Leadership succession: Sunrise, sunset

Please note that next week DermWorld Insights & Inquiries will be discussing the terbinafine-resistant infections that have now come to the United States.

By Warren R. Heymann, MD, FAAD
May 17, 2023
Vol. 5, No. 20

Topol’s recent passing unleashed an avalanche of emotion. I watched Fiddler on the Roof for the first time in the 1971 Norman Jewison production with my parents. Topol played the role of Tevye, a weary milkman with five daughters, as he navigated the pressures of a changing, antisemitic world countered against his penchant for tradition. There are so many poignant scenes in this movie, but (for me) none more than when Tevye and his wife Golde sing “Sunrise, Sunset” as their eldest daughter Tzeitel takes her marriage vows with the poor tailor Motel. Somberly accepting how one season follows another, Tevye asks himself, “What words of wisdom can I give them? How can I help to ease their way?”

I am asking myself that question to assist our new Division Head of Dermatology at Cooper Medical School of Rowan University, Dr. Camille Introcaso. I was officially named to that position 35 years ago, when I received an unsolicited call from my rabbi, the late Albert Lewis, who gave me a blessing for a successful tenure. At the time, I could not have envisioned what would unfold; in retrospect, what a blessing this role has been. Succession planning is a key element of leadership and knowing when to implement it is vital to organizational success. My late mother emphatically insisted that her children not overstay their welcome. (By the way, I am not retiring — I will be continuing my practice and the academic work that I enjoy!)

Leadership roles have changed dramatically from the time I started medical school in 1975, when department chairs were classical “triple threats” — clinicians, researchers, and educators. Changes in academic leadership positions are similar regardless of the specialty. Lee et al opine, “The evolving landscape of academic surgery demands leaders who are not only effective clinicians and researchers, but also administrators able to navigate complex hospital organizations, financial pressures in the era of quality measures, and inclusion of an increasingly diverse workforce.” (1) Lang and Keenan acknowledge the significant gap between traditional training in academia and the knowledge and skills needed to lead and manage complicated systems. “Academic leaders need training that can guide them through the university system of education, governance, finances, human resources (HR), accreditation, research and utilization of space and resources.” They identify six domains of competency for physician-leaders: “technical skills and knowledge (including strategic planning and financial operations), industry knowledge (including clinical processes and health-care trends), problem-solving skills, emotional intelligence (EI), communication skills and a commitment to lifelong learning.” In their interviews with senior academic leaders at the University of Alberta, the “ability to influence” was the considered the highest rated necessary leadership skill. (2)

Salazar et al contend, “There is a growing consensus that an accomplished curriculum vitae and prior achievement as an academician may not correlate with success as a chairperson of a contemporary academic orthopaedic [or any other] department.” When I started out, I was learning by the proverbial seat of my pants, although now academic leadership training is an educational behemoth. Such courses (including the AAD Leadership Institute) hone essential skills for successful leadership, including thoughtful listening, visioning, strategic planning, change management, team building, personnel management, business skills, and systems thinking. (3)

Most readers of this commentary will not be dermatology chairs, but everyone can be well-served by the wisdom espoused in this commentary, as we all are leaders in our practice setting.

Fortunately, Dr. Introcaso does not need my advice. My only pithy comment is “be there, be fair, be square.” She already has the requisite leadership skills to thrive in her new role as division head, especially if she heeds Golde’s advice about her relationship with our faculty, “Now they must learn from one another day by day.”

Point to Remember: Advancing to become a chair of dermatology, or any position of authority, can be daunting. The skills that promoted you may not provide the skills necessary for success. Take advantage of educational resources, mentors, and colleagues for their collective wisdom.

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I took the liberty of asking my colleagues of the Association of Professors of Dermatology “What is the most important advice Chairs of Dermatology should offer their successors?”

I received the following replies (listed in order of receipt).

Our experts’ viewpoints

Vesna M. Petronic-Rosic, MD, MSc, MBA, FAAD
Attending Dermatologist and Director of Dermatopathology
John H. Stroger, Jr. Hospital of Cook County

I was Chief/Chair for 5 years: Section Chief at the University of Chicago (2 years) and Founding Chair for the Georgetown University Department of Dermatology (3 years). The most important advice I can offer to my successors is to share their privilege by going above and beyond to support their faculty, residents, students, and staff in achieving as much as possible. Offer guidance, provide opportunities, and propel their careers without being prompted to do so. It is the most fulfilling and gratifying responsibility of the position and it will make you more successful and oh, so proud!

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Jane M. Grant-Kels, MD, FAAD
Professor of Dermatology, Pathology, and Pediatrics
Vice Chair, Department of Dermatology
Director, Cutaneous Oncology Center and Melanoma Program
Assistant Residency Program Director
UConn Health

My advice is very simple. My top 10 in no special order:

1. You have to mentor and care for your faculty better than you do yourself. A really good chair is selfless.

2. What you say can impact a person a lot more than you think. Be kind and think before you talk.

3. You have to be the first one in and the last one out. Even when it snows and you have no patients scheduled, you have to go in. You have to be a role model.

