Serving as a Temporary Pathology Chair: “Boon” or “Boondoggle”?

Introduction

Changes in department leadership are difficult for faculty and administration alike. This may be particularly true in health sciences disciplines because of the clinical mission that is intertwined with education and research. In addition, health sciences chairs often have a higher level of responsibility and longer length of service than their counterparts in other university departments, which can also impact their relationship with faculty and deans. ^{1 -3} Depending on institutional culture, when health sciences chairs step down, a temporary chair is often appointed until a permanent chair can be identified.

These various time-limited positions fall into the following categories: “acting chair” (service while the permanent chair is on leave or is temporarily indisposed), “interim chair” (service after departure of the prior chair and before the search for chair is completed), “term-limited chair” (usually one nonrenewable term of less than 5 years), and “terminal chair” (the incumbent chair being asked to stay until a successor is appointed; Table 1). At some institutions, the terms “acting” and “interim” chair are used for any of these temporary positions. These positions may pose an array of issues and opportunities for individuals who are invited to assume them and may include questions such as:

Should I be a caretaker/placeholder or a change-agent? If I want the permanent position and serve as caretaker, the dean and faculty may think that I am not creative and energetic while, if I make too many changes, they may become unhappy;

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Table 1.

Types of Temporary Chairs.

Acting chair  One who serves while the permanent chair is on leave or is temporarily indisposed Interim chair  One who serves after departure of the prior chair and before a new chair is appointed Term-limited chair  One who serves a nonrenewable term of less than 5 years Terminal chair  A permanent chair who is asked to stay until a successor is appointed

Although the transition of medical school chairs is a frequent occurrence and the answers to these questions often have a significant impact on leadership transition, faculty productivity, and departmental success, the literature on these topics is relatively limited. ^{4 -9}

The Association of Pathology Chairs (APC) Senior Fellows Group (SFG; former chairs of academic departments of pathology who have chosen to remain active in APC) have published a variety of studies describing service as a pathology chair. ^{10 -14} Because of the interest in this topic by current and potential pathology chairs, the SFG sponsored a discussion group on these issues at the 2019 APC Annual Meeting and engaged a panel of discussants who had served in these various roles.

Methodology

Discussion group panelists included the authors of this report, who have held various roles including an acting chair, interim chair, interim dean, interim vice chancellor, and then subsequent permanent holder of each office (D.N.B.); an interim chair (M.R.G.); a long-term (4 year) interim chair who became permanent chair (J.L.); a long-term (8 year) interim chair who subsequently served 12 years as permanent chair and is now a terminal chair (D.S.K.); a former interim chair who did not seek the permanent position (D.N.H.); a former department chair who had served as a medical school dean at 2 different institutions (D.E.P.); and a former chair, dean, university executive vice president, medical center and health sciences center chief executive officer, and health system board chair (F.S.). The reflections of these individuals and those of the audience participants provided the basis for this report.

Because the information collected for this report is the output of a discussion group, the University of California, San Diego Human Research Protections Program does not require institutional review board review.

Results

The “Acting” and “Interim” Chair

The discussion identified numerous potential benefits as well as risks in service as either interim or acting chair. The major benefits fell into several categories: personal and professional growth coupled with experience and skill development; assessment of interest and ability to serve as a permanent chair; dealing with departmental needs, priorities, faculty, and staff; and increased opportunities to engage with institutional leaders in addressing strategic and tactical issues. Potential risks included dealing with the time, effort, and resources needed to resolve issues facing the department and institution; not having the appropriate level of authority and influence to deal with issues; changes in the relationship with other faculty and staff; diminished personal productivity and work–life integration; and a weakened position as permanent chair candidate.

A significant issue mentioned frequently was the importance in determining whether the position was intended by the dean primarily to manage (ie, “caretaker”) or to lead (ie, “change-agent”). This difference was felt to have a significant impact on the advantages and disadvantages of the role. A detailed list of the potential risks and benefits that were identified for acting and interim chairs is given in Table 2.

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Table 2.

The “Acting” or “Interim” Chair.

