Career transitions: Reflections of former chairs and academic health center leaders.

The 2022 Association of Pathology Chairs Annual Meeting included a live discussion session and a pre-meeting recorded panel webinar sponsored by the Senior Fellows Group (former chairs of academic departments of pathology who have remained active in the Association of Pathology Chairs). The presentation was focused on transition planning for academic health center leaders. Each of the discussion group panelists had served as a pathology department chair as well as in more senior leadership positions, and they provided perspectives based upon their personal experiences. It was noted that such positions are often "at will" appointments of indeterminate length and that those above department chair generally carry greater risks and less stability. Becoming "addicted" to a leadership position was not considered beneficial to the individual or to the institution served and makes transitioning more difficult. Ongoing organizational succession planning was deemed helpful to mitigate such addiction and facilitate personal transition planning. Modes of transitioning discussed included those planned (e.g., voluntary retirement, resignation, administrative advancement) and unplanned (e.g., being "fired"; unexpected personal, health, or family issues). Unplanned transitions were felt to be more difficult, while anticipating when it is time to go and planning for it provided greater personal fulfillment after transition. Many career options were identified after serving in a leadership position, including a return to teaching, research, and/or clinical service; writing; mentoring; becoming more active in professional organizations and boards; philanthropic work; and "reinventing oneself" by moving to another career entirely.

Introduction

Leaving one's administrative position is challenging for both the incumbent and for the unit that he/she is overseeing. Higher level positions (e.g., department chair, dean, vice chancellor/vice president for health affairs, chief medical officer, health system chief executive officer) are often more difficult to leave given their generally vast array of responsibilities and their visibility. At the same time, higher administrative positions are often “at will” appointments, frequently carry more risk, and have less stability. Transitioning from these positions can be planned (e.g., retirement, resignation, administrative advancement) or unplanned (e.g., health issues, family issues, and “being fired”). Coping mechanisms will vary depending upon the nature of the departure. These issues have been the topics of discussion in the literature.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11

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) sponsored a live discussion of this topic at the 2022 APC Annual Meeting Chairs Boot Camp using a pre-recorded pre-meeting panel presentation.

Materials and methods

The discussion group panel included the authors of this report: moderator (DNB) and four panelists (LMB, AIG, DEP, FS). All panelists and the moderator had been former pathology department chairs and had held additional administrative posts after serving as chair including medical school dean (DNB, LMB, DEP, FS) with one (DEP) who had served as dean in two different institutions, an academic health center chief executive officer at two institutions and a health system board chair at one (FS), vice chancellor for health affairs (DNB), executive vice president for academic affairs (LMB), executive director of a medical center library (LMB), acting vice dean for research and international affairs (AIG), and interim vice dean for graduate and life sciences education (AIG).

Because the information generated for this report was the outcome of a discussion group, University of California San Diego Institutional Review Board approval was not required.

Results

Planned transitioning

Individuals for whom transitioning is planned (e.g., retirement, resignation) are tasked with knowing when it is time to leave. Signs that it is time to plan for a transition include when the “spark” has gone out; when one does not feel appreciated anymore; and when one feels that he/she has “plateaued” and has few, if any, new things to offer. Furthermore, “addiction” to the position because of its prestige and power is a sign that one should began to “wean” oneself away from it. These considerations are shown in Table 1.

Table 1

When it is time to transition.

Panel findings:

The “spark” has gone out

One does not feel appreciated anymore

One feels that he/she has reached a “plateau” with few new things to offer

One has become “addicted” to the position

Other findings from the literature:

Attraction of other career opportunities above the chair1

Interest in starting career in new discipline1

Exploring a new area of interest1

Desire to return to teaching, research, and service1,5

Family issues, health issues, geographic issues1

Unplanned transitioning

It is critically important to feel fulfilled after transitioning and is usually easier when being promoted to a higher administrative position within the institution or at another institution, reflecting a successful tenure in that leadership role. However, when the transition is unplanned and abrupt due to problems of health, family issues, or administrative/political strife, it is more difficult emotionally and practically to achieve fulfillment. In those situations, individuals often feel lost, forgotten, and miss being in charge, which can result in difficulty interacting with colleagues and former leadership peers.

Panelist perspectives

The four panelists and moderator candidly shared their views and experiences about transitioning from administrative positions. One panelist indicated that department chairs are the “organizational linchpins” and play the most critical role in the university, being responsible for 80% of decisions made. The motivations for leadership include a desire to accomplish, to make a difference, to be involved in meaningful work, to have challenges and complexity, to enable others to develop and succeed, to have power and influence, and to serve. It is critically important for leaders to understand and remember their core personal and professional values and interests in order to craft an appropriate career development plan that includes the ultimate transition from the position. They should reflect on why they aspired to a leadership position and periodically should evaluate their success in accomplishing their personal and institutional goals to determine if they want to continue in the position.

When leaders feel that they have plateaued (e.g., experiencing tasks as repetitive and routine, noting a decline in their learning curve), they should develop a transition plan with a timeline and should aim for proactive, adaptive change rather than reactive change. Options include resuming non-administrative faculty positions, seeking another administrative position, moving to a position outside academic medicine, or retiring.

Another discussant emphasized the importance of knowing what one enjoys doing. Because his/her chairship had a two-term limit, he/she was forced to begin planning for transition at its outset and did so by identifying specific university and extramural academic platforms that supported his/her interests and values.

Yet another panelist described his/her pathway through a chairship and higher administrative positions, laying out his/her thought processes and various options available during the transition. Indications of when it is time to transition include when one no longer wants to be a caretaker, when one does not agree with his/her boss's values/decisions, and when one's position is reorganized into an unworkable one.

Finally, another panelist emphasized the importance of balancing personal considerations (e.g., job satisfaction, stimulation, and appreciation; family and social factors) against institutional ones (e.g., organizational fit, resources, priorities, personnel). He/she recommended that one perform due diligence and seek advice from colleagues, friends, and family in deciding when to transition, again considering institutional factors in the process (e.g., ongoing succession planning, giving adequate lead time). One should listen to his/her “gut” as well as “mind” in making decisions. This panelist stressed the importance of placing family first, knowing oneself, avoiding “stepping-stone” positions, having vision, and driving change.

Panelist perspectives are summarized in Table 2.

Table 2

Panelist perspectives.

Department chairs are organizational “linchpins”

- They are the key interface between administration and faculty

- They provide an interface with other disciplines (departