EDITORIAL J Oral Maxillofac Surg 72:651-652, 2014
Musings of Chairs cess myself, I know that ‘ looking good on paper’’ is its own art form. We all know that as we review candidates, we miss the diamonds in the rough and match applicants that look far better on paper than in real life. One person suggested simplifying the task by asking the most senior person in the unit to review and select the applicants. Year after year that individual proved to have perfect instincts; historically, he was almost never wrong in his assessment of resident candidates. Another suggested tossing the applications in the air, then randomly selecting the folders from the pile on the floor to fill the match list. Empirically, both methods offer similar probabilities for success. Financial issues were commonly cited, but they took a variety of forms. First, and most critical, was the financial viability of the faculty practice. Although many view academic practice as a destination for ‘ interesting teaching cases,’ we strive to maintain a thriving full-scope practice with a complex payor- and case-mix. Our clinical practice is the engine that drives department activities; income from clinical operations supports research projects, resident presentations at national meetings, service on national committees, and grant writing, to name a few. However, there is a double-edged sword to being successful in some academic enterprises. Several of my colleagues reported institutional policies in which surpluses from their departments’ operations were at risk of being allocated to offset shortfalls from others. No matter how one heeds such a warning, it is impossible for an outsider to get a bead on how an institution is wired, its decision-making culture, and the extent to which one is free to act in an entrepreneurial fashion. Every institution has its own quirks, and they are only discoverable from the inside. In this economy, department chairs derive little insulation from institutional walls. We must be allowed to act as strategically and nimbly as anyone running a multimillion-dollar business enterprise. I also found a lot of concern for the growing financial burden borne by our residents, and the extent to which increasing educational debt affects residents’ career and practice choices. At one institution, the chair routinely reads aloud the personal statement from the original application for each chief resident celebrating the completion of their training. Servicing the educational debt is forcing many of those who once dreamed of academic careers—many of whom find themselves with growing families—to seek
If you aren’t in over your head, how do you know how tall you are?—T. S. Eliot
As I sit pondering this month’s editorial, I have completed my first 100 days as a newly installed department chair. The honeymoon is over. There are now at least 1,000 things I want done yesterday. I have learned one important lesson: institutions operate at a glacial pace. Nonetheless, I am happy to report a few key accomplishments. Our new Grand Rounds lecture series hosted more than 100 guests at its inaugural session. I managed, as no trivial effort, to secure a state license and privileges at the university hospitals. Also, most importantly, I recognize and can even name most of my residents. I have always had great respect for the department chairs with whom I have been privileged to work. Perhaps for this reason, I found the prospect of taking on this role myself a bit daunting. Indeed, I waited a long time in my career (too long, some say) to tackle this position, being quite fearful that the demands of the chairmanship would ruin my academic career if undertaken prematurely. If Hollywood were to be believed, being top dog is all that matters. But, like teachers, nurses and priests, running an academic department is more of a calling than a career choice. Believing as I do that data are the keys to any worthy pursuit, I solicited input and insights from venerable colleagues who are or have been department chairs. Specifically, I asked ‘ What are the 5 things that keep you up at night?’’ I received thoughtful responses from 11 individuals whose identities I will preserve to protect the innocent. In the interest of full disclosure, I will omit such responses as ‘ creationists’’ and ‘ climate change deniers’’ as thought-provoking, yet nonresponsive. The rest I will share, as it occurs to me that there is resonance with running any practice, whether academic or otherwise. Top of mind for most respondents was the role as caretaker for the next generation. This includes the challenge of selecting good candidates, whether residents, faculty, or support staff. In an academic environment, you live for a long time with your hiring successes and failures. Many encouraged me to dig deeper than the CVand the references provided. We are a small specialty. Most candidates who are unknown to us have only 2 or 3 degrees of separation. Selecting residents, however, remains a crapshoot, regardless of the institution or one’s own experience. Having just completed the search pro-
651
652 alternate career tracks. Although understandable and within their rights to do so, it falls back on those of us in academics to consider from where the next generation of educators and investigators will come. While we are fighting to improve the viability of our enterprise, we must also work to demonstrate that academics is a secure and rewarding career path for those who are so inclined. Another category of issues focused on the role of oral and maxillofacial surgeons in the academic medical center at large. One service chief shared with me that he frequently examines whether his faculty members are respected as peers of the hospital’s staff surgeons and more importantly, whether the oral and maxillofacial surgery (OMS) department is accepted as an integral member of the institution’s surgical division. This is certainly one of the most critical success factors for an academic OMS department. When the medical center leadership deals with OMS by proxy (‘‘if it’s okay with Plastics than it’s okay with me’’) or considers OMS to be ‘‘hospital dentistry,’’ these are signs that OMS is not well-integrated with mainstream surgical practice. Although it is the case that OMS is a small specialty on a national scale, within an academic medical center, OMS has the potential to