Potential benefits  Assessment of one’s desire and “fit” for being a permanent chair  Personal and professional experience and growth  Development of leadership and management skills  Increased interaction with department faculty and staff on a different level  Increased interaction with other chairs and institutional leaders  Participation in institutional decision-making  Learning to prioritize institutional and departmental needs above one’s own  Setting an example for faculty, staff, and trainees  Learning when and how to delegate responsibility and authority Potential risks  Responsibility for resolving issues during a tumultuous and/or protracted period of transition  Serving as a manager (“caretaker”) instead of leader (“change-agent”)  Inadequate resources for departmental needs and faculty retention and recruitment  Less engagement/compliance from faculty who may ignore “one of their own” as leader  Weaker negotiating position as an internal candidate for permanent chair  Uncertainty about retaining availability of one’s original position  Diminished academic productivity

The “Term-Limited” Chair

The major potential benefits and risks of service as term-limited chair include those mentioned above and listed in Table 2 for acting and interim chairs. In addition, there is a greater likelihood that nontraditional candidates may be considered for a term-limited appointment, which provides the opportunity for the appointee and the dean to evaluate the growth of an individual over a period of time that is longer than that for most acting or interim chairs. In a sense, this may be considered to be a “trial run.” Such nontraditional candidates include individuals who are not full professor rank, those who may have less administrative experience, and those who are not in a tenure-track appointment. Because the role is term limited, there is a risk (as is also the case for acting and interim chairs) that expectations for service will be different than that for permanent chairs. This may include a diminished level of authority and lower expectation for making changes. Another potential risk is that term-limited chairs who have served for a longer period of time than the usual acting or interim chair may feel that they have earned the right to become permanent chair, resulting in tension among the chair, the dean, and the department. In some instances, this may even lead to the departure of the disgruntled term-limited chair. A summary of benefits and risks for term-limited chairs is provided in Table 3.

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Table 3.

The “Term-Limited” Chair.

Potential benefits (in addition to those listed in Table 2)  Greater opportunity for nontraditional candidates to serve as chair  Longer time period for chair and dean to evaluate performance Potential risks (in addition to those listed in Table 2)  Diminished authority and expectations for making changes  Disappointment and tension with dean if not appointed as permanent chair

The “Terminal Chair”

Assuming that the terminal chair has served the department and institution well and decided to step down voluntarily, the potential benefit of this position to the department is to provide stability and continuity, with the faculty knowing that their current leader will remain until a successor is in place. It also provides the dean more time to initiate a thorough department review and subsequently recruit the best possible new chair. However, retaining the current chair in a terminal appointment can also be a disadvantage to the department because there may be less impetus to move the search quickly. A risk to the terminal chair is that she/he may become a “lame duck” for a prolonged period of time, with diminished influence and authority. Moreover, during a prolonged time period, the dean may reallocate resources for other priorities that arise or sequester them to create a package for the new chair. A summary of potential benefits and risks for terminal chairs is provided in Table 4.

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Table 4.

The “Terminal” Chair.

Potential benefits  Increased stability and security with continuity of the chair  More time to do a thorough department review and search Potential risks  Search may become protracted with the former chair in place  Diminished authority and influence as a prolonged “lame duck”  Reduced available resources, which are reallocated or sequestered for a new chair  Reduced effectiveness in faculty recruitment

Discussion

Academic health centers are experiencing a greater turnover of department chairs, ⁵ resulting in the appointment of more temporary chairs. Being asked to serve as acting, interim, term-limited, and even terminal chair is often unexpected, and such service may cause considerable angst on the part of the candidate as well as the department, particularly if these positions are subsequently protracted.

The conditions under which temporary chairs (especially interim chairs) are appointed can have profound impact on the success of the interim leadership. The death of the incumbent chair (particularly if unexpected) usually thrusts the department into turmoil. That said, the department is usually sympathetic to the appointed interim leader as it works through its grief. In contrast, the involuntary removal of the incumbent chair usually creates a somewhat hostile environment, especially when factions supportive of the incumbent chair are in conflict with those who did not support the chair and who may have contributed to her/his demise. Further complications may occur depending upon the reasons for removal of the incumbent chair (eg, physical or mental impairment, fiscal irresponsibility, failure to embrace strategic directions of the school, and even malfeasance). Interim chair service in those situations provides an additional challenge that may be further complicated by strained relationships with the dean due to the problems that led to departure of the permanent chair. In contrast, the impending departure of a retiring chair is usually known sufficiently far in advance that there can be a careful planning process for appointment of temporary leadership.

There was consensus among the discussion group participants that the benefits of serving as a temporary chair are increased when the role is one of leadership with the authority and resources to make changes. Although service to the department and institution as a “caretaker” to manage transition to a permanent chair is sometimes the priority of the dean and is important for the department, this type of role provides a different set of risks and benefits to those individuals who accept the position. It was observed that the longer an individual serves in any temporary position, there may be an increased risk of becoming a caretaker manager, especially if resources become limited as they are saved for a new chair or are used for other institutional priorities. With prolonged temporary leadership, opportunities for needed change can be lost, and without needed change, there is risk that the department may stagnate. Alternatively, increased time as a temporary chair may actually provide more opportunity to exert leadership and obtain resources to deal with issues that can no longer be deferred. These matters can also impact a terminal chair who may be asked to slow down changes and resource utilization in anticipation of a new chair’s priorities or conversely is asked to increase the pace of changes, especially to resolve issues in preparation for arrival of the new chair.

