Retaining the Value of Former Department Chairs: The Association of Pathology Chairs Experience.

Serving as a clinical department chair in an academic health center is an increasingly complex and difficult position. In 2014, the Association of Pathology Chairs engaged former chairs to assist its members by establishing an ad hoc committee of "Senior Fellows," which then became a permanent Senior Fellows Group. The Senior Fellows Group currently includes more than 50 former chairs, many of whom subsequently served as deans, medical center executives, and in other leadership roles. The primary mission of the Senior Fellows Group has been to provide advice, consultation, and mentoring to members of the Association of Pathology Chairs, especially new chairs and faculty interested in leadership roles. All new chairs are asked if they wish to select or be assigned a Senior Fellow advisor. Each Senior Fellow is listed on the Association of Pathology Chairs website with the areas of advice they are willing to provide, which include: "on-boarding" issues and opportunities facing a new chair; strategy (eg, departmental priorities, mission balance); administration (eg, financial, operational); institutional reviews of chairs/departments; interaction with institutional leaders (eg, other chairs, deans, hospital leadership); fundraising; faculty management (eg, recruitment, retention, annual evaluations, productivity, dismissal); and personal issues (eg, work-life balance, stepping down, retirement). The Senior Fellows Group also has participated actively in essentially all Association of Pathology Chairs programs, committees, fundraising, and projects. The organized structure and function of the Senior Fellows Group has been of significant value to the membership of the Association of Pathology Chairs, as well as to the participating former chairs, and may provide a model for other academic organizations to utilize this important resource.

Chairing a clinical department in an academic health center is well-recognized as a significantly complex and challenging leadership position, requiring the ability to balance and synergize the often-competing missions of patient care, education, and research. In addition, the chair must be knowledgeable, if not skilled, in several areas including human resources, finance, communications, negotiation, operations, compliance, and strategic planning. These responsibilities have become more challenging over the past decade with reduced funding and increased regulatory constraints, and especially in the past year with the social, economic, and health crises exacerbated by the COVID-19 pandemic.

The need of department chairs for advice and help to deal with these issues has been documented[1,2] and addressed in part by leadership and management courses available to chairs at their own institutions and through professional societies.[3-5] Comprehensive national programs that are specifically focused on leadership development for academic health center chairs also have been established, such as the 2 week “Program for Chairs of Clinical Services” at Harvard Chan School of Public Health[6] and the 3½ day seminar on “Organizational Leadership in Academic Medicine for New Associate Deans and Department Chairs” at the Association of American Medical Colleges.[7]

Although chairs may seek advice from colleagues, there is often reluctance (especially by new chairs) to seek advice from the prior department chair(s) in order to maintain the perception of being independent and in charge of directing departmental priorities. Chairs of other departments can be very helpful in providing information and advice about institutional processes, the personalities and priorities of medical school, and hospital/health system leaders, as well as organizational culture, but are of limited help with issues specific to the departmental practices of a different specialty. Likewise, new and even experienced chairs may be reluctant to ask for help from peers at the same or other institutions to avoid giving the impression that there are personal or departmental deficits. However, former chairs at other institutions may be a significant resource for advice and assistance to chairs that could avoid these concerns and be facilitated through their member organizations.

With these issues in mind, a group of former chair members of the Association of Pathology Chairs (APC) initiated the creation of a “Senior Fellows Group” (SFG) to proactively support the APC by offering their services to advise, coach, and mentor new, interim, and experienced chairs confidentially and to participate in programs and projects of the APC. Having existed for more than 6 years, the APC SFG has contributed substantial value to the APC, its members, and to the Senior Fellow participants themselves. While a few professional associations of department chairs have categories of “emeritus” and “honorary” member (eg, Association of Medical School Pharmacology Chairs, Association of Medical School Pediatric Department Chairs, Association of Academic Chairs of Emergency Medicine),[8-10] to our knowledge, none have a group or section of former chairs dedicated to serving the parent association and its members in this organized manner.

The Association of Pathology Chairs Senior Fellows Group

The APC was formally established in 1968 as a nonprofit society to serve as the voice of academic pathology departments in the United States and Canada. It provides education, training, information resources, and networking opportunities for chairs, residency program directors, medical student educators, department administrators, and program coordinators through various committees and sections.[11]

The APC SFG membership is limited to former pathology department chairs who apply for membership in the group and are dedicated to providing service to the APC. Membership does not require a fee but must be renewed every 3 years and requires documentation that the Senior Fellow has provided active service to the APC membership. This may include service as an advisor or mentor, participation at annual or regional meetings, engagement in APC sponsored projects, membership on APC committees, and so on.