establish meaningful relevance to the greater patient care dialog, to demonstrate educational, clinical, and even economic value to the surgical care team, and to pull a disproportionate share of its weight in committees on quality, medical staff affairs, and information technology, to name a few. These types of institutional ‘‘investments’’ take a lot of face time, but they are essential to ensuring that OMS has a seat at the table. Resident education challenges reverberated among the respondents. Of chief concern is whether we are offering residents excellent, exciting, and relevant learning opportunities. Within that context is the challenge of providing appropriate levels of supervision that permit a constant growth of responsibility, allowing our residents to quickly transition into independent and productive practitioners. Our graduates must leave our programs able to support themselves as oral and maxillofacial surgeons and well positioned to achieve board certification. But we also wish for our residents to be productive members of our academic enterprise during their tenure. We preach critical
EDITORIAL
and analytical thinking, yet are increasingly challenged to stimulate a desire to pursue research endeavors. I am not alone in wishing to engage and further inflame the spirit of wonder and curiosity in the surgical sciences among those who will one day inherit our specialty. Those at the helm of double-degree programs report unique issues concerning the maintenance of an interdisciplinary training program. Regardless of how mature or touted the program, a double-degree curriculum requires constant care and feeding. Inevitably, whether through leadership turnover or just a passing thought, there will be some well-positioned medical school administrator who will question the value of a dual-credentialed OMS program. When pressed, preceptors will remember in great detail an OMS resident who struggled one day on an obstetrics-gynecological rotation while neglecting to recall the one who showed the plastic surgery attending how to apply arch bars. Even in the most supportive settings, however, OMS chairs must continue to monitor the latest thinking in medical education. A move toward a longitudinal medical curriculum, for example, will challenge current thinking about how OMS training coordinates with medical school. We must play an active role in these discussions, not only to ensure the ongoing fit for OMS residents, but to articulate how trends in medical education necessarily drive thinking about undergraduate dental curricula as well. It is important that dental graduates from our own institutions emerge as qualified and competitive candidates for OMS training programs. Thanks to generous colleagues, I believe I was able to walk into my new role with eyes wide open. I try very hard to remember that there are opportunities hiding in the shadow of every challenge. However, every once in a while, I start to feel like the mire is getting rather deep. That is when I smile to myself and remember that I am six-foot-four. THOMAS B. DODSON, DMD, MPH Associate Editor
Ó 2014 American Association of Oral and Maxillofacial Surgeons http://dx.doi.org/10.1016/j.joms.2014.01.015
Musings of Chairs cess myself, I know that ‘ looking good on paper’’ is its own art form. We all know that as we review candidates, we miss the diamonds in the rough and match applicants that look far better on paper than in real life. One person suggested simplifying the task by asking the most senior person in the unit to review and select the applicants. Year after year that individual proved to have perfect instincts; historically, he was almost never wrong in his assessment of resident candidates. Another suggested tossing the applications in the air, then randomly selecting the folders from the pile on the floor to fill the match list. Empirically, both methods offer similar probabilities for success. Financial issues were commonly cited, but they took a variety of forms. First, and most critical, was the financial viability of the faculty practice. Although many view academic practice as a destination for ‘ interesting teaching cases,’ we strive to maintain a thriving full-scope practice with a complex payor- and case-mix. Our clinical practice is the engine that drives department activities; income from clinical operations supports research projects, resident presentations at national meetings, service on national committees, and grant writing, to name a few. However, there is a double-edged sword to being successful in some academic enterprises. Several of my colleagues reported institutional policies in which surpluses from their departments’ operations were at risk of being allocated to offset shortfalls from others. No matter how one heeds such a warning, it is impossible for an outsider to get a bead on how an institution is wired, its decision-making culture, and the extent to which one is free to act in an entrepreneurial fashion. Every institution has its own quirks, and they are only discoverable from the inside. In this economy, department chairs derive little insulation from institutional walls. We must be allowed to act as strategically and nimbly as anyone running a multimillion-dollar business enterprise. I also found a lot of concern for the growing financial burden borne by our residents, and the extent to which increasing educational debt affects residents’ career and practice choices. At one institution, the chair routinely reads aloud the personal statement from the original application for each chief resident celebrating the completion of their training. Servicing the educational debt is forcing many of those who once dreamed of academic careers—many of whom find themselves with growing families—to seek
If you aren’t in over your head, how do you know how tall you are?—T. S. Eliot
