs office, no schoolhas a comprehensive faculty developmentsystem.” The “tyranny of the urgent” sets pri-orities on a day-to-day basis while a “conspir-acy of interruptions” ensures that the juniorfaculty member delays establishing a clearplan for the future. This is manifested in apromotion dossier that is hit or miss—evi-dence of trying to do anything and everythingsimultaneously without any clear focus or tar-get. “I’m working so hard but I am not gettinganything done” is a common complaint ofthe person in this situation. Part of the solu-tion is to establish a clear plan shortly after

arrival. Finding a mentor has a number ofadvantages, not the least of which is helpingthe junior faculty member to develop a planfor the future. From an institutional perspec-tive, developing a plan for the futureimproves the chances that the junior facultymember will build on a firm foundation andachieve success.

Pitfall 3: Lack of Mentoring or Guidance

Mentoring and guidance are important inthe development of careers in academicmedicine. This appears to be especially truefor women and underrepresented minori-ties, who often have a difficult time identify-ing mentors. Ideally, institutions should havea system for identifying and linking mentorsand protégés. However, it is likely that juniorfaculty members will need to find mentorson their own. Ideally, mentors assist juniorfaculty members with moving away from the“tyranny of the urgent” and toward a planthat will support the personal and profes-sional growth of the junior member. Howev-er, the mentor-protégé relationship is com-plex. Multiple mentors may be needed tospan the diversity of job demands where

guidance is needed. Junior faculty shouldunderstand that no senior faculty member islikely to ask: “May I be your mentor?” In fact,some senior faculty members may approachthe junior person with an agenda that is notin the junior faculty member’s best interest.

Pitfall 4: Exploitation by Other Faculty

I wish I could report that all other facultymembers are kindly mentors who take pridein assisting their junior colleagues in becom-ing successful. This may not be the case,however. An invitation to assume the role ofco-investigator on a grant can be very flatter-ing and a healthy step in the right direction.On the other hand, being saddled with all ofthe “grunt work” associated with a project isfar from flattering and is likely to steal valu-able time and effort from accomplishingwhat one needs in order to be successfullypromoted and/or tenured. Accepting addi-tional responsibilities always comes at somecost. Therefore, it is wise to be very specific.Draft a Memorandum of Understanding thatclearly states your role, your expectations,and the commitment you are making. Youshould state your understanding of the roleof the other party, what you understand asbeing expected of you, and your under-standing of the commitment being made toyou. Both parties should initial the docu-ment to indicate agreement and each partyshould retain a copy. The aphorism that“good fences make good neighbors” is veryapplicable as the document may preventmisunderstanding in the future. The processof constructing a Memorandum of Under-standing is valuable in and of itself. It willgive you a good “feel” for the potential work-ing relationship. In fact, it may lead you tosay, “No thanks.”

Pitfall 5: Lack of Discipline and Perseverance

Not exercising discipline and perseverancein the pursuit of extramural funding,improved teaching, and development ofmanuscripts is the downfall of many brightand energetic junior faculty members. Theaward of extramural funding is important fortwo reasons. The first reason is that it paysthe bills. The second reason, which is oftenoverlooked, is because it validates yourresearch efforts. In other words, some personor persons (peer reviewers, program officers)

Academic Physician & Scientist ■ December 2006 3

“The ‘tyranny of the urgent’ sets priorities on a day-

to-day basis while a ‘conspiracy of interruptions’

ensures that the junior faculty member delays

establishing a clear plan for the future.”

“The combination of good mentoring and discipline can be very

effective in helping to you move beyond what feels like rejection.”

4 Academic Physician & Scientist ■ December 2006

think enough of your efforts to provide youwith financial support. Junior faculty shouldnot expect success with the first submissionof a grant application. Likewise, it is atypicalfor a new faculty member to receive superi-or teaching evaluation scores the first time heor she offers a lecture or course. It’s no dif-ferent concerning the development of amanuscript. It may require several iterations

before it is publishable. Don’t give up! Juniorfaculty members should develop the disci-pline to remain focused on a project untilsuccess is achieved. Receiving a low priorityscore or a rejection letter is demoralizing—but it isn’t the end of the world. Learning touse these experiences to produce betterscholarship is in the best interest of the indi-vidual, the profession, and science. The

combination of good mentoring and disci-pline can be very effective in helping to youmove beyond what feels like rejection.

I am certain that other pitfalls exist forjunior faculty members. The five pitfallslisted may not be the most daunting. Frommy perspective, they seem to be the mostcommon. I hope that learning about thesepitfalls will help you to avoid them. ❖

Some say the “triple-threat” facultymember is becoming an artifact ofhistory. The exponential expansion

of knowledge, combined with increasingcompetition for research grants and thedemand for ever-expanding clinical ser-vice loads, has made it nearly impossiblefor all but the truly exceptional individualto perform both significantly and substan-tially in all three sectors of academic med-icine. Thus, there has been steady move-ment since the early 1990s toward morehighly regarded research and clinicaltracks for the full-time faculty memberwhose career is better suited to a concen-tration in one or two of the traditional sec-tors of academic medicine.

Growth in Medical SchoolsTable 1 shows how medical schools havechanged between 1975 and 2000.

The number of medical students hasincreased during this 25-year period by only550, to 15,901 (3.6%), but faculty size hasincreased by 63,000; federal grants nowexceed $8 billion; and clinical revenue, atnearly $15 billion, exceeds 50% of the totaloperating costs of US medical schools in

contrast to less than 3% in the mid-1960s,when Medicare and Medicaid were enactedinto law.

Medical education is a priority but itnow competes (and sometimes not verywell) with research and patient care.1 Theconsiderable growth in faculty was stimulat-ed by competition for federal grant fund-ing—often the “gold standard” of excellencein ranking medical schools—and clinicalincome as the cost of maintaining thesehugely expensive enterprises continues torise.

Status of the Tenure TrackTenure used to be the benchmark of excel-lence for most individuals in academic med-icine (and still is for many). It represents,however, a substantial liability to the medicalschool and its parent university when tied tototal salary, as was often the case. Withincreasing frequency, the tenure commitmenthas been uncoupled from salary or its defini-tion has been recast to limit it to a core uni-

versity base salary, often a fraction of totalsalary for the faculty member in a clinicaldepartment. In a 1997 article in AcademicMedicine, Jones and Gold reported on theevolving growth in the number of institutionsthat are introducing clinical and researchtracks to accommodate the changing land-scape in academic medical centers.2 This hasrequired a culture shift for many, as facultyassigned to these tracks in the past were oftenregarded as “second class” citizens in theacademy.

Schools that have made progress inachieving respected status for faculty in thesetracks have found it possible to recruit excel-lent talent and allow them to thrive in theirfocal area. Thus, the tapestry of the well-bal-anced school is now rich with dimensionand texture in proper proportion because itsbroad, tripartite missions of education,research, and patient care have been accom-plished with a balance of a relative few triple-threat individuals coupled with an increas-ing number of those who demonstrateexceptional performance in one of the mis-sion areas, while contributing in a support-ive role in at least one other.

Schools with the most rigorous criteriaexpect the individual to contribute in ameaningful fashion to the teaching processand to the advancement of the science andart of medicine through the publication ofobservations and the presentation of find-ings and technique at professional meetings.Highly respected institutions, such as JohnsHopkins, offer rather long-term commit-ments (as much as ten years) to individualsat rank whose performance warrants it but

Non-Tenure Tracks Now More RespectedB Y D AV I D J . B A C H R A C H , F A C M P E / F A C H E

C A R E E RWatch

David J. Bachrach has more than 30years of experience in academic medi-

cine administration and provides leadershipcoaching to physicians in academic medicalcenters and teaching hospitals. He may bereached at The Physician Executive’s Coach,2650 Juilliard Street, Boulder, CO 80305;(303) 497-0844, or www.PhysXCoach.com.

Table 1. Changes in medical schools, 1975-2000

The National Science Foundation(NSF) reports that 45% of recentrecipients of doctoral degrees in sci-

ence, engineering, and health completed orwere completing postdoctoral appointments.1

How did they find a laboratory? Too often,faculty scientists have the faulty belief that “ifthe science is good, nothing else matters”when it comes to selecting postdoctoral schol-ars. Even though finding a postdoctoral schol-ar with a scientific profile similar to your ownand a set of skills in hand is an important con-sideration, making a decision about bringingsomeone into the laboratory based on thisdimension alone is a mistake. Too often, thefantasy of the “ideal candidate” wears offquickly and problems begin to emerge.

This column is directed toward facultymembers who plan to invest the time, ener-gy, effort, and resources required to bring apostdoc into their laboratory. Knowing whatto look for in a potential postdoc leads toselecting candidates offering the greatestpromise for success—and the least“promise” for creating problems. When onecalculates the effort, expense, and sacri-fices—as well as the lost opportunities—required to recruit, appoint, and train apostdoc, it becomes clear that making thebest choice is a critical decision. Regardingthe selection of a postdoc as an investmentin one’s science is reasonable. Beforeembarking on the search for a postdoc foryour laboratory, you should carefully assessyour needs and ask: Is a postdoc appropri-ate for the project, or would a techniciansuffice? Are resources available to support apostdoc? Am I prepared to share credit witha postdoc? Your decision to recruit a post-doc should be fully informed in order foryou to make and protect your investment.

Recruiting a Good Postdoctoral Scholar

Although it may seem self-evident to somereaders, asking the question, “What is apostdoctoral scholar?” is a good first step.Just last year (2007), the NIH and NSFdefined a postdoctoral scholar as:

An individual who has received adoctoral degree (or equivalent) and isengaged in a temporary and definedperiod of mentored advanced trainingto enhance the professional skills andresearch independence needed to pur-sue his or her chosen career path.2

All investigators should understand thatthis definition clearly specifies that postdoc-toral scholars are to be mentored—animportant distinction faculty scientistssometimes fail to consider in the selectionprocess. An orientation and training periodwill be expected from the day the scholararrives, and ongoing mentorship is anexpectation. In other words, recognize thatyou are not hiring an employee. You areagreeing to host a trainee, albeit a traineealready in possession of a high degree ofknowledge and related skills.

Before beginning to search for a postdoc,take the time to review the definition and tolearn the relevant policies at your university.Meet the people who are responsible for theoversight of human resources issues forpostdocs.

Finding a Postdoctoral ScholarIdeally, a valued colleague who is very famil-iar with your line of research will contactyou with information about a protégé whois finishing or has just finished his or herdegree. Ideally, the protégé’s science andskills are aligned with yours and, tempera-mentally, you find the individual to be com-patible with your work style. You shouldconsider contacting colleagues to inquireabout potential postdocs—especially if youknow the skills and knowledge you desirein a postdoc. The Sigma Xi Postdoc Surveyreports that a significant number of post-docs found their current positions throughpersonal contact with their future mentors.3

Selection of the right postdoc requiresdue diligence. Remember, you are makingan investment. As with other investments,you should read the “fine print” and makewell-informed decisions. Do you wantsomeone with the skills to continue with anongoing project? Or do you want someonewith a new set of skills and who will takeyour laboratory to “the next step”?Fortunately, resources now exist to assistwith recruiting the right person. There are anumber of Web-based services that willallow you to advertise postdoc positions.4

Remember, recruiting is only the firststep. You should start early—six to ninemonths before you need the person in thelaboratory—as it may take this long torecruit and select a scholar. Once you beginto receive inquiries or applications, you willneed to screen responses and offer inter-views to the most promising candidates.Whether you rely on e-mail and telephoneinterviews or have the resources to arrangeface-to-face meetings, it is critical you takethe time to carefully check references.