The SFG is led by an executive committee consisting of a chair, vice-chair, secretary, 2 councilors, and the immediate past chair. These individuals are elected by the SFG membership for 2 years with the possibility of serving 1 additional term in the respective office. The chair of the SFG is a voting member of the APC council, which is the governing body of the APC. The executive committee reviews applications for membership, including renewals, and makes recommendations to the APC Council, which has the authority for granting membership.

The current 53 members of the APC SFG include several who subsequently have had significant leadership positions after serving as a pathology chair. These include 8 medical school deans, 4 vice-chancellors/vice presidents for health affairs, 3 health system chief executive officers, 4 senior associate/vice deans, the chief medical officer of a health system, chief medical officer of a national laboratory chain, executive director of American Board of Pathology, chief executive officer of the American Medical Association, president of the College of American Pathologists, executive director of a medical library, medical director of The Marcus Foundation, director of Office of Research on Women’s Health at the National Institutes of Health, and director of a research institute. Some former chairs held more than one of these positions, and some of the positions were held concurrently. Of the 53 members, 7 are women, reflecting the approximate percent of current women chairs in the APC. The length of service as pathology chair averaged 15 years (median = 13 years) with a range of 1 to 34 years, and several individuals served as chair in more than 1 institution. The composition of SFG members is summarized in Table 1.

Table 1.

Composition of APC Senior Fellow Group.

Number	53
Men	46 (87%)
Women	7 (13%)
Length of service as chair
Range	1- 34 years
Mean	14.9 years
Standard deviation	8.1 years
Median	13 years
Post-chair leadership positions*
Medical school dean	8
Vice-chancellor/vice president for health affairs	4
Health system chief executive officer	3
Senior associate/vice dean	4
Chief medical officer of health system	1
Chief medical officer of national laboratory chain	1
Medical director of a foundation	1
Executive director of American Board of Pathology	1
Chief executive officer of American Medical Association	1
President of College of American Pathologists	1
Executive director of a medical library	1
Director of office of research on women’s health (NIH)	1
Director of research institute	1

Abbreviation: APC, Association of Pathology Chairs.

* Some of these positions were held concurrently after serving as chair and several were held successively by the same individuals.

Evolution of the Senior Fellows Group

Association of Pathology Chair’s members are organized into professional sections of chairs, program directors, educators, and administrators that function as peer groups to address common issues and develop best practices. Since 2006, the APC doubled its staff to support the expansion of member programs and services for all sections and created new committees to address advocacy, leadership development, and workforce diversity. For many years, APC had a membership category for Senior Fellows, who were elected by APC council in limited numbers to consult with committees and represent the APC in appropriate forums. Amid the backdrop of increased organizational activity, the APC Bylaws and Operating Procedures were revised in 2011 to make Senior Fellow membership more voluntary and provide 3-year renewable terms.

A Discussion Group organized by Senior Fellows was held at the July 2014 APC Annual Meeting to “review the current status of the organization; identify value-added contributions that Senior Fellows can provide to other individual APC members and Sections; and discuss how best to maximize the membership, cohesiveness, and effectiveness of this group.” A survey of the then 20 Senior Fellows was conducted to help identify the potential role of Senior Fellows in helping the APC and individual chair members. A strong consensus was that Senior Fellows could be most helpful in advising and mentoring new chairs.

The Discussion Group included Senior Fellows, current chairs, and several APC officers, which subsequently resulted in specific recommendations to the APC Council in September 2014. These recommendations included the creation of an Ad Hoc Senior Fellows Committee that would:

develop a process for engagement and communication among Senior Fellows;

survey APC leadership to identify areas, programs, and specific activities to which Senior Fellows might contribute;

survey current Senior Fellows to identify how they have been involved in APC activities, area(s) of their interest and expertise, and areas, programs, and specific activities to which they might contribute; and

develop incentives for Senior Fellows to attend APC meetings and participate in activities by reducing registration fees for attendance to reflect marginal costs and changing requirements for maintaining Senior Fellow status to better reflect engagement rather than just meeting attendance.

Following approval by the APC Council in January 2015, the APC President, Donald Karcher, created the Senior Fellows Ad Hoc Committee and appointed Fred Sanfilippo and Fred Gorstein as chair and vice-chair, respectively.