As I sit pondering this month’s editorial, I have completed my first 100 days as a newly installed department chair. The honeymoon is over. There are now at least 1,000 things I want done yesterday. I have learned one important lesson: institutions operate at a glacial pace. Nonetheless, I am happy to report a few key accomplishments. Our new Grand Rounds lecture series hosted more than 100 guests at its inaugural session. I managed, as no trivial effort, to secure a state license and privileges at the university hospitals. Also, most importantly, I recognize and can even name most of my residents. I have always had great respect for the department chairs with whom I have been privileged to work. Perhaps for this reason, I found the prospect of taking on this role myself a bit daunting. Indeed, I waited a long time in my career (too long, some say) to tackle this position, being quite fearful that the demands of the chairmanship would ruin my academic career if undertaken prematurely. If Hollywood were to be believed, being top dog is all that matters. But, like teachers, nurses and priests, running an academic department is more of a calling than a career choice. Believing as I do that data are the keys to any worthy pursuit, I solicited input and insights from venerable colleagues who are or have been department chairs. Specifically, I asked ‘ What are the 5 things that keep you up at night?’’ I received thoughtful responses from 11 individuals whose identities I will preserve to protect the innocent. In the interest of full disclosure, I will omit such responses as ‘ creationists’’ and ‘ climate change deniers’’ as thought-provoking, yet nonresponsive. The rest I will share, as it occurs to me that there is resonance with running any practice, whether academic or otherwise. Top of mind for most respondents was the role as caretaker for the next generation. This includes the challenge of selecting good candidates, whether residents, faculty, or support staff. In an academic environment, you live for a long time with your hiring successes and failures. Many encouraged me to dig deeper than the CVand the references provided. We are a small specialty. Most candidates who are unknown to us have only 2 or 3 degrees of separation. Selecting residents, however, remains a crapshoot, regardless of the institution or one’s own experience. Having just completed the search pro-
651
652 alternate career tracks. Although understandable and within their rights to do so, it falls back on those of us in academics to consider from where the next generation of educators and investigators will come. While we are fighting to improve the viability of our enterprise, we must also work to demonstrate that academics is a secure and rewarding career path for those who are so inclined. Another category of issues focused on the role of oral and maxillofacial surgeons in the academic medical center at large. One service chief shared with me that he frequently examines whether his faculty members are respected as peers of the hospital’s staff surgeons and more importantly, whether the oral and maxillofacial surgery (OMS) department is accepted as an integral member of the institution’s surgical division. This is certainly one of the most critical success factors for an academic OMS department. When the medical center leadership deals with OMS by proxy (‘‘if it’s okay with Plastics than it’s okay with me’’) or considers OMS to be ‘‘hospital dentistry,’’ these are signs that OMS is not well-integrated with mainstream surgical practice. Although it is the case that OMS is a small specialty on a national scale, within an academic medical center, OMS has the potential to establish meaningful relevance to the greater patient care dialog, to demonstrate educational, clinical, and even economic value to the surgical care team, and to pull a disproportionate share of its weight in committees on quality, medical staff affairs, and information technology, to name a few. These types of institutional ‘‘investments’’ take a lot of face time, but they are essential to ensuring that OMS has a seat at the table. Resident education challenges reverberated among the respondents. Of chief concern is whether we are offering residents excellent, exciting, and relevant learning opportunities. Within that context is the challenge of providing appropriate levels of supervision that permit a constant growth of responsibility, allowing our residents to quickly transition into independent and productive practitioners. Our graduates must leave our programs able to support themselves as oral and maxillofacial surgeons and well positioned to achieve board certification. But we also wish for our residents to be productive members of our academic enterprise during their tenure. We preach critical
EDITORIAL
and analytical thinking, yet are increasingly challenged to stimulate a desire to pursue research endeavors. I am not alone in wishing to engage and further inflame the spirit of wonder and curiosity in the surgical sciences among those who will one day inherit our specialty. Those at the helm of double-degree programs report unique issues concerning the maintenance of an interdisciplinary training program. Regardless of how mature or touted the program, a double-degree curriculum requires constant care and feeding. Inevitably, whether through leadership turnover or just a passing thought, there will be some well-positioned medical school administrator who will question the value of a dual-credentialed OMS program. When pressed, preceptors will remember in great detail an OMS resident who struggled one day on an obstetrics-gynecological rotation while neglecting to recall the one who showed the plastic surgery attending how to apply arch bars. Even in the most supportive settings, however, OMS chairs must continue to monitor the latest thinking in medical education. A move toward a longitudinal medical curriculum, for example, will challenge current thinking about how OMS training coordinates with medical school. We must play an active role in these discussions, not only to ensure the ongoing fit for OMS residents, but to articulate how trends in medical education necessarily drive thinking about undergraduate dental curricula as well. It is important that dental graduates from our own institutions emerge as qualified and competitive candidates for OMS training programs. Thanks to generous colleagues, I believe I was able to walk into my new role with eyes wide open. I try very hard to remember that there are opportunities hiding in the shadow of every challenge. However, every once in a while, I start to feel like the mire is getting rather deep. That is when I smile to myself and remember that I am six-foot-four. THOMAS B. DODSON, DMD, MPH Associate Editor
Ó 2014 American Association of Oral and Maxillofacial Surgeons http://dx.doi.org/10.1016/j.joms.2014.01.015