Bringing a Postdoc into Your Laboratory

Crafting a detailed letter of offer/appoint-ment is of the utmost importance. Engagingthe postdoc in this process is a chance to“test drive” a working relationship. In myexperience dealing with both disgruntledscholars and disgruntled faculty members, Ihave found the lack of clarity around expec-tations to be common—one party generallyaccuses the other of failing to live up to hisor her part of an agreement.

Authorship concerns, access to researchdata after the postdoctoral period, and theexpectation for the length of the experienceshould be included in the appointment let-ter. You should include information aboutremuneration, moving costs, assistance withvisa issues, and other pertinent issues.Details related to what happens after theperiod of postdoctoral scholarship shouldbe discussed and documented. For exam-ple, will the postdoc have the option of

4 Academic Physician & Scientist ■ June 2008

Investing in a Postdoc for Your LabB Y R . K E V I N G R I G S B Y, D S W

C A R E E RWatch

R.Kevin Grigsby, DSW, is Vice Dean forFaculty and Administrative Affairs at

Pennsylvania State College of Medicine inHershey, PA. E-mail: kgrigsby@psu.edu.

Academic Physician & Scientist ■ June 2008 5

using the research data to build a founda-tion to support independent scholarship? Asavvy postdoc will expect training and men-torship in exchange for his or her contribu-tion to your science. You might think youdo not have time to deal with these details“up front.” Experience suggests that settingand documenting expectations before thecandidate agrees to come to your laboratorymakes life easier for the candidate andimproves the quality of the experience.5

More important, it makes life easier for you!

Be Prepared to Ask and Answer Questions

Good candidates will ask good questions,and so should you. After all, you are trying tofind a partner with whom you will share yourlife’s work. As a mentor, you will be sharingknowledge, expertise, and, to some degree,rewards with your postdoctoral colleague.Discussing the length of the commitment youare making to the postdoc and what youexpect in return should be a part of the con-versation. Although most postdocs are in thelaboratory for about two years,6 some facultysponsors may not have the resources to sup-port a postdoc for two years or may want acommitment of three or more years. Beexplicit in your answers and include them inthe offer or appointment letter.

You should be prepared to explainwhether your organization uses the NationalResearch Service Award (NRSA) stipendscale7 levels or a different formula for estab-lishing postdoctoral stipends. After acceptinga postdoc, but prior to his or her arrival, youmay want to work with him or her to preparean application for an NRSA PostdoctoralFellowship (F32) Award. This may enable theperson to arrive with some resources in hand.

Things are not the same all over; helpingthe candidate to understand differences inthe cost of living across the country can bevery helpful to candidates, as the differentialscan be remarkable. Several online calculatorsdesigned to compare the costs of living indifferent areas of the country are available.8

When the Postdoc ArrivesReview your expectations with the postdoc.Because these should be included in the let-ter of offer or appointment, there should beno surprises. If your university is a memberof the National Postdoctoral Association(and even if it is not), introducing the post-

doc to the NPA Web site is to your advan-tage.9 Likewise, if your campus has an officefor postdoctoral affairs, introduce yourscholar and link her or him to any orienta-tion classes offered.

Introducing the scholar to other postdocshelps the newcomer begin to establish asocial network of support for the newlyarrived scholar. Peer relationships are invalu-able to the newly arrived. One of the mostcommon mistakes I’ve seen made by men-tors is keeping postdoctoral scholars isolatedin the mistaken belief that it leads to maxi-mum productivity in the laboratory. Nothingcould be further from the truth! If the post-doc feels unsupported and isolated, produc-tivity is likely to be less robust than if thepostdoc feels supported both in and outsidethe laboratory. Helping the scholar to focus isimportant, but failing to establish a socialsupport network typically results in poorproductivity and, at times, early departure.

When It’s Over—LaunchingPostdoctoral Scholars

Too often, the “what’s next question” is notaddressed until very late in the process. Thisconversation should begin before the schol-ar arrives in your lab. Although this maysound premature, it is not. A candidateshould know whether he or she is expectedto find another position after the postdoc-toral period, whether he or she has theoption of employment at your institution

after the postdoctoral experience, and, if so,whether obtaining extramural funding isexpected. Engaging in conversation aboutwhat’s next should occur before the scholararrives, and should be repeated frequentlythrough the duration of the scholarshipperiod. You have an obligation to helplaunch the postdoc into the next phase ofhis or her career. In fact, the postdoc’s suc-cess will reflect favorably on you—and viceversa. Helping the postdoc to know what toexpect is in his or her—and your—bestinterest as you go about sharing success.

Notes1. Scheff J. Best places to work: postdocs. The

Scientist 2008;22(3):53. www.nsf.gov/statistics/infbrief/nsf08307/?govDel=USNSF_141,accessed April 4, 2008.

2. National Postdoctoral Association, www.nation-alpostdoc.org/site/c.eoJMIWOBIrH/b.1390015/apps/s/content.asp?ct=3524369, accessedApril 4, 2008.

3. Sigma Xi Postdoc Survey, http://postdoc.sigmaxi.org/, accessed April 7, 2008.

4. See http://aaas.sciencecareers.org/js.php, www.nationalpostdoc.org/site/c.eoJMIWOBIrH/b.1532377/k.8C40/NPA_Job_Board.htm, or www.acphysci.com/aps/app. Accessed April 4, 2008.

5. Sigma Xi Survey Offers Surprising Insights.www.sigmaxi.org/postdoc/release.html,accessed April 7, 2008.

6. Hoffer TB, Grigorian K, Hedberg E. Postdoc partic-ipation of science, engineering and health doctoraterecipients. National Science Foundation, March2008. www.nsf.gov/statistics/infbrief/nsf08307/?govDel=USNSF_141, accessed April 4, 2008.

7. National Institutes of Health. Revision: Ruth L.Kirschstein National Research Service Award(NRSA) Stipend and Other Budgetary LevelsEffective for Fiscal Year 2007. http://grants.nih.gov/grants/guide/notice-files/NOT-OD-07-057.html, accessed April 4, 2008.

8. CNNMoney.com. How far will my salary go inanother city? http://cgi.money.cnn.com/tools/costofliving/costofliving.html, accessed April 4,2008.

9. National Postdoctoral Association, www.nationalpostdoc.org/site/c.eoJMIWOBIrH/b.1388059/, accessed April 4, 2008.

“Before embarking on the search for a postdocfor your laboratory, you should carefullyassess your needs and ask: Is a postdocappropriate for the project, or would atechnician suffice? Are resources available tosupport a postdoc? Am I prepared to share?”

For an expanded version of this article, including additional tips

and references, visit the APS Website at www.acphysci.com.

AcknowledgmentThe author appreciates critical comments andsuggested edits from Rob Milner, PhD, Professorof Neural and Behavioral Science and Director,Office for Postdoctoral Affairs at PennsylvaniaState College of Medicine.

Despite dire predictions, academichealth centers (AHCs) continueto survive, and in some cases, to

thrive.1 All too often, however, conflictsamong departments, work units, andindividuals result in an organizationalenvironment that is less efficient and lesssatisfying for the individuals comprisingthe human element of the organization.Emotional pain is generated in the courseof everyday workplace activities. Leftunchecked, an undesirable by-productknown as organizational toxicity willemerge and manifest in a loss of self worth,feelings of hopelessness, and a loss of ener-gy and drive on the part of individuals inthe organization.2 Management of this painis necessary if an organization is to be suc-cessful in the creation of a workplacewhere working together adds value towork units, individuals, and the organiza-tion as a whole.

Recent contributions to the professionalbusiness literature have identified personswithin organizations who “voluntarilyshoulder the sadness and the anger that areendemic to organizational life.”3 These indi-viduals, known as toxin handlers, manageorganizational pain and, as such, are of great

strategic value. In AHCs, the dean of facultyaffairs or director of human resources fre-quently serves as a formal toxin handler and,as such, plays a critical role in managingorganizational pain. Typically, they are notthe only persons involved in mitigatingorganizational pain. In addition to individu-als who formally shoulder sadness andanger endemic to life in an organization,informal toxin handlers exist within organi-zations and are equally critical to the successof the organization. Formal toxin handlersare seldom acknowledged or rewarded formuch of this work within organizations, butinformal toxin handlers may be overlookedentirely, often at the expense of the individ-ual. These individuals may be deans,department chairs, division chiefs, or simplytrusted peers in the organization.Acknowledging their presence and reward-ing them for serving in this role leads toimproved organizational performance.

What Is Organizational Pain?Organizational pain is the emotional oraffective response of individuals in anorganization to events occurring in theeveryday life of the organization.Organizational pain is ubiquitous—andinevitable.

Painful events may be obvious, such asdownsizing and related layoffs, widely pub-licized accounting irregularities, and mergers(or failed mergers). Other painful events maybe less obvious, such as changes in leader-ship, a shift in organizational culture, or theloss of market share. Ineffective responses toorganizational pain detract from and, attimes, may destroy an environment con-ducive to success. The faulty belief that theorganization can ignore organizational painuntil it “blows over” often compounds theproblem. When an individual’s attitudes oran organization’s policies disregard “the emo-tional attachment people have to their con-tributions to work,” the result can be the cre-ation of an emotionally toxic environment.4

Role of the Toxin Handler It is critical that organizations understand therole of the toxin handler and, in turn,acknowledge and reward him or her for the

Academic Physician & Scientist (ISSN 1093-1139), a comprehensive source for recruitment news and classified advertising in academic medicine, is published 10 times a year by Lippincott Williams & Wilkins (LWW), a global medical publisher, and is endorsed by the Association of American Medical Colleges (AAMC), which represents the 125 accredited U.S. medical schools; the 16 accredited Canadian medical schools; some 400 major teachinghospitals, including Veterans Administration medical centers; more than 105,000 faculty in 98 academic and scientific societies; and the nation's 66,000 medical students and 97,000 residents. Subscription is free to all members of the academic medical community residing in the United States. For all others,annual paid subscription rates are: $96, US individuals; $131, U.S. institutions; $122, non-US individuals; $168, non-US institutions. ©2006 Lippincott Williams & Wilkins. Printed in the U.S.A. Opinions expressed by the authors and advertisers are their own and not necessarily those of theAAMC or of LWW. Neither the AAMC nor LWW guarantees, warrants, or endorses any product, service, or claim made or advertised in this publication.

C A R E E RWatch

Managing Organizational Pain in Academic Health Centers

B Y R . K E V I N G R I G S B Y, D S W

2 Academic Physician & Scientist ■ January 2006

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®

value added to the organization, as these per-sons play a key role in organizational success.

Toxin handlers alleviate organizationalpain in five ways. In formal and informalmeetings with individuals and group, they:❖ Listen empathetically.❖ Suggest solutions.❖ Work behind the scenes to prevent pain.❖ Carry the confidences of others.❖ Reframe difficult messages.5

The behavioral manifestation of empathet-ic listening is “lending an ear” to a colleague,student, or staff member when she or hehas experienced a painful organizationalevent. Sometimes, the toxin handler doesnothing more than to listen to another ven-tilate feelings of disappointment, anger, orfeeling neglected. Responses may includenothing more than “tell me more” or a nodof the head. Empathetic listening validatesthe speaker’s feelings. Even if the person’sperceptions are off-target, the toxin handler isexperiencing an emotional reaction to thoseperceptions. Although this may sound muchlike psychotherapy, it is not. The sole focus is,and should remain, limited to organizationalissues. It is neither fruitful nor appropriate forthe toxin handler to assume the role of ther-apist—although the work may be therapeu-tic in the context of the organization.

