lifecycles of a clinical chair philip g. boysen md professor of anesthesiology and medicine chair,...

Lifecycles of a Clinical Chair

Philip G. Boysen MDProfessor of Anesthesiology and Medicine

Chair, Department of AnesthesiologyThe University of North Carolina at Chapel Hill

Transition Timeline

Time zero:What got you the position?

Experience? Potential?0 – 5 years:

Rapid growth, ascendancy5 – 10 years:

harvest mode; ?resources

Deviations from Pattern

• The no-starter• The slow starter• The flame out• The successful 10-12 year cycle

Getting Started

• The Search Firm• The Search Committee• You, your new colleagues• The members of the Department

The Dean can hire and fire you. He makes you the boss. The people confer leader.

Phil Boysen

Entry

• Clear goals and expectations• Dean/Institutional goals• Your goals for the Department

• Thorough analysis of Department and the Institution

• Resources match the goals• Get it in writing

Clinical Environment

• Faculty quality, time, space, morale, compensation

• Daily and monthly schedules• Hospital organizational chart• OR governance• Data:

Who keeps it? Who has it? Is there any?Are decisions data driven?

Be careful! If you have to fix clinical services you will never get to the rest of the mission.

Ted Copeland

Finance• Balance sheet, P&L statement, cash flow• Collection rate, adjusted collection rate• Payor mix, who negotiates contracts• Billing services & cost

• Practice plan• Outsource

• Taxes & who takes your money• Reserves! Mandated? Access?

The Top Three Reasons why Chairs lose their Jobs

MoneyMONEY$$$$

S. Gelman

Research

• NIH dollars: the coin of the realm• Physician scientists are disappearing • Identify collaborators• Are you included in the research

culture?

Open Door PolicyCome right In . . .

Unless you are hear about time, space, money, then go away!

J. Reves

Education

• Perhaps the easiest to assume, not so easy to fix

• Pretend you are an RRC site visitor• Visit the ACGME website• Ask to see the Department’s most

recent PIF, internal review, and all ACGME correspondence

• Examine program performance on ABA exams

Administration

• Stature in the Institution depends on citizenship and participation

• Review list of all committees, actual attendance, and Chair/Leadership positions

The Dangers of Incumbency: Intuitional

• The hiring Dean is gone, often LONG gone

• The hospital CEO has retired/moved on

• Colleagues (other Chairs) have left or stepped down

• Reneged on promises; no new resources

The Dangers of Incumbency: Chair

• You should have been taking vacations• You should have been exercising• You should have been watching your

weight• You should have been grooming

successors• You have fallen into other bad habits• Now you need time away to think, re-

energize (Institutional leaders don’t seem to get this!)

If you come to a fork in the road, take it!

Yogi Berra

Environmental Surveillance: People

• Craftsman• Jungle Fighter• Company Man• Gamesman

The Gamesman, Maccoby, 1978

Craftsman

• Drive to build the best• Competition vs. self and the

materials

Jungle Fighter

• Kill or be killed• Dominate or be dominated

Company Man

• Climb corporate ladder or fail• Competition is the price for a secure

position

Gamesman

• Win or loose; triumph or humiliation• The contest, new plays, new options,

pleasure in designing the play

Do Something!Lead, follow, or get out of the way. Thomas Paine

As we look ahead into the next century, leaders will be those who empower others. Bill Gates

Don't tell people how to do things. Tell them what to do and let them surprise you with their results. George Patton

The President of the United States hears a hundred voices telling him that he is the greatest man in the world. He must listen carefully to hear the one voice that tells him he's not. Harry Truman

The task of the leader is to get his people from where they are to where they have not been. Henry Kissinger