4. Walk around the clinic, offices, and labs at least twice a day. Let folks see you and know that you are available.

5. When someone comes to your office in crisis at 6 or 7 PM, stay and listen to them. They obviously really need you and postponing it might have negative consequences.

6. Give folks in your department credit. Do not steal credit for what others have accomplished — and this applies to secretaries as well as lab techs and physician colleagues.

7. Exercise and make time for your family and pets. I am a dog lover. It is not just quality of time — it is also quantity.

8. Hire folks to do things in your home that you do not like to do. For me — I had a housekeeper and we had a gardener so we did not have to cut the lawn.

9. Bring your children to work so that they know where you work and what you do.

10. Pay attention to your spouse and make sure you let them know how much you appreciate their support.

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Dirk Elston, MD, FAAD
Professor and Chairman
Department of Dermatology and Dermatologic Surgery
Medical University of South Carolina

Listen, listen, listen. Try to be fair to all, and above all, consistent.

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Paul Nghiem, MD, PhD, FAAD
Professor & Head, University of Washington Dermatology
George F. Odland Endowed Chair
Seattle, Washington

“Identify and communicate regularly with several trusted colleagues among your fellow Chairs — perhaps folks who have launched in that role just a few years ahead, but also some more experienced leaders as well. Their advice and support are priceless.”

“The biggest challenges you are likely to have will relate to human behavior. Work hard to identify trustworthy people, do not ignore ‘red flags,’ and do not look the other way when you initially see inappropriate behavior. Discuss professionalism issues promptly with the person and with your support team.”

“Dermatology is a small community, and there are simply not enough dermatologists. We all benefit when our colleagues’ programs around the country are stronger; we cross-train people and our future patients will benefit from having the strongest programs around the country.”

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Robert T. Brodell, MD, FAAD, FRCP Edin
Tenured Professor and Chair, Department of Pathology
Professor and Past Founding Chair, Department of Dermatology
Billy S. Guyton, MD Distinguished Professor
University of Mississippi Medical Center
Jackson, Mississippi

After ten years as founding chair of the Department of Dermatology at the University of Mississippi Medical Center, I retired from that job and took on the role of Chair of the Department of Pathology. After years of preparation and succession planning…Jeremy Jackson, MD became chair of the department after years of service as Director of Clinics and then Vice-Chair of the department. He was ready…more creative, organized, and brilliant than I ever was in the past and equaling me in mission-driven zeal and focus on the culture of the department. No advice was necessary, but this is what I told him:

• Family first…and bring your family along for the ride when you can!

• The Platinum rule: Don’t treat others the way you would want to be treated. Rather, treat others as you would want to be treated if you were them!

• Make yourself an amalgam of all of the individuals who have influenced you…but, most of all, be yourself. Never try to be someone else!

• To give anything less than your best is to sacrifice the gift. (Steve Prefontaine)

• The secret of successful individuals is helping others. (From Adam Grant — Give and Take)

• Focus on the culture of the department…everything else will take care of itself as each individual (faculty, residents, medical students, nurses, administrative staff, schedulers, receptionists) believe that they can’t possibly pay back those around them for all of the help they have received) (From Gustavo Grodnitzky — Culture Trumps Everything). Remember: Culture eats strategy for breakfast. (Peter Drucker) Finally, as chair, both patients and staff are your customers. As faculty focus on patients, education, and research…you need to focus on making it as easy as possible for them to accomplish their missions.

• Take some time to write a personal mission statement and place it at the top of your CV to crystalize why you have chosen the mission to lead. (Kimberly Lumpkin, MD)

• Attend a leadership conference for chairs. Harvard University has a good one!

• Read self-help books…of your choice!

• Don’t shy away from problems…take them head on! Small problems will become big problems if you ignore them.

• If you have a knee-jerk negative reaction to someone’s point of view…try to put yourself in their shoes to understand it before you react. You have two ears and one mouth…for a reason…listen!

• Never forget that: Home is not where you are from, it is where you are needed. (William H. Foege)

• Being a chair is an amazing opportunity to “do good!” Do your best, and don’t become frustrated when an issue can’t be resolved to your liking…move on to the next one and savor the victories when they come. Remember the quote variously attributed to Abraham Lincoln and Winston Churchill —Success: The ability to move from failure to failure without loss of enthusiasm. 