Suggesting solutions offers the opportu-nity to develop alternative perspectives andapproaches to resolving, reducing, or man-aging pain. This may take the form ofbrainstorming, recalling or reviewing whathas happened in the past in similar cases,or making the decision to involve moreformal actions to make the organizationalpain less intense.

Some toxin handlers have a proclivityfor working behind the scenes to prevent orga-nizational pain. This is not to say that theyare invested in trying to avoid experiencingpain. To the contrary, these persons have anuncanny ability to sense the potential forpain and to intervene to effectively preventits manifestation. In some cases, individualsmay be referred to as “natural peacemakers,”as they have no formal training in how toprevent pain—they just do it.

Carrying the confidences of others requiresthe toxin handler to be sensitive andrespectful of coworkers. Trust is paramount,as sensitive information about one’s feelingsis often shared in describing reactions toorganizational pain or to the potential fororganizational pain. When individuals

expect to have a “difficult conversation”with a coworker or if they have receivedpainful news, those individuals can oftenfind comfort sharing that information withsomeone he or she trusts.

Reframing difficult messages requirestranslation skills on the part of toxin han-dlers. Often, the intended message of thespeaker does not result in the expectedimpact of the message. The recipient of themessage may need assistance in understand-ing that she or he has misinterpreted theintended meaning. The linguist DeborahTannen describes this situation aptly: “Everytime we open our mouths to speak, we aretaking a leap of faith—faith that what we saywill be understood by our listeners, more orless as we mean it.”6 Misunderstanding canlead to both acute “flare-ups” of organiza-tional pain or to chronic pain in the organi-zation. Reframing involves stating the mes-sage in language familiar to the listener as ameans for helping the listener “get it.”

Value of the Toxin HandlerToxin handlers add value to organizations inmany ways. At present, rapid change is a factof life in most AHCs. Leadership turnover,declining bottom lines, and downsizing ofpersonnel can all be sources of organizationalpain, even during periods of relative organiza-tional stability. Organizational instability andrapid change can lead to acceleration in thegeneration of organizational pain. A climate inwhich uncertainty is rampant is often mani-fested in collective anxiety, a form of organiza-tional pain stemming from the ambiguityendemic to rapid organizational change.

Toxin handlers detect collective anxietyearly in the change process. They interveneto minimize and manage the pain, and bydoing so add value to the organization. Ineffect, toxin handlers play a critical role inthe creation of a humane workplace.

The Bottom Line:Recognizing, Supporting, and

Rewarding Toxin HandlersMoses et al. believe that two fundamentalchanges must occur in academic medicalcenters to meet the challenge of the future.They argue that the ties between academicand private practitioners must be strength-ened and that the organizational structureof AHCs must be simplified.7 As these fun-damental changes occur, organizationalpain will be endemic. Even in an ideal orga-nization, it is unlikely that management oforganizational pain will be systematic andcomprehensive. Toxin handlers, whetherformal or informal, will help to mitigate theorganizational pain that is a result of thestatus quo or as a result of rapid change.

Frost and Robinson recommend severalactions in support of toxin handlers. Thefirst is simply to acknowledge that toxinhandlers exist and serve an important role.Second is to create opportunities for toxinhandlers to share experiences with one

another and to support one anoth-er. In fact, the organization mayneed to import an expert on thetopic to facilitate the creation ofsupport networks. Finally, sometoxin handlers may need respitefrom the stressful environment ormay need to exit the stressful envi-ronment entirely.8

Ultimately, recognizing, support-ing, and rewarding toxic handlersin AHCs will help the organization

to function more effectively and efficient-ly—even in the midst of rapid change. ❖

References 1. Moses H, Thier SO, Matheson DHM. Why have

academic medical centers survived? JAMA2005;293:1495-1500.

2. Frost PJ. Toxic emotions at work. Boston:Harvard Business School Press, 2003.

3. Frost PJ, Robinson S. The toxic handler: organi-zational hero-and casualty. Harvard BusinessReview 1999 (July-August);97-106.

4. Frost, 2003, p. 56.5. Frost and Robinson, 1999, p. 99.6. Tannen D. Talking from 9 to 5. New York:

William Morrow and Co., 1994, p. 242.7. Moses et al, 2005, p. 1498.8. Frost and Robinson, 1999, pp. 102-104.

Academic Physician & Scientist ■ January 2006 3

"Organizational painis the emotional or

affective response ofindividuals in anorganization to

events occurring inthe everyday life ofthe organization."

For an expanded version of this article, visit the APS Web site

at www.acphysci.com.

Sears had a classic saying that itoffered to new trainees: “If youdon’t have time to do it right, how will

you ever have time to do it over?” A varia-tion on this theme applied today in aca-demic medicine might be: “If you don’thave the time/resources to nurture yourcurrent valued faculty, how will you everhave the time/resources to recruit his or herreplacement?”

In a perfect world our medical schoolswould be filled with just the right people allthe time. When we create a new position, asuitable candidate will be immediately avail-able to fill it. When a faculty memberannounces that they were leaving, the per-fect replacement would slide into positionas the departing colleague’s moving vanpulls out—a new candidate so perfect thathe or she would require no training or ori-entation and would slide into the slot “up tospeed” and ready to assume a full comple-ment of responsibilities.

It is no surprise that we do not live in aperfect world—we’re not even close. Infact, more often than not we operate atbelow-optimal staffing levels and often takefar longer than most of us feel we should torecruit, relocate and orient new faculty.

Some of this is unavoidable but the processcan be improved upon. More important,some faculty turnover need not occur at allif we maintain an effective process of facul-ty communication. (At a future time we’llexplore the benefits that should be presentin a well thought-out and executed recruit-ing process.)

Are You CommunicatingEffectively with Your Faculty?

There are several essential componentsinherent in an effective faculty communica-tion process. When they are present, wehave good to great outcomes. When theyare absent, we suffer disruptions in our mis-sion areas, loss of “customer” loyalty (notonly patients but also medical student andresident candidates), increased costs, anddiminished revenues. What is needed? Let

us start with these five major elements:1. Clearly articulated roles, goals and per-

formance expectations conveyed in awell-written and understood positiondescription. Includes objective andsubjective measures of performancethat are reported to the incumbent atappropriate intervals (at least annually)and discussed with their supervisor.

2. A well-defined and consistently appliedperformance evaluation process. Theprocess includes incumbent self-evalua-tion and goal setting for the year(s) aheadfollowed by face-to-face discussion witha supervisor who confirms and/or adjuststhe document to be consistent with theneeds and expectations of the operatingunit in which the individual resides.

3. Mechanisms for performance recognitionthat reward accomplishment of expectedgoals, as well as attainment of “stretch”goals that exceed minimum expectations.Longer-term recognition of performancecomes in the form of academic advance-ment and, for those who seek it,increased responsibilities associated withadvancement in the administrative ranksto section chief, chair, or dean.

4. An effective compensation review

Academic Physician & Scientist (ISSN 1093-1139), a comprehensive source for recruitment news and classified advertising in academic medicine, is published 10 times a year by Lippincott Williams & Wilkins (LWW), a global medical publisher, and is endorsed by the Association of American Medical Colleges (AAMC), which represents the 125 accredited U.S. medical schools; the 16 accredited Canadian medical schools; some 400 major teachinghospitals, including Veterans Administration medical centers; more than 105,000 faculty in 98 academic and scientific societies; and the nation's 66,000 medical students and 97,000 residents. Subscription is free to all members of the academic medical community residing in the United States. For all others,annual paid subscription rates are: $96, US individuals; $131, U.S. institutions; $122, non-US individuals; $168, non-US institutions. ©2005 Lippincott Williams & Wilkins. Printed in the U.S.A. Opinions expressed by the authors and advertisers are their own and not necessarily those of theAAMC or of LWW. Neither the AAMC nor LWW guarantees, warrants, or endorses any product, service, or claim made or advertised in this publication.

C A R E E RWatch

Retain or Replace: The True Costs of UnintendedFaculty Departures and How to Minimize Them

B Y D AV I D J . B A C H R A C H , F A C M P E / F A C H E

2 Academic Physician & Scientist ■ March 2005

David J. Bachrach has more than 30 years ofexperience in academic medicine administration

and provides leadership coaching to physician execu-tives in academic medical centers and teaching hospi-tals. He may be reached at The Physician Executive’sCoach, 2650 Juilliard Street, Boulder, CO 80305,(303) 497-0844 or www.PhysXCoach.com.

Editor: Deborah Wenger

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Associate Director of Production:Barbara Nakahara

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Publisher: Ken Senerth

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Director of Advertising Sales: Paul Tucker

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process that includes periodic examina-tion of marketplace and competitive fac-tors such that compensation (salary andbenefits) are set at levels that will allowan organization to attract and retain thefaculty they want and need to meet theirmulti-dimensional goals of teaching/research/patient care/administration.While it should go without saying, andit often doesn’t, this process shouldinclude equity reviews to affirm that anysalary differences are due to time-in-grade and demonstrated performancerather than gender/race or other factorsof diversity. Adjustments to achieveequity goals must often compete withmeritorious performance rewards forattention but should, in fact, be madebefore merit adjustments.

5. While performance excellence mayinclude noneconomic recognition, theharsh reality is that additional income(often in the form of incentive awardsthat do not become a part of the indi-vidual’s base compensation) is oftenthe best near-term motivator of suchperformance. As modest or robust assuch a mechanism may be, it should beobjective, unambiguously measured,consistently applied and equitablyawarded in a timely fashion based uponindividual and/or (as predetermined)group performance.While all these are essential to an effec-

tive process, I have found that the elementthat is often missing, or least well devel-oped, is that which deals with a welldefined, executed, and meaningful evalua-tion process.

Are You Maintaining an EffectiveEvaluation System?

Faculty turnover occurs, in part, when facul-ty do not know where they stand. Do yourfaculty know what you think of them? Dothey know what you expect of them? Do theyknow how they are doing? Is their view ofthemselves consistent with your view of them?If the answers to these questions leave thefaculty member in doubt, then whatevermechanism you presently have in placewould appear not to be working. Here aresome thoughts that may lead to a remedy.

The Role of the Chair in This Process

Chairs—as well as deans, in their relation-ship to chairs—have three priority func-tions, all essential and all of equal value. Ifeach of them is done well the chair is likelyto be judged a success; with one or moredone poorly, it will be difficult for the chairto succeed in his or her role. The time thatmust be committed to these activities willvary according to the size and complexity ofthe department, but a large department mayrequire that 50 to 60% of the chair’s time ifhe or she is to be successful—this is not apart-time job. The first of the three appliesmost directly to faculty retention.

❖ Recruit, nurture, cultivate, encourage,foster, mentor, promote (and, when nec-essary, discipline and even dismiss) thefaculty.

❖ Establish and communicate the vision ofthe department, consistent with thevision of the medical school, and trans-late this vision into individual and col-lective faculty activities, measures of per-formance, outcomes, and deliverables.

❖ Effectively steward resources: Garner,allocate/re-allocate, properly conserve,and apply to their highest-and-best usethe resources entrusted to them consis-tent with the objective of fulfilling themission of the organization (why does itexist?), advancing the organizationtoward its vision (where is it going?), andoperating within its principles (by whatrules does it operate?).