In 2017, the value of the Ad Hoc Senior Fellows Committee to the APC and its members was recognized as warranting creation of a permanent organizational structure for the Senior Fellows. The 2 existing organizational categories in the APC were Committees and Sections, neither of which fit the membership and desired structure and function for Senior Fellows. A novel “Senior Fellows Group” was therefore proposed through bylaw changes and operating procedures that would allow self-election of Senior Fellow leadership, representation on other committees, and voting privileges on the APC Council. Following endorsement by the Senior Fellows and APC Council, these changes were approved in July 2017 by the full APC membership.

In 2020, additional changes were adopted that allowed individuals who had served as an interim chair for 5 or more years to qualify for Senior Fellow membership and allowed Senior Fellows to be appointed to serve as APC Past President, if they had previously been an APC President.

Advising, Coaching, Mentoring Activities of Senior Fellows

A major role for Senior Fellows has been advising, coaching, and mentoring pathology chairs, especially for those who have been recently appointed to an interim or permanent position. When the APC office is notified that a new chair has been appointed, the new chair is contacted and offered the opportunity to have a Senior Fellow advisor from an online listing that includes a profile of each Senior Fellow with demographic information as well as areas in which they feel comfortable providing advice (Table 2). New chairs expressing interest can identify specific Senior Fellows or ask for one to be assigned. This information is provided to the SFG Executive Committee, which works with individual Senior Fellow(s) to find appropriate matches so that each new chair is provided with at least one mentor. New chairs may select more than 1 Senior Fellow in order to provide a broader perspective, and women chairs are generally assigned at least 1 female mentor. Contact between Senior Fellows and their mentees is expected to occur by email, telephone, and visual media, and in many cases, direct contact is made during APC annual meetings or at regional meetings. A majority of new chairs indicate interest in having a Senior Fellow mentor and the SFG leadership follows up periodically with mentors to assure that contact has been made with their mentees.

Table 2.

Senior Fellow Activities.

Provide Advise, Coaching, Mentorship
“On-boarding” issues and opportunities for new chairs (eg, leadership training)Strategic issues (eg, departmental priorities, mission balance)Administrative issues (eg, financial, operational)Periodic institutional reviews of chairs/departmentsInteraction with other institutional leaders (eg, other chairs, deans, hospital C suite)Fundraising (eg, interacting with development staff, donors, foundations)Managing faculty (eg, recruitment, retention, annual evaluations, productivity, dismissal)Personal issues (eg, work–life balance, stepping down, retirement)
Participation on APC Committees
Advocacy Graduate Medical Education Leadership Development & Diversity Practice and Management Research Undergraduate Education
Participation in APC Annual and Regional Meetings
Boot Camps Discussion Groups Plenary Sessions New Chairs sessions
Participation in APC Initiatives
Pathology Leadership Academy Society of ‘67 Projects and Publications Webinars

Abbreviation: APC, Association of Pathology Chairs.

In addition to the assignment of Senior Fellow mentors to individual new chairs, a session is held during the APC annual meeting for new chairs to discuss topics of interest with SFG members. Prior to the meeting, new chairs are invited to complete a survey indicating topics they wish to discuss and are asked to provide specific questions. Using the survey results as a guide, a brief overview presentation of the issues is given by a panel of Senior Fellows. For the virtual 2020 APC annual meeting, the areas of interest expressed by the new chairs included: faculty behavior/alignment; aligning department missions/activity; institutional interfaces; personal issues; clinical service/operations; finance/business; and strategic planning.

In addition to this formal mentoring process for new chairs, experienced chairs are routinely reminded that they may use the online listing to contact any Senior Fellow directly for advice or help on any area listed by that Senior Fellow. This informal, confidential process has been used extensively by many chairs and Senior Fellows.

Senior Fellow Participation in Association of Pathology Chairs

Since 2014, Senior Fellows have been significantly engaged in virtually all aspects of APC activities. This has included the participation of individual Senior Fellows on APC standing committees and the APC Council, as well as organized contributions to annual and regional meetings, the APC Pathology Leadership Academy (PLA), the Society of ‘67 fundraising arm of the APC, and development of the Senior Fellow advisory program for active chairs, as described above.

Contributions by the Senior Fellows at APC annual meetings have included: developing half-day “Boot Camp” programs open to all APC members to deal with priority issues identified by new and experienced chairs; participating in the planning and moderating of plenary and workshop sessions; sponsoring Discussion Groups on selected topics; and organizing advisory sessions with new chairs. Senior Fellows, who serve and have served in other leadership roles such as deans and medical center CEOs, also have been helpful in identifying and inviting national thought leaders to participate at APC meetings.