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Erik Stratman, MD, FAAD
Clinical Professor of Dermatology, University of Wisconsin-MadisonChair
Department of Dermatology
Marshfield Clinic

My advice to new chair is actually something I took from the former CEO of Coca Cola, Brian Dyson. I would tell the new chair to imagine life as a game in which you are juggling five balls in the air. The balls are named work, family, health, friends, and spirit — and you’re in charge of keeping all of these in the air. You need to recognize early that work is a rubber ball. If you drop it, it will bounce back. But the other four balls — family, health, friends, and spirit are made of glass. If you drop one of these, they will be irrevocably scuffed, marked, nicked, damaged, or even shattered. They will never be the same. You must understand that and strive for balance in your life.

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Katherine H. Fiala, MD, FAAD
Chair of Dermatology
Baylor Scott and White Health at the Texas A&M School of Medicine

I became interim chair six months before COVID hit. Two years of being interim through a pandemic prepared me to face just about anything. Since I was able to lead (as interim) through the enormous amount of change that was happening moment to moment during COVID, being appointed chair almost felt like a breath of fresh air! An effective department chair is able to listen and weigh all of the competing requests, then decide which avenue is the best for the entire department. The decision then must be effectively communicated back to the team with reasons why one route was chosen over the other. If our employees feel like they are heard, then when we can’t grant exactly what was requested, they still feel like their opinions were taken into consideration.

I felt called to become a physician, then my calling transformed into an educator of dermatologists. Now, my calling has transformed into a leader who tries to make coming to work fulfilling, balanced, and hopefully joyful for our entire department’s team members. 

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Kristen M. Kelly, MD, FAAD
Chair, Department of Dermatology
Professor Departments of Dermatology and Surgery
University of California, Irvine

1. Communicate: Work hard to communicate with your faculty, your residents and students, your staff, and your administration. Of course, this is an ongoing process. Also reach out to other chairs in dermatology and in other departments. Learn from them and look for opportunities to incorporate ideas that have worked in other departments.

2. Collaborate: Help your faculty to collaborate with each other and to reach across your school of medicine, your campus, across the U.S. and around the world to collaborate on research questions, other academic pursuits, teaching objectives, and social initiatives.

3. Culture: Assess the culture of your department and consider how you can elevate this.

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Finally, I invited the dynamic father-son dermatology chair duo, O. Fred Miller and Jeffrey Miller to offer their viewpoints.

O. Fred Miller III, MD, FAAD
Retired Chair Emeritus
Division of Dermatology
Geisinger Health System
Danville, Pennsylvania

Jeffrey J. Miller, MD, MBA, FAAD
Professor and Chair
Department of Dermatology
Penn State Health/Penn State College of Medicine

Congratulations! As a Chair, it is a PRIVILEGE to serve your institution and your dermatology TEAM of health care professionals (physicians, advanced practice providers, residents/fellows, medical students, nurses/MAs, administrative support team, environmental service workers, etc.). A former Dean’s lesson resonates with us: “The Chair is the most difficult job because you are in this ‘tug of war’ in service to both the institution and the team.” Here are four pivotal lessons we learned.

1. Be vulnerable. Admit to your mistakes and share, when appropriate, that you struggle, too. As Chair, you are called to make difficult decisions without clear answers. In this position, I (JJM) have experienced stress and several restless nights. I choose to share these moments of anxiety with my TEAM. We support one another and continue to facilitate discussions around OUR mental health.

2. Remember the WHY. As health care becomes corporatized (“no margin, no mission”), it is imperative to ground your decisions in a commitment to our missions of patient care, education, research, and community health. Our True North is always what best serves our patients.

3. Empower EVERYONE on your team. For example, our schedulers helped develop ways to improve patient access. They ARE the front line — with a profound understanding of our patients and family’s needs. Through celebrating diversity of experience, skillset, and thought, everyone feels empowered to make a difference.

4. Dream BIG.

Embrace the partnership and mentorship of the person you succeed — that is a gift because he has been there for me (JJM) as I have advanced in my career. Treasure that relationship.

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1. Lee TC, Reyna C, Shah SA, Lewis JD. The road to academic surgical leadership: Characteristics and experiences of surgical chairpersons. Surgery. 2020 Oct;168(4):707-713. doi: 10.1016/j.surg.2020.05.022. Epub 2020 Jul 11. PMID: 32660864; PMCID: PMC7541787.

2. Lang M, Keenan L. Canadian medical faculty senior leaders: what skills do they need? Leadersh Health Serv (Bradf Engl). 2022 Aug 25;ahead-of-print(ahead-of-print). doi: 10.1108/LHS-03-2022-0023. PMID: 36000765.

3. Salazar DH, Herndon JH, Vail TP, Zuckerman JD, Gelberman RH. The Academic Chair: Achieving Success in a Rapidly Evolving Health-Care Environment: AOA Critical Issues. J Bone Joint Surg Am. 2018 Oct 17;100(20):e133. doi: 10.2106/JBJS.17.01056. PMID: 30334894.

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