Retention is the GoalAre you able to keep the faculty you want?When you lose faculty to another institu-tion, is it because of legitimate reasons suchas a spousal move or promotion? If you arelosing faculty due to disenchantment or dis-

illusionment then there is an opportunity, aswell as a need, to fix the problem.

The cost of replacing faculty is consider-able. In recent publications on the subject J.Deane Waldman, MD, examines the ele-ments of cost for different categories ofemployee within an academic health cen-ter.1 When the components of recruiting,lost productivity during training of the newemployee, lost efficiencies of others in theunit, and lost revenues are factored in, thiscost may amount to as much as 5% of theoperating budget of the academic medicalcenter (AMC). In an organization with5100 employees (including 625 physi-cians) and a $500 million annual budget,that amounts to $25 million. It is not diffi-cult to imagine that a far smaller investmentin systems and processes, coupled with amodest investment in a competitive com-pensation strategy, could be easily accom-modated within the scope of this figure.

Where Do We Go from Here?While some will elect to maintain a “busi-ness as usual” approach, and thus are like-ly to continue to be faced with costly facul-ty turnover, others will venture forth with a

commitment to an effective evaluation toolthat is consistently applied in a timely fash-ion across the faculty. This may best be doneby the dean committing to the process byapplying it to the chairs whom he or she isresponsible for evaluating. While thisrequires a considerable amount of time toimplement, once in place the benefitsreceived year after year far outweigh the typ-ical annual time commitment. Further, themost effective programs will not be “stand-alone” but rather will be an integral part ofan enhanced communication program thatgoes beyond evaluation to include other fac-tors that lead to an improved sense of com-munity within the institution. All such pro-grams lead to a stronger, more resilient, andthus more effective organization. ❖

Note1. Waldman JD et al. The shocking cost of turnover

in health care. Health Care Management Review2004;29(1):2-7 and Waldman JD et al.Measuring retention rather than turnover: a dif-ferent and complementary HR calculus. HumanResources Planning 2004;27(3).

"The element that isoften missing is thatwhich deals with a

well defined,executed, and

meaningfulevaluation process."

Academic Physician & Scientist ■ March 2005 3

Career Watch

continued from page 2

For an expanded version of this article, visit the APS Web site

at www.acphysci.com.

Academic Physician & Scientist is endorsed by the AAMC and is published by Lippincott Williams & Wilkins.

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for listings of positions in academic

medicine

September 2005

See pages 6-8 for these topics and others

HHIGHLIGHTSIGHLIGHTS FFRROMOM

ACADEMIC MEDICINETHE JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES

www.academicmedicine.org

▼ The Complex Relationship BetweenOsteopathic Medicine and Primary Care

▼ Achieving a Balance of Power Between Medical Schools and Teaching Hospitals

▼ Evaluation of a Faculty Development Program in Palliative Care

▼ Learning Styles Affect Efficacy of CME Programs

THE COMPREHENSIVE S INGLE SOURCE FOR RECRUITMENT IN ACADEMIC MEDICINE

Strategies for Successful Faculty Retention

B Y D E B O R A H C . K . W E N G E R

Spotlight on:ORTHOPEDICS

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wwwwww.acph.acphysci.comysci.comfor expanded versions of APS articlesand for weekly updates of positions

listed for academic medicine.

Developing a stable academic depart-ment virtually from the ground up is achallenge under any circumstances in

today’s climate. It is an even greater challengefor an orthopedics department affiliated with apublic hospital, which receives no directresearch support from its institution. Yet theDepartment of Orthopaedic Surgery at DenverHealth Medical Center has done just that, mov-ing from a one-person department in 1998 toits current 12 physicians—all with a subspe-cialty focus, and establishing a research depart-ment in only eight years.

“People who go into academics are few innumber and have significantly different inter-ests and needs” from orthopedists who go intoprivate practice, says Wade R. Smith, MD,Director of Orthopaedic Surgery at DenverHealth Medical Center and Associate Professorat University of Colorado Health SciencesCenter. “We have to try to make sure that wefulfill those needs. Teaching, research, theopportunity to develop in a focused area, cre-ativity in lifestyle—if you can offer those things,that will keep that small group of people wholike academics happy.”

The key is “keeping the work environmentbalanced with the hospital’s need to be produc-tive and run a good business,” Dr. Smith con-tinues. His department functions in a synergis-tic way with the other three hospitals in the

institution’s system. “We’re the trauma portionof the University of Colorado,” he explains.“We see the highest volume of patients everymonth. It’s very intense, but it decreases thepressure on the other hospitals in the system,so they can focus on other services.”

Concentrating trauma services in onearea among the four hospitals frees upother orthopedic surgeons to focus on thesubspecialties of their choice. Dr. Smithelucidates: “Elective surgeons havegone into academics because theywant to work at an advancedtertiary level; they’re doing

Continued on page 4

I N S I D E

Page 2

Career WatchDeciphering theOrganizational

Culture andDeveloping

Political Savvy by Janet Bickel, MA

Skipjack ProjectHow Should Medical Schools

Respond to the ChangingExpectations of Students?

by Cathy J. Lazarus, MD

Page 5

their own research and they’re never going tobe good trauma surgeons. University hospi-tals that are not willing to support a strongtrauma program will force these surgeons totake call, which is meaningless in terms oftheir academic interests. If you can get thingsfocused—if you can establish a separate hos-pital or academic department that hasenough people who are compensated appro-priately and have the academic incentive toform a trauma program, they will also enablethe elective portion to grow.”

TransparencyTransparency is another key feature of thedepartment. “We run a very open depart-ment,” Dr. Smith observes. “We’re all salaried,and our salaries are competitive enough sothat we can hire top-quality people, and thefact that there are no financial incentivesbecomes irrelevant. Because they’re not com-peting with each other, they work bettertogether, which improves the quality of care.

“We have no hidden pool of money.Everyone knows what everyone else makesand we make all our financial decisionsopenly. We have economic, financial, andpolitical realities just like any business, butin general, all decisions are made transpar-ently, with input from every level.”

Research and Mentoring“You have to make it clear to the people youhire that research is part of the job,” says Dr.Smith. “We mentor them, but we also haveaccountability that works within the systemfor productivity.” Mentoring takes place on anumber of different levels. “We have a resi-dent research program within the university,and we have initiated a formal research men-toring program to teach young researchershow to be mentors for residents. This hasalso proven to be a great way to teachresearchers how to do research—in reality,you’re mentoring them too.

“In our department, we sit down withnew faculty and outline their goals and areas

of interest and we create timelines. If theirinterests aren’t obviously available here,we’ll figure out how to change that.”

Kagan Ozer, MD, Assistant Professor atthe University of Colorado Health SciencesCenter, gives a concrete example of how thesystem works: “Working in a level 1 traumacenter is the challenge that attracted me themost. I am a hand/microsurgeon who previ-ously spent quite some time in microvascu-lar research; we are currently setting up amicrovascular lab for research and training.”

One of the catalysts for a successfulresearch program is, of course, funding. Inthese strained financial times, funding mustarise from a variety of sources. “If you havea critical mass of initial research in yourdepartment and your group works togetherand keeps good records, you can start toaccumulate some industry research money,which can become seed money for biggerstudies and peer-reviewed grants,” Dr.Smith notes. “We’re currently approximate-ly 60% funded by industry grants and 40%peer-review funded, but we hope to reversethat to 60-40 the other way soon.”

“Most people who remain in academiaare interested in research, teaching, or both.The ‘carrot’ for them is to have strongresearch support, having a research depart-ment that is large enough to run clinical andnonclinical studies,” says Steven J. Morgan,MD, Associate Professor of Orthopedics andResidency Program Director at University ofColorado School of Medicine. Ideally, hesays, the institution should support fundingto the extent that the core of the researchdepartment should not be dependent onoutside funding. “The pressure is always onto get funding. Some research will not befunded at all, ultimately not every study isgoing to get peer-reviewed funding. Thereought to be a core of research support that isfunded by the institution. The general prac-tice, however, is to offer someone fundingfor the first few years; then they are requiredto become self-supporting. In many casesthe emphasis of the researcher then ulti-mately becomes locating funding sources asopposed to research. A quality partially sup-

ported research department alleviates someof this stress. You have to have some sort ofcore resources available to do research.”

Funding, of course, is not the only “car-rot” for researchers, particularly in thisdepartment. “You also have to make it a funplace to work,” says Dr. Morgan. There areother incentives as well for those inclined toacademic careers. “People typically don’thave to build a practice in these institutions.There’s a large volume of patients that youcan care for, so the system allows people toconcentrate on their areas of interest. Youcan just focus on your own area withouthaving to spend time on other things.

“If people have an acumen for acade-mics, we try to steer them in that direction.Trainees are introduced to research duringresidency; they have to do two research pro-jects over five years. They participate in theresearch process from start to finish—theywork on developing the research, recruitingfunding, doing the research, and producinga publication-quality paper.”

Directions and GoalsDr. Morgan reports that the department isattempting to develop a researcher residen-cy program, in which the resident will beplaced on an academic track that will incor-porate one or two years of mentoredresearch during the course of the residency.“We could do a better job of rocketing theminto academic positions if we train them thatway,” he says. “If you can identify someoneearly, as they enter the residency program,they can get the mentoring to be a goodclinician and a good scientist. They’d alsoget a head start on building a body of workthat would enable them to compete forpeer-reviewed research grants.”

“Our department is going to continue toexpand,” declares Dr. Smith. “Our realgoals are to continue our education mis-sion in training trauma fellows from allover the world, as well as continuing toexpand our research in trauma and ourpatient care volume.

“You can never expand until you suf-fer—your suffering will prove that you needto grow.” ❖

4 Academic Physician & Scientist ■ September 2005

Orthopedic Faculty Retention

continued from page 1

For an expanded version of this article, visit the APS Web site

at www.acphysci.com.

The key is ‘keeping the work environment balanced with the

hospital's need to be productive and run a good business.’

One of the many challengesjunior faculty members face isknowing whom to trust. For

the most part, faculty, staff, students,and administrators welcome new facul-ty with open arms—at least, it usuallyappears this way. In the initial period ofappointment, introductions are offered,receptions are held, and efforts are made tohelp new faculty feel welcome.

After only a few weeks, however, routinehas returned, veterans have resumed theirroles, and the recruits have faded from viewas “the new faculty members.” This is a crit-ical time period, as the neophytes come torely on the few persons in the immediatevicinity who are willing to help them learn tonavigate the new organizational culture. Ofcourse, this process includes learning aboutthe various personalities and other subtletiesthat comprise the cultural landscape of theorganization. Inevitably, someone will shareless-than-flattering information about some-one else. Some comments may be no morethan idle chatter, but other revelations mayinclude intimate details of a highly personalor even sensational nature. Although therewas no intention of becoming involved,some persons may suddenly find themselvesdrawn into the trap of gossip.

What Is Gossip?The body of literature about gossip is signif-icant. Gossip is a key human social activity.1

As such, it has been studied by anthropolo-gists, sociologists, and linguists. Some soci-olinguists have focused on gossip, viewing itas a gendered form of communication.2

However, other research clearly demon-strates gossip is a social activity of bothmales and females.3 Levin and Arluke foundthat although women spent more time gos-siping than men and were more likely togossip about friends and family members,there were no significant sex differencesabout the derogatory tone of gossip.4

Gossip has a social function. While the

use of gossip as a means of social controlmay immediately come to mind, researchfindings suggest that gossip may serve as astrategy for enhancing the status of individ-uals.5 Through gossip, persons are recog-nized as members of a group, allowing par-ticipants to “negotiate aspects of groupmembership, and the inclusion or exclusionof others, by working out shared values.”6

No person living or working in proximity toothers is isolated from gossip. In academichealth centers (AHCs), the trap of gossip isnot limited to junior faculty. Everyone canbenefit from learning how to deal with gos-sip. Other persons seem to have an uncan-ny knack of becoming the topic of gossip.The seasoned faculty member has usuallyfound some way of managing her or hisinvolvement with gossip, but those who arenew to the organization need to find aneffective strategy for managing gossip.