In 2016, the APC developed its first PLA for pathology faculty wishing to enhance their leadership skills. From the onset, this 1 to 2 day program has included a luncheon session organized by Senior Fellows to provide their perspective, answer questions, and network with participants. Senior Fellows have also helped plan, moderate, and speak at various PLA sessions.

In 2017, the APC formed the Society of ‘67 as a means of raising funds to support APC programs and new initiatives. The Senior Fellows were actively engaged in the development of the Society and have been involved both as the major donor group and as board members.

Studies and Projects Led by Senior Fellows

The APC SFG has led a variety of projects that have been published (Table 3). These include issues and opportunities identified by Senior Fellows following service as a chair with reflections on their life after being a pathology chair[12-14]; a review of the most common questions asked of Senior Fellows by current chairs[15]; advantages and disadvantages of serving as a temporary pathology chair[16]; advice on how to deal with deans and medical center leadership[17]; and the relationship of academic departments of pathology with their affiliated Veterans Affairs Healthcare Systems[18] and their associated children’s hospitals.[19]

Table 3.

APC SFG Projects and Publications.

Topic (published)

Issues/opportunities identified after serving as chair[12-14]  Most common questions asked of APC SFG by current chairs[15]  Advantages/disadvantages of serving as temporary pathology chair[16]  Advice on dealing with deans and medical center leadership[17]  Relationship of academic pathology departments with affiliated Veteran’s Affairs Healthcare Systems[18]  Relationship of academic pathology departments with associated children’s hospitals[19]

Ongoing/planned

Leadership of women in academic pathology Directory of APC SFG with demographic information and responses to questions about their careers Webinars on leadership during crisis Historical aspects of pathology Roundtable discussions on topics of interest to chairs Mentorship programs for medical students interested in pathology with emphasis on underrepresented minorities

Abbreviations: APC, Association of Pathology Chairs; SFG, Senior Fellows Group.

Ongoing and planned projects include a survey study of women leaders in academic pathology and the particular issues they face; creation of a Senior Fellows directory with demographic information and answers to selected questions about their careers; production of webinars and discussion roundtables on leadership during crises; enhancing faculty productivity and increasing departmental effectiveness; preparation of manuscripts on historical aspects of academic pathology; and development of mentorship programs for medical students interested in pathology with special emphasis on attracting underrepresented minorities to the discipline.

Benefits to Current Chairs, the Association of Pathology Chairs, and Senior Fellows

Most clinical specialties have professional organizations of academic department chairs to help members deal with the complex leadership and management issues they face as well as to support the advancement of their discipline. A major benefit of these organizations is to provide a network of peers to help chairs deal with issues in and across their clinical service, research, and education missions. However, there often is reluctance of a chair to seek advice from peers, especially if it would suggest personal shortcomings and/or departmental failures. Similarly, chairs are frequently hesitant to engage former chairs of their own department for fear of being perceived as unable to make their own decisions.

Although former chairs may not be up to date with some of the current issues facing active chairs and their specialty, they represent a significant potential resource based on their prior experience as chair as well as from the subsequent roles they may have had. The ability of current chairs in the APC to identify a potential advisor, coach, or mentor from a large list of former chairs who provide their background and advisory interests has proven useful, especially for new chairs. Having an organizational structure and processes to identify potential advisors for interested chairs has helped to facilitate and optimize matching chairs who desire help with the former chairs who are most appropriate.

In addition to providing personal value to current chairs, the activities of SFG members have helped advance the purpose and initiatives of the APC. As listed in Table 2, Senior Fellows have been involved in essentially all APC committees, projects, programs, and meetings. The additional perspectives and resources that former chairs have provided to the APC has been of significant strategic and operational value.

Reciprocally, the opportunity to participate in the SFG has provided significant value to former chairs themselves. Many former chairs have a substantial interest in helping current chairs and their former professional society as a way of “paying back” for the benefits they had received and as a means of staying active in their specialty. In fact, it was former chairs who suggested the development of a Senior Fellows structure to enhance their ability to help current chairs and the APC. The significant and rapid growth of SFG membership, especially by those who had been active leaders in the APC, demonstrates the perceived value of this activity by former chairs.

In summary, the creation of the SFG as a formal body within the APC to facilitate the engagement and contributions of former chairs has proven to be of significant value to other APC members, the Association, and former chairs. The contributions of former chairs through an organizational structure can provide an important resource for current chairs and their professional societies.