As advocated by Soltys, ⁴ it is important for individuals in these temporary positions to negotiate for appropriate resources for the department and especially for themselves to account for their diminished academic productivity if they return to their original faculty positions. It is also important for these individuals to have explicit instruction (in writing) of what they are expected and empowered to do and not to do, especially recruitment of faculty and staff; handling of faculty merits, promotions, and discipline; making administrative appointments; making major budgetary decisions; and developing a strategic plan. Such documentation will also increase the likelihood of compliance by faculty and staff who otherwise may ignore or “wait out” the decisions of a temporary chair. Some discussants commented that interim chairs should have the full authority of the permanent chair. In some cases, this may also be appropriate for acting chairs, although their term is typically shorter. In all cases, communication and transparency is paramount to the success of the temporary chair.

Several individuals noted that interim chairs should function as “stabilizers” or “transition brokers” in the time interval between the former chair and the new chair because, as noted by Rud, ⁷ these periods of time are frequently characterized by faculty anxiety over their personal welfare. The importance of maintaining stability was also emphasized by Bullock et al, ⁶ who indicated that interim leaders can continue to promote department core values, minimize negativity, maintain open communication, and deal with faculty challenges. Similarly, Quillen et al ⁵ considered the most important role of interim leadership being that of providing stability during a time of transition.

It was observed by some discussants that the ideal candidate for interim chair is a department faculty member who is respected by colleagues and who will not be a candidate for permanent chair. Others viewed the position as an opportunity for individuals aspiring to be chair to demonstrate their talents. However, there was consensus that such service in some instances can be injurious to one’s academic productivity, especially if one returns to the faculty after service as interim chair. It was felt that term-limited chairs should be used when there is a failed search or if there is an internal candidate who is questionable because of lack of seniority, rank, or fit with the desired profile. A nonrenewable term of less than 5 years (often 3 years) is common, which allows deans to “try out” promising nontraditional candidates without a long-term commitment.

Life as a temporary chair can be very difficult in dealing with one’s former department faculty peers. For example, some faculty may decide to “cash in” on promises that they thought were made by the prior chair (eg, higher salaries, appointment to leadership positions, assignment of more space), whether or not such promises were indeed firm. The importance of demanding documentation of prior commitments is paramount, although it places an interim chair in the unenviable position of having to turn down requests from colleagues, whom they ultimately will rejoin when their service as interim chair has expired. Additionally, other institutional leaders (especially other department chairs) may view the interim chair as being in a weakened negotiating position for institutional resources and responsibilities.

As with permanent chairs, temporary chairs run the risk of becoming “addicted” to the position and fearing its termination. This can result in inappropriate aversion to the risks inherent in making necessary changes and dealing with difficult and contentious problems. It may also lead to the departure of the temporary chair if he/she is not subsequently appointed permanent chair.

Some participants in the audience discussion emphasized that succession planning is an essential responsibility for any chair and that this should occur before the chair even decides to step down. Others noted the importance of creating a process for early identification and proactive mentoring of talented faculty who could serve as a temporary chair.

Prior deans commented on criteria they had used in selecting interim, acting, and term-limited chairs. There was consensus that a necessary attribute of a temporary chair is a high level of confidence and trust by the departmental faculty being served. Ideally, to avoid potential conflicts of interest and provide the best opportunity to find the most appropriate permanent chair, a temporary chair should not be a candidate for the permanent position. However, it was noted that in several cases a noncandidate for the permanent position did such an outstanding job that they were asked to consider the permanent position. In rare cases, the level of conflict within a department is so great that some deans went to another discipline outside the department to appoint a temporary chair in order to protect any departmental faculty member from potential repercussions during or after serving as temporary chair. This often indicates the dean’s lack of confidence in the department and may be extremely disruptive for all parties. However, in 2 instances cited, this appeared to be successful in bringing greater stability to the department and allowing successful recruitment of a permanent chair.

It was agreed by all discussants that providing explicit, objective expectations for performance is essential in appointing temporary chairs and that describing the implicit, objective expectations of behavior is very useful as well. The ultimate decision in selecting temporary chairs (as with permanent chairs) is often a complex process to find the best fit between the attributes of the candidates and those of the department and the institution and then balancing the needs of each in terms of risk–benefit.

With the increasing turnover of department chairs, the frequency of temporary chair appointments will inevitably increase. The reflections offered by this discussion group are likely applicable to department chairs in other disciplines as well as to other leadership positions (eg, dean, chief executive officer, vice president) that may utilize acting, interim, term-limited, and terminal roles.