Managing GossipOver the years, I have found it useful toview gossip as a technique people employ toexpress interpersonal conflict. Often, gossipis a tool used by persons who are unawareof more effective means of dealing with con-flict or who are unable to enhance their ownstatus in their organization through theirown accomplishments or contributions.Just as there are ways of eliminating, reduc-ing, or managing other conflicts, such as sig-nificant financial conflicts of interest, thereare techniques for successfully eliminating,reducing, or managing gossip and the relat-ed interpersonal conflicts.

Some organizational cultures embraceconflict, recognizing it is a part of humaninteraction that can be used to improve over-all organizational performance. Other orga-nizations seem to eschew conflict by deny-

ing, ignoring, or repressing it. Truth betold, conflict is inevitable. At best, it canonly be postponed. Likewise, gossip isinevitable. Denying, ignoring, or repress-ing gossip only makes things worse. Just

as it is unlikely interpersonal conflict will beeliminated in the workplace, it is unlikelygossip will be eliminated. As with other con-flicts, if gossip can’t be eliminated, it is bestto find strategies to reduce or manage it.

Strategies for GossipManagement

Some persons argue the best strategy tomanage gossip is not to respond when onehears it. “I just let it go in one ear and out theother” may sound reasonable. Behavioristswould argue that a verbal response to gossip“rewards” the speaker, leading to repetitionof gossip. It would seem that the response ofsilence would not constitute positive rein-forcement—but this is not the case. Theeuphemism “silence is consent” applies inthe case of gossip. Silence is often taken asagreement with the statement made by thespeaker—no matter how outrageous thestatement may be. Silence is not an effectiveresponse if one wants the gossiping party tocease and desist.

A verbal response is best. However,scolding the person for gossiping is unlikelyto be effective, especially if it is done in theview of others. Taking the person aside andclearly stating your lack of comfort may beeffective, but it may also alienate the otherperson. It is very difficult to communicateovert disapproval without the other personfeeling scolded or embarrassed.

One simple verbal response is to let theperson know you heard the comment, butthen to ask directly, “Why are you telling methis?” The advantage to this response istwofold: It puts the person on notice thatyou have heard the comment, and it placesthe responsibility for any action on them.You have not “accepted” the comment. Ofcourse, you should not repeat the comment

4 Academic Physician & Scientist � January 2007

The Deadly Trap of Gossip: A Pitfall for Junior Faculty B Y R . K E V I N G R I G S B Y, D S W

C A R E E RWatch

R.Kevin Grigsby, DSW, is Vice Dean for Faculty andAdministrative Affairs at Penn State College of

Medicine in Hershey, PA. E-mail: kgrigsby@psu.edu

Academic Physician & Scientist � January 2007 5

you heard to others.A similar verbal response is to ask the

speaker, “What do you want me to do withthis information?” Again, the speaker is puton notice that the comment has beenheard—but the comment has not beenaccepted. Instead, the responsibility forexplaining the rationale for the utterance isplaced on the speaker. Should the responseto your question be “I don’t know,” simplyacknowledging you heard the response bystating “OK, I wasn’t sure” is sufficient.

Another strategy to change the directionof the conversation is to politely reject thecomment with a more neutral response. Forexample, the remark is made: “You knowshe is such a flirt!” In turn, the response “Idon’t know her very well. Some people arejust really friendly” is more neutral and, as aresult, disarming. The initial remark has notbeen validated and no “scolding” hasoccurred. Responding to gossip with theretort: “You shouldn’t talk about other peo-ple. Shame on you!” is unlikely to stop thegossip. No one likes to be scolded, especial-ly in the view of others. In fact, this responsemay lead to the speaker becoming the nexttarget of gossip.

An additional strategy is to respond tothe gossip by asking for clarification. Forexample, the remark “He is so vain!” mightbe met with the question: “What do youmean?” or with the statement: “I don’t reallyunderstand what you mean.” Again, youhave not accepted or validated the remarkand you have placed the onus for explainingthe remark on the speaker.

Remaining on good terms with thespeaker is important, especially if the personis of higher status (senior faculty member),is a superior (division chief), or has controlover resources (office assistant). As a juniorfaculty member, you want to establish a rep-utation as a person who listens to others andis not aloof. At the same time, you want toavoid the dreaded trap of being labeled as agossip or of becoming the subject of gossip.This takes skill, as most of us never had spe-cific professional training as part of our cur-riculum as physicians and scientists.

Three Major RulesIn a recent Career Watch article, I stated,“Knowing when to keep one’s mouth shut isa virtue.”7 Nowhere is this more true thanwhen dealing with gossip. If a person is

identified and confirmed as the source ofgossip, the ability to create trusting relation-ships and to establish credibility will beseverely compromised.

The first two rules should be followed toestablish and maintain trust and credibility:

1. Don’t become a source or channel ofgossip, and

2. Even if you have been privy to gossip,don’t repeat it to anyone.

Following these rules and managing gos-sip encountered in the workplace does notguarantee overwhelming success. On theother hand, following these rules and manag-ing gossip can be a critical factor on the roadto engendering trust and credibility and, ulti-mately, being perceived by others as a personof integrity—an immensely helpful attributefor which we all strive.

Rule number three is often unstated orunderstated. It is critical to success, howev-er. Simply put, don’t engage in behavior thatcan lead to your becoming the subject ofgossip. Keep your personal affairs personal.Long hours in the laboratory or clinics mayleave little time for socialization outside theworkplace. Junior faculty may find them-selves drawn to coworkers, residents, post-doctoral scholars, or students. It may betempting to become involved in personalrelationships with those in closest proximi-ty, especially if there are similarities in age,interests, and in the developmental tasks ofentering a profession. It is important to bevery cognizant that things have changed.You are a faculty member and your behavior

will be judged differently. When studentsand residents begin dating, others scarcelynotice. If and when a faculty member beginsdating a coworker, a resident, a postdoctor-al scholar, or a student, however, everyonenotices and people start talking. You may bethe last to know that people are talkingabout you. In fact, you may not know untilit is too late, especially if the relationshipsours. You have worked very hard, investedheavily in your career, and, in turn, had tomake many sacrifices. You are on your wayto establishing credibility and a establishinga solid reputation as a professional. There isalways some risk of becoming the topic ofgossip, even if you don’t do anything todeserve it. You must ask yourself if it isworth the risk you take when you allowyour personal life to become the topic ofgossip. If you choose to bring your person-al life into the workplace, you should beprepared to endure the consequences.Those who have been in the world of theAHC for a long time will tell you it is notworth the risk, as we have all seen the neg-ative consequences brought about by allow-ing one’s personal life to become the topicdu jour in the workplace. ❖

References1. Dunbar R. Grooming, Gossip, and the Evolution of

Language. London: Faber and Faber, 1996.2. Thornborrow J, Morris D. Gossip as strategy: the

management if talk about others on reality TVshow “Big Brother.” J Sociolinguistics 2004;8(2):246–271.

3. Brenneis D. Telling troubles: narrative, conflict,and experience. In C. Briggs (ed.) DisorderlyDiscourse: Narrative, Conflict and Inequality.Oxford: Oxford University Press, 1996, pp.41–52.

4. Levin J, Arluke A. An exploratory analysis of sexdifferences in gossip. Sex Roles 1985;12(3–4):281–286.

5. McAndrew FT, Milenkovic MA. Of tabloids andfamily secrets: the evolutionary psychology ofgossip. J Appl Soc Psychol 2002;32(5):1064–1082.

6. Jaworski A, Coupland J. Othering in gossip:“you go out and have a laugh and you can pullyeah okay but like …“. Language in Society2005;34:667–694.

7. Grigsby RK. Are you really a team player?Academic Physician and Scientist 2006;July/August:4–5.

“Denying, ignoring, or repressing gossip only

makes things worse....As with other conflicts, if

gossip can’t be eliminated, it is best to find

strategies to reduce or manage it.”

For an expanded version of this article, including additional tacticsfor managing gossip, see the APSWeb site at www.acphysci.com.

Knowing when, how, and why toapologize isn’t easy. As with thepractice of medicine, proficien-

cy requires not only knowledge, butalso skill in the art of apology. We are allhuman—and, as such, fallible. Whether wecan admit it or not, we would love to beinfallible. A few folks may believe they areinfallible—but we all know that everyonemakes mistakes that may result in someemotional or physical injury to others. Asincere apology for those mistakes can go along way in promoting and maintainingpositive relationships with those who haveexperienced emotional or physical injurybecause of our errors.

What Is an Apology?Some persons and some organizations arebetter than others at dealing with interper-sonal or organizational conflict. Conflict ispervasive in human relationships. Althoughsome persons appear to be predisposed toact as “peacemakers,” this is certainly notthe norm. In the face of this fact, some orga-nizations, including a growing number ofacademic health centers (AHCs), offer con-flict management training to their facultyand staff. As a result (hopefully) conflicts aremore readily resolved or managed.

Even with conflict management training,sooner or later, we will find ourselves in theuncomfortable position of having beenwrong. At this time it is important toremember the even the best of us make mis-takes. When we make mistakes, most of uswill agree that acknowledging our error(s)and/or wrongdoing and offering a sincereapology is a reasonable response. The psy-chologist, marriage and family therapist,and pastoral counselor Carl Schneiderdefines apology as follows:

Apology involves the acknowledgement ofinjury with the acceptance of responsibility,affect (felt regret or shame—the person mustmean it), and vulnerability—the risking of

an acknowledgement without excuses.1

Knowing the definition of apology doesn’tmake apologizing any less difficult. Clearly, itis easier said than done. Acknowledging ourhuman frailty is sobering, to say the least, andmost persons are uncomfortable with makingsincere apologies. Most of us have not hadtraining in how and when to say “I’m sorry”other than being admonished by adults to“Say you’re sorry!” when we were children.Understanding the “when, why, and how” ofapology is a useful skill.

Types of ApologyAs children, we learned to admit when wewere wrong within interpersonal relation-ships. Different approaches may be neces-sary depending upon the nature of the situ-ation. In short, there are types of apology.Deborah Levi offers a “typology of apology”:❖ Tactical apology—when a person accused

of wrongdoing offers an apology that isrhetorical and strategic—and not neces-sary heartfelt.

❖ Explanation apology—when a personaccused of wrongdoing offers an apologythat is merely a gesture that is meant tocounter an accusation of wrongdoing. Infact, it may be used to defend the actionsof the accused.

❖ Formalistic apology—when a personaccused of wrongdoing offers an apologyafter being admonished to do so by anauthority figure—who may also be theindividual who suffered the wrongdoing.

❖ Happy ending apology—when a personaccused of wrongdoing fully acknowl-edges responsibility for the wrongdoingand is genuinely remorseful.2

One might question if any of the firstthree types are really apologies at all. In fact,

they are, but they don’t measure up qual-itatively nor are they as effective as the“happy ending” apology. Rather thandwelling on the first three types, this arti-cle focuses on making ethically sound

apologies designed to improve our relation-ships with others—happy endings.

When Is Apology Warranted?Barbara Kellerman makes the point: “Whenwe wrong someone we know, even uninten-tionally, we are generally expected to apolo-gize.”3 I think most of us agree and have thisexpectation of others. But do we really havethis expectation of ourselves? Do we reallyknow when an apology is warranted andwhen it is not? To complicate matters, socialroles may require different behaviors. Forexample, an apology to an individual familymember is markedly different than the CEOof an AHC publicly apologizing for a mis-take made in the AHC that resulted in thedeath of a patient. The complexity of AHCsrequires sincere apology that transcendsinterpersonal relationships, especially in sit-uations where a person or persons experi-enced “hurt” at the hands of an organiza-tion.4 Apologizing carries risk in bothcases—but the risks are very different, as adoctor speaks to a family member as anindividual and the CEO speaks for the col-lective. Likewise, in both cases, apology hasimplications—but the implications are typi-cally broad when one is in a leadership role,as in the case of the public apology by theCEO. An apology to an intimate is typicallymore limited, but no less important. Ourlives would be less complicated if we couldknow precisely when an apology is warrant-ed—and when it is not. In truth, there is nouniversal answer to the question of whenapology is warranted. It may be better tobase our decision to apologize on when oneis expected. Acknowledging injury andaccepting responsibility for causing aninjury allows us to meet the expectation ofothers.

4 Academic Physician & Scientist ■ June 2007

The Fine Art of Apology:When, Why, and How to Say ‘I’m Sorry’B Y R . K E V I N G R I G S B Y, D S W

C A R E E RWatch

R.Kevin Grigsby, DSW, is Vice Dean for Faculty andAdministrative Affairs at Penn State College of

Medicine in Hershey, PA. E-mail: kgrigsby@psu.edu.

Academic Physician & Scientist ■ June 2007 5

Why Is Apologizing Important?You may have heard the phrase, “Goodfences make good neighbors.” A corollarymight be: “Mending fences makes for goodneighborhoods.” Offering an apology pavesthe way for reconciliation and, in somecases, forgiveness. Aaron Lazare argues thateffective apologies must, at a minimum,meet one of seven psychological needs:❖ Dignity must be restored to the offended

party.❖ Both parties agree on a set of values. As

such, they agree that wrongdoingoccurred.

❖ It is clear to both parties that the offend-ed person was not responsible for theoffense.

❖ The offended person is assured that theoffense will not recur.

❖ The offended person witnesses theoffending party experiencing some typeof punishment.

❖ The offended person is compensated insome manner for experiencing theoffense.

❖ Offended persons have the opportunityto express their feelings about theoffenders, and, in some cases, are able togrieve the loss.5

Ideally, when the offended parties havemore than one need, all the needs would bemet by the apology. When an apology meetsthe needs of the offended party, forgive-ness—by the offended—is possible. Whenan apology is effective, the offended partyfeels lifted of a burden. In turn, forgivenesscan help the offender feel lifted of the bur-den of guilt.

How to ApologizeLearning how to apologize is similar tolearning any new behavior. It may feel awk-ward and may not be polished at first, butwith practice, everyone can learn to do it.There are several tips that will help you asyou learn how to apologize.

First of all, wait until the right time andyou are in the right place. Although publicapology is often appropriate, especiallywhen one is apologizing for the behavior ofa group or organization, discretion shouldbe used. Most apologies can and shouldhappen in a private setting. Remember, youwill be raising a topic that may recall a badexperience or bad feelings. Be respectful asyou approach this task.

Be direct and succinct in your approach.Acknowledge the fact that injury hasoccurred and then take responsibility forwhat happened. Be authentic in expressingyour remorse and demonstrate your vulner-ability. In other words, avoid excuses andoffer to repair the damage.

Even if you follow these steps, be pre-pared for rejection. Sometimes, the personapologizing has an expectation that theapology will lead to immediate forgivenessand acceptance. Forgiveness and acceptancemay take time. If you think of the offense asan emotional bruise, think of the healingprocess as the color changes we see as abruise heals. It may take a couple of weeksbefore the “natural” state has returned.

Listening to the response to our apolo-gies is important. In a previous CareerWatch column, I offered the advice:“Knowing when to keep one’s mouth shut isa virtue.”6 Keeping quiet may be very diffi-cult, as post-apology listening is not easy.We may hear unpleasant observations fromanother about our own shortcomings. Wemay hear the expression of anger or rage.We may have to endure a tearful episodethat, in turn, brings us to tears. One of theways we let others know we are trulyresponsible and accountable for our mis-takes is by listening to the other party ver-balize the feelings associated with ouractions. However, there are two positiveaspects that may emerge in this process.First, taking the time to listen creates anopportunity to hear an apology from the

offended party in response to our apology.The offended party may feel remorse abouthis or her behavior that preceded the event.He or she may be embarrassed by his or herbehavioral response to the offense. Any timestrong emotions are involved, the potentialfor “emotional bruising” increases. Second,we may hear the offended party forgive usfor our faulty behavior.

Use Apology to Everyone’sAdvantage

Too often, an apology is warranted, butnever happens. Resulting conflicts fester, attimes resulting in an adversarial legal processinvolving attorneys as the wronged partyseeks justice. There is a time and place forusing the adversarial process—but there aremany times when adversarial processescould be avoided altogether through theproper use of apology. A higher degree of“emotional intelligence” often leads to lessconflict in general.7 Individuals who are con-scientious in understanding organizationalculture and developing organizational savvymay be more adept at preventing, reducing,or managing interpersonal conflicts.8

Knowing when, why, and how to apologizewithin an organizational culture reflects ahigher degree of emotional intelligence.Whether we choose to be proactive or reac-tive, two things are sure: we will make mis-takes and conflict will not go away by itself ifwe are too proud to say “I’m sorry.” ❖

References1. Schneider C. “I’m sorry”: the power of apology

in mediation. Mediate.com www.mediate.com/articles/apology.cfm 2. Downloaded January 1,2007.

2. Levi DL. Note: the role of apology in mediation.NYU Law Rev 1997;72(5):1165-1210.

3. Kellerman B. When should a leader apologize-and when not? Harvard Bus Rev April 2006Reprint R0604D.

4. British Columbia Office of the Ombudsman.The power of apology: removing the legal barri-ers. Special Report no. 27 to the LegislativeAssembly of British Columbia, February 2006.

5. Lazare A. Making peace through apology.Greater Good Fall 2004:16-19.

6. Grigsby RK. Are you really a team player?Academic Physician and Scientist 2006;July/August:4-5.

7. Bachrach DJ. Emotional intelligence is impor-tant in determining leadership success. AcademicPhysician and Scientist 2004;January:1-3.

8. Bickel J. Deciphering the organizational cultureand developing political savvy. AcademicPhysician and Scientist 2005;September:1-3.

“There is a time and place for using the ad-versarial process—but there are many timeswhen adversarial processes could be avoidedaltogether through the proper use of apology.”

The complexities of academicmedical centers (AMCs)demand good leadership.

Hopefully, AMCs recognize good lead-ers for their contributions to the organi-zation. In spite of whether a personhas been a good leader or has not,every leader is subject to his or herown mortality—be it physical or pro-fessional. Changes in leadership areinevitable. Organizations—and lead-ers—are usually in a reactive positionto transitions in leadership each time aleadership vacancy occurs or a need fornew leadership is identified. However, thechoice to take a proactive approach offersadvantages. Succession planning, a deliber-ate process designed to promote organiza-tional stability during changes in leader-ship, is a useful tool that allowsorganizations to take a proactive approachto leadership transitions.

What Is Succession Planning?Succession planning is a rational andplanned approach to maintaining arefreshed, renewed, and vital organizationby promoting successful leadership transi-tions. Changes in leadership occur as a nat-ural and inevitable part of organizationallife. Planned transitions occur due to retire-

ment of key leaders or career advancementof key leaders within or outside the organi-zation. Unexpected departure of key leadersmay occur with the diagnosis or progressionof a serious illness, sudden death, termina-tion of employment, rapid advancementelsewhere, or reassignment of duties to fillanother leadership vacancy. Whetherplanned or unexpected, organizationsshould orient succession planning to bothimmediate and long-term leadership needs.

Advantages of Succession PlanningActive planning for transitions offers severaladvantages to the organization. A forward-thinking, rational transition process allows anorganization to promote or maintain contin-ued effective organizational performance over

time. Succession planning offers anopportunity to develop the next genera-tion of leaders and to retain the “knowl-edge assets” of the leader in the aftermathof his or her departure.

Everyone in a leadership positionneeds a succession plan. Successionplanning allows an individual to planfor his or her own professional future,whether accepting a new role, movingto the next phase in a career, transition-ing to another career, or returning to aprevious role, e.g. a department chair

returning to the teaching faculty.

Why Is It a Difficult Topic?Let’s face facts: It’s uncomfortable to

think and talk about one’s mortality. Mostof us don’t spend a lot of time thinkingabout or planning for “the worst.” Ofcourse, leadership transition isn’t usuallydeath in the literal sense, but it may repre-sent a form of “professional” death. As such,asking others to plan for “the end” is likelyto be unwelcome or misinterpreted unlessone is careful to include a discussion offuture options. Orientation to the future iscritical, because such options may in factlead to, or result in revitalization, renewal,and greater fulfillment.

Approaching succession planning with

Academic Physician & Scientist (ISSN 1093-1139), a comprehensive source for recruitment news and classified advertising in academic medicine, is published 10 times a year by Lippincott Williams & Wilkins (LWW), a global medical publisher, and is endorsed by the Association of American Medical Colleges (AAMC), which represents the 125 accredited U.S. medical schools; the 16 accredited Canadian medical schools; some 400 major teachinghospitals, including Veterans Administration medical centers; more than 105,000 faculty in 98 academic and scientific societies; and the nation's 66,000 medical students and 97,000 residents. Subscription is free to all members of the academic medical community residing in the United States. For all others,annual paid subscription rates are: $96, US individuals; $131, U.S. institutions; $122, non-US individuals; $168, non-US institutions. ©2005 Lippincott Williams & Wilkins. Printed in the U.S.A. Opinions expressed by the authors and advertisers are their own and not necessarily those of theAAMC or of LWW. Neither the AAMC nor LWW guarantees, warrants, or endorses any product, service, or claim made or advertised in this publication.

C A R E E RWatch

The Need for Succession PlanningBY LUANNE THORNDYKE, MD, AND R. KEVIN GRIGSBY, DSW

2 Academic Physician & Scientist ■ April 2005

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Luanne Thorndyke, MD, is the Associate Dean forProfessional Development and Associate Professor of

Medicine of the Penn State University College of Medicinein Hershey, PA. She is responsible for leading activities torecruit, sustain and retain faculty, and for post-graduateeducational programming for physicians, nurses, andallied health personnel. R. Kevin Grigsby, DSW is ViceDean for Faculty and Administrative Affairs andProfessor in the Department of Neural and BehavioralSciences at Penn State College of Medicine. He may bereached at kgrigsby@psu.edu.

attention to psychological understandingand sensitivity to the topic is important.Individuals may react as if “death” is immi-nent. Elisabeth Kubler-Ross identified stagesin the process of coming to terms withdeath. Although the leader may not bedying literally, the stages of denial, anger,bargaining, depression, and acceptance maybe demonstrated in response to a profes-sional “terminal prognosis.” Effective succes-sion planning encourages the leader to con-sciously acknowledge a “life after” the lead-ership transition.

As a result, succession planning is a topicoften neglected in many organizations.Without an effective plan for leadershiptransition, an organization may lose groundwhen the inevitable change in leadershipoccurs. Organizational stability and perfor-mance may be threatened by the leadershipvacancy. New leadership may be assigned tounprepared personnel. If succession plan-ning is an afterthought, the organizationmay experience a difficult “lesson learned”about the wisdom of planning for a stableand predictable future.

Start EarlySuccession planning should begin on the firstday on the job. A good starting point is toconduct an organizational assessment. Howdoes your organization plan for transitions inleadership? How do you plan for transitionsin leadership when you are the leader? Whatare the desirable knowledge/skills/behaviorsfor a particular leadership position? Throughassessing both the short-term and long-termneed for leadership, one can begin to identi-fy and develop key personnel over time.Evaluating and assessing current personnel aspotential successors should be an ongoingprocess. On the other hand, the organizationor individual should be prepared to look out-side the organization if internal talent isunavailable.

Engaging in developing, coaching, andmentoring potential successors is a soundinvestment, with both short term rewards aswell as long term pay-off. Through thisprocess, potential successors can be offeredthe opportunity to demonstrate skills on aninterim—and relatively safe—basis.Recognizing that future needs may requirenew or additional skills allows the organiza-tion and its leaders to be proactive in devel-oping leadership skills in current leadersand potential successors. Embedding the

expectation for succession planning in theannual performance review process offers amechanism to weave succession planninginto the fabric of the organization.

Enhancing the ProcessStart by acknowledging the uncomfortablenature of planning for and implementingtransitions. Explicitly identify competenciesneeded for the position. A changed behav-ioral repertoire can enhance the transitionprocess. Even so, the topic may be unwel-come (“This is too morbid!”) or misinterpret-ed (“Does this mean I’m going to get fired?”).

Organizations can prepare their leadersto incorporate succession planning in theirleadership portfolio by introducing the sub-ject to the leadership group. Individuals areless likely to feel singled out or threatenedwhen the topic is raised as a theoretical con-struct rather than as a request for response.It is important to acknowledge that the topicis uncomfortable and allow ample opportu-nity for frank discussion. Emphasizing thepositive aspects of succession planning will

help leaders to accept it as a strategy for“protecting investment” in the organization.

Leaders want to be seen as vital to the lifeand success of the organization. An unex-pressed wish may be that “the whole placewill fall apart when I am gone” and rein-forces a sense of self-importance. Effectivesuccession planning is difficult in this mind-set. A better perspective on succession plan-ning is to view it as a specific type of men-toring designed to “build a legacy” within theorganization. Mentoring for succession pro-vides for the retention of the “knowledgeassets” of the leader and leaves a continuingimprint upon the organization. From thisperspective, the leader can cultivate and per-petuate impact that will transcend thechange of personnel.

Organizations need to recognize and rein-force effective grooming and mentoring, par-ticularly in the area of administrative leader-ship. In some organizations, an effort todevelop and establish a culture of mentoringwithin the organization may be needed.Public, tangible support for the process ofsuccession planning can be provided throughtransition workshops for new (and old) lead-ers. Discussion of succession planning is anecessary introduction to this often-neglect-ed topic. Additional training may be neededto fill gaps in skill sets, including the art andskill of mentoring. Again, using the annual

performance evaluation process presentsan opportunity to introduce the conceptof succession planning and offers a mech-anism to incorporate succession planningas routine within the organization. Transitions in leadership are inevitable. Aproactive pursuit is better than reactiveresponse. Organizations should establishan expectation of succession planning asa necessary part of planning for the

future. Grooming a potential successor is aform of strategic mentoring, and investingone’s knowledge assets for the benefit of theorganization. Ideally, leaders should startearly but the point is that it is important tostart. Leaders may need to learn new skillsto maintain their effectiveness and to engagein this type of planning. The organizationmay need to look outside for new talent.Individually, succession planning is plan-ning for the future. The topic is uncomfort-able, but it can be woven into the fabric ofthe organization by making it an expectationfor all leaders and cultivating the concept ofbuilding a leadership legacy. ❖

Academic Physician & Scientist ■ April 2005 3

Luanne Thorndyke:"Succession planningis a useful tool thatallows organizations

to take aproactive approach

to leadershiptransitions."

For an expanded version of this article, visit the APS Web site

at www.acphysci.com.

R. Kevin Grigsby:"Succession planningoffers an opportunityto develop the next

generationof leaders."

4 Academic Physician & Scientist ■ March 2009

At the 2007 Annual Meeting of theAssociation of American MedicalColleges, there was a presentation

titled “Who’s on Your Personal LeadershipBoard.” This concept was developed toemphasize that effective leaders (and all fac-ulty) need a mosaic of advisors or a circle ofcolleagues to provide advice, feedback,expertise, and counsel.1,2 In contrast to tra-ditional models of mentoring, this “mosaicof advisors” may include experts, politicalstrategists, confidants, sounding boards,boosters/cheerleaders, peer colleagues, andexecutive coaches, among others. The notionof a personal leadership or advisory boardspeaks to the need for a range of personaland professional support, advice, and polit-ical acumen in dealing with the complexenvironment of the academic health center.

Coaching and the PersonalLeadership/Advisory Board

Executive coaches are important membersof a personal leadership or advisory board incareer management.3 Long a part of the cor-porate world, coaching has begun to beembraced in academia and academic healthcenters because of the need to maximize anorganization’s significant investment in tal-ent, particularly critical in the current high-stakes, complex, fast-paced, and changingenvironment. Coaches can assist with strate-gic career planning, help with technicalissues in the job campaign (e.g., cover let-ters, preparing the executive summary,interviews, negotiations), provide supportduring transitions in the workplace, helpleaders to “hit the ground running,” developnew skills needed, and assess the changingenvironment and the best strategic responseto it.4,5 Executive coaches afford a confiden-tial, independent sounding board—the val-ued and dispassionate “third opinion”coined by Saj-nicole Joni.6

Although they may be trained as such,coaches are not functioning as mentors, ther-apists, or employment lawyers while theyare engaged in the coaching relationship;

rather, they establish the coaching relationshipas a “safe place” where professional and per-sonal issues related to advancement andsuccess in the workplace can be safely airedand addressed. In a recent study, executivecoaches noted that although they werehired 97% of the time to address profes-sional issues, they assisted their clients withpersonal issues 76% of the time.3

Selecting CoachesAs suggested above, coaches come from awide range of backgrounds and variousfields of expertise. Although executivecoaches typically work one-on-one with aclient, it is important to note that no singleindividual has all the answers. Of criticalimportance to the success of coaching aretwo parameters: (1) the rapport and respectthat develop between coach and coachingclient, and (2) the coach’s particular exper-tise in relation to the client’s needs.3 Typicalcategories of expertise might include:❖ Coaches with human resources or orga-

nizational development experience areparticularly useful when an academicleader needs to assess a unit such as adivision or department, decide the opti-mum structure and job descriptions,and manage personnel throughout thehiring, development, and accountabilityprocesses.

❖ Coaches with career counseling exper-tise may be particularly valuable when

someone wishes to make a strategic careerplan, manage a career or job transition,or conduct a job campaign.

❖ Coaches with a clinical psychology orsociology background bring invaluableperspective and skills to leaders whomay be superb at the technical aspects oftheir jobs, but wish to improve theirinterpersonal skills and relationshipswith bosses, peers, and direct reports.

❖ Coaches who come with a business back-ground bring expertise to areas such asfinancial management.

❖ Coaches who have “been there, donethat”—such as former chairs or deans—may be just the right people to coach anew chair or dean because of their directexperience and perspective.

The Co-Coaching ConceptCo-coaching offers another approach to exec-utive coaching, and may have advantages incertain situations, essentially offering a “two-for-one” benefit for the client. Co-coachingrefers to two individuals working simultane-ously with a single client. Both coaches aretypically present during phone or face-to-facemeetings, and both review and provide inputto written material, such as executive sum-maries, strategic plans, and the like.

Co-coaching offers several benefits:❖ Multiple perspectives of the coaching

team help avoid blind spots based on thelimited perspective of a single coach.

❖ Overlapping and distinct expertisecan provide a unique combination ofskills that can be particularly useful incertain situations, e.g., a psychology back-ground (for the inevitable need to increaseinterpersonal skills as one moves intoleadership) and career counseling exper-tise (for the equally critical need forincreased strategic focus and ability tonavigate political waters).

❖ Coverage is greater; one of the two con-sultants is generally available at all times.

❖ Two styles of presenting may help toprovide hard-to-hear feedback, which

What Is Team Coaching, and Why Use Co-Coaches?B Y J U D I T H K A P U S T I N K AT Z , E d D , S A L L Y R O S E N , M D , M F S , A N DP A G E M O R A H A N , P h D

C A R E E RWatch

Judith Kapustin Katz, EdD, Sally E. Rosen,MD, and Page S. Morahan, PhD, work

with scientists and faculty to provide strategicplanning for rewarding careers. They areindependent consultants and members of theExecutive Leadership in Academic Medicine(ELAM) Leadership Program ConsultingAlliance (www.elamalliance.org). ContactDr. Rosen at 610-574-3991 or Sally.Rosen@comcast.net, Dr. Morahan at 215-947-6542or psmorahan@att.net and Dr. Katz at 610-664-4785 or katzknect@aol.com.

Academic Physician & Scientist ■ March 2009 5

therefore may be more likely to be“heard” by the client.

❖ Co-coaching helps the client understandthe benefits of obtaining more than oneperspective, reinforcing the concept of apersonal leadership/advisory board, andlessening the likelihood of developingdependency on any one resource.3

There are additional benefits for thecoach. Executive coaching can be an isolat-ed and isolating profession. Co-coachingaffords an instant consultative, collegial pro-fessional “network,” where professionalopinions can be shared and strategies for theclient can be discussed in a confidentialenvironment.

Co-Coaching Case StudiesCase 1. Toxic Work Environment: A highlysuccessful senior physician faculty membertakes an executive level position at an academ-ic medical center. Within a short period of time,there is an unanticipated change in leadershipat the institution. The senior physician, newlyappointed to his position, suddenly finds himselfthe target of mistreatment—petty harassmentover budget/travel expenses, exclusion fromkey meetings—and he is not sure how to pro-ceed strategically to preserve his career. Does heremain on the job, hoping that things willimprove? Should he plan to transition to a newposition? How does he cope with the emotionaltoll of trying to make these strategic career deci-sions while remaining “successful” in his currentposition?

In this example, the client needs to focuson strategies to navigate a treacherous polit-ical terrain while preserving his professionalintegrity, and also deal with the psychologi-cal impact of working in a toxic environ-ment. Team coaching, with both the focuson strategic career planning and thepsychological perspective, can offer supportfor a difficult day-to-day situation and pro-vide help in strategizing next steps. And incomplex situations like this, additions to thePersonal Leadership/Advisory Board, suchas employment lawyers, may be needed, aswell as support from others who have expe-rienced similar situations.

Case 2. New Leadership Position: An asso-ciate professor of medicine, who is currentlyserving as a division director, wants to begin toconsider applying for chair positions. Althoughshe is very accomplished and recognized for her

expertise in her field, she has not applied for anew position in years, let alone a position atanother institution. She has always been “sec-ond in command.” Additionally, she has somedoubts about her ability to assume a higher levelof leadership and already feels like an“imposter” in her current position—she is con-cerned that if she takes a chair position, eventhough this is her career goal, everyone willrealize that she is an “imposter.” She eventuallysuccessfully obtains a chair position, which is agreat fit for her, but she finds herself hesitatingto jump in and assume the mantle of leader-ship—of being the one in charge.

In this example, the client initially needssupport and assistance in the job campaignfor a new leadership position, includinghelp with technical issues such as preparingthe executive summary and working with asearch firm. Once she secures the desiredposition, she must deal with the psycholog-ical aspects of her fear of being “found out”as an imposter in order to be successful.Again, team coaching might be of help, asboth aspects—the strategic as well as theinterpersonal—are critical for the ultimatesuccess of this individual.

Co-Coaching and theLeadership Continuum

The leadership continuum concept has beenproposed as a way of viewing the actual-ization of the goals for advancement and

success in leadership.7 The continuum hasfour repeating cycles: preparing for leader-ship; transitioning into leadership; ensuringsuccess; and transitioning again from oneleadership position to another. Co-coaching,with focus on the combination of (1) inter-personal, (2) communication style, and(3) strategic career issues, may be particu-larly helpful in the following situationsduring the cycles of the leadership continu-um (see more details in the full article on theAPS Web site):❖ Transition into leadership.❖ Strategic risk taking.❖ Becoming comfortable with power

“with” as well as “over.”❖ Making and traversing the decision to

move on.

ConclusionIn summary, executive coaching with asingle coach or a co-coaching duo can bea useful addition to the personal leader-ship/advisory board. This is anotherapproach to add to one’s career consultingrepertoire. In the complex environmentsof the academy and/or the academic healthcenter, leaders will benefit from diverseexpertise and experience with a personaland professional leadership/advisoryboard that is at the ready in order to assuretheir sustained success. ❖

References

1. Morahan PS. How to find and be your own bestmentor. Academic Physician & Scientist Nov-Dec2000;8.

2. Morzinski JA, Fisher J. A nationwide study ofthe influence of faculty development programson colleague relationships. Acad Med 2002;77:402–406.

3. Coutu D, Karrman C. What coaches can do foryou. Harvard Bus Rev January 2009:91-97.

4. Ciampa D, Watkins M. Right from the Start—Taking Charge in a New Leadership Role.Cambridge, MA: Harvard Business Press, 1999.

5. Watkins M. The First 90 Days. Cambridge, MA:Harvard Business Press, 2003.

6. Merrill-Sands D. Commentary on the thirdopinion. Reflections 2005;6:12.

7. Morahan P, Rosen S, Gleason KA, Richman RC.A continuum of leadership development—model for sustained success for women leadersin academic medicine. Faculty Vitae. AAMC,Winter 2009. www.aamc.org.

Sally E. Rosen, MD: “The notion of apersonal leadership or advisory boardspeaks to the need for a range of personaland professional support, advice, andpolitical acumen.”

For an expanded version of this article, visit the APS Web site at

www.acphysci.com.

4 Academic Physician & Scientist ■ November/December 2008

You’ve been offered the chair of adepartment at a different medicalschool and have been impressed

with the way the search process has beenhandled over the past six months. You havesubmitted a carefully thought out visionstatement for the department and the deanhas accepted it in principle. You now havebeen asked to construct a comprehensivestatement of expectations and resourceneeds. You have been invited to communi-cate with the school’s associate deans con-cerning any other information you feel youmay need before next month’s final visit.

The information you have receivedthroughout the search process has beenhelpful and quite comprehensive, but youare now wondering what questions youhaven’t asked, and what further informationyou should have in order to make a firmand final decision.

Most people undergo such a significant,life-changing decision only a few times intheir careers, and although they may getadvice from others who have been throughthe process, the best guidance may comefrom those who negotiate these packages allthe time, even those who have done so fromthe “other side of the table.” Here are somethings you can do to help you answer thequestion, “Do I know enough to accept thisposition?”

What Information Do I Need to Make a Decision?

The Personal PackageLet’s get the personal part of the package outof the way. Get information on competitivesalaries for chairs in your discipline. Thebest source will be through your currentchair, the department administrator, or yourinstitution’s associate dean for faculty affairsor administration and finance—if you arecomfortable revealing that you are in asearch. Otherwise, you may need to workthrough a colleague at another institution

or ask your new institution to provide doc-umentation. These individuals likely haveaccess to AAMC salary data and/or data col-lected by your discipline’s society of depart-ment chairs.

You should propose a salary either at orabove the AAMC’s 50th percentile, or deter-mine whether the school has a practice ofcompensating all its chairs at a given per-centile level. Upward adjustments in highhousing cost areas, or access to housing/mortgage support funds, may be discussed.Many schools offer an incentive componenttied to the chair’s leadership performance,although some either guarantee this in thefirst year or add it to the compensationpackage as a part of setting goals for yeartwo and beyond.

Basic benefit packages are probably notnegotiable, but some elements of the pack-age may be discussed, including startingdate; relocation costs for family members,household contents, automobiles, and office/laboratory equipment; office/laboratory ren-ovations; office/mobile equipment, such ascomputers and cell phones; interim housingand travel between acceptance and reloca-tion dates; interim travel for up to one yearif your family doesn’t relocate at the sametime that you commence your new role; andleadership coaching support for your firstyear or two.

The Chair’s Leadership Package You will undoubtedly get advice fromfriends and colleagues concerning the nego-tiation process. There are often two thingstold to people in your position at this time:

(1) Whatever you do, get it now and get itin writing! And (2) More is better—and a lotmore is better still (sometime referred to as“package envy”).

However, here are some things you reallyneed to know:❖ The offer needs to be “sufficient”—not

necessarily large, but sufficient to get thejob done. Accordingly, it’s the programdescription that you have put forward, thetimeline for its accomplishment, and themeasures of success that need to bepinned down in writing, more so than theprecise resources you will receive—although it is important to build and agreeon an inventory of resources, as describedbelow.

❖ You will not be able to anticipate every-thing you will need to be successful overthe next five to 10 years—no one can. Assuch, it is more important that you, thedean, and the senior staff in medicaladministration agree in writing to theprinciple that, within reason, resourcesneeded to be successful that are not com-mitted to as a part of the offer will beprovided in good faith in the future, tothe degree that the institution canrespond at that time.

❖ It is important is that you and the deanmutually agree to the following princi-ple: “If I lead the department to a level ofperformance equal to or greater than thatwhich has been described in your offerand my acceptance, I will have access toadditional resources to take the depart-ment to the next level, as I will describein my rolling five-year vision statementand action plan.” Most deans will wel-come such a discussion, as it speaks toyour focus on accomplishment, and notjust a large package of resources for thesake of bragging rights.There is rarely as much information

available to you as you would like; you willneed to trust those with whom you havebeen dealing and will depend on at your

You’ve Been Offered the Chair…But DoYou Know Enough to Take It?B Y D AV I D J . B A C H R A C H

C A R E E RWatch

David J. Bachrach has more than 35 yearsof experience in academic medicine. For

the past 10 years he has been providing lead-ership coaching services to physicians in aca-demic medical centers and teaching hospitals.E-mail: PhysXCoach@aol.com; phone: 303-497-0844; Web site: www.PhysXCoach.com.

Academic Physician & Scientist ■ November/December 2008 5

new institution. Your confidence in thecommitments of others can be enhancedby taking a number of simple steps. First,plan your final visit to include one-on-onevisits with the chairs who are the “powerbrokers” at the institution; include chairswho have been recruited by the incumbentdean in the past three years, as they can tellyou how well commitments are honored.Further, meet with the search committee toconvey that you intend to call on themonce you arrive to assist with your transi-tion. And third, at many institutions one ormore of the associate deans are involved indeveloping and negotiating chair packages.With so many contributors, I have wit-nessed various levels of clarity—and ambi-guity—in offer letters. It is important thatif they do not do so, you should develop areference document that specifies commit-ments, and make it a part of the offer doc-umentation.

Inventory of Current and Incremental Resources

Most recruitment package negotiations arebuilt on a commitment to incrementalresources: “How much [positions/space forvarious functions/dollars] will you add tothe department’s resource base as a part ofmy recruitment?” In my judgment, the best-constructed offer packages describe allresources accessible to the new chair—thosethat now exist and those that will be addedas a part of this commitment. Here is someinformation to ask for as you prepare foryour visit:❖ People: Ask for a list of all faculty, by

subdiscipline, rank, age (yes, you can askfor this information), and any commen-tary on likely duration of tenure with theinstitution. A discussion in advance ofyour visit with the associate dean for fac-ulty affairs regarding these data, and thepolicies and practices followed by theinstitution concerning adjustments infaculty appointments, will let you knowhow much flexibility you will have toshape the department in the next fewyears, and thus will provide additionaljustification for how many new positions(and core support) you will need torequest.

❖ Space: An inventory of all space in thedepartment (including annotations aboutthe condition of the space and its suit-

ability to support the programs you havedescribed) is essential before you starttalking about incremental space or large,nonrecurring dollar allocations forremodeling or new construction. Adepartment with grossly outdated spacewill require a larger package for remod-eling than one that has access to new,well-designed space.

❖ Schedules of existing resources (separateschedules for positions, space, equip-ment, and recurring and nonrecurringfunds) including what now exists, whatwill be added, and when this will occur,should be requested. This multidimen-sional matrix is complicated and willlikely have many footnotes explainingcomplex relationships and referencinginstitutional policies, procedures, prac-tices, and principles.With a draft of your spreadsheet in

hand, plan to visit with each one of theindividuals who will be responsible forhonoring these commitments. For exam-ple, the associate dean for research maycontrol research space; plan to go over thecommitment for new (or retained) researchspace with him or her, walk the space withthis person and the school’s facilities expertsee if their assessment of current conditionis consonant with the intended use, and/orwhether the dollars allocated for upgrading

will get the job done (You might say, “I amnot interested, per se, in how much moneyis in the package for this work; I care onlythat it is sufficient to get the job done insuch a fashion and timeframe in whichI can recruit and retain faculty.”) You’ll wantto go through a similar exercise for office,educational, and clinical space allocated tothe department for fulfillment of yourvision. Ideally, you will secure the “sign-off”of each associate dean or hospital directoron your offer package for each area ofresponsibility.

Finally, you need to ask about the cultureof the institution—not necessarily whatpeople say they want it to be, but ratherwhat it really is. Some institutions subscribeto the credo, “Each tub on its own bottom,”while others speak sincerely about collabo-ration. An institution that says “We rewardcollaboration and cooperation with a greaterwillingness to make funds available to thosewho demonstrate better utilization ofresources by sharing expensive assets” givesyou greater flexibility for deploying commit-ted assets. Knowing the culture will be afactor in determining the level of specificitywith which you will need to be comfortablewhen making your decision whether toaccept the offer.

Summary Few candidates will have as much informa-tion, or as much time, as they would like tomake a commitment to their new position.Accordingly, key factors need to be in place,along with as many specifics as can beagreed to in advance. Essential is a clearcharacterization of the department five and10 years hence; a sense of trust with thedean and senior staff that resources will besufficient to accomplish these goals; anunderstanding of the culture, as well as poli-cies and practices, of the institution, withthe agreement that these are sufficient toallow you to sculpt the department as need-ed; and, last, that those who have comebefore you speak to the veracity and integri-ty of the people with whom you will deal, soyou will know that what they say is whatthey mean, and what they do. ❖

For an expanded version of this column, including additional

tips, visit the APS Web site atwww.acphysci.com.

“Essential is a clear characterization ofthe department five and 10 years hence[and] a sense of trust with the dean andsenior staff that resources will besufficient to accomplish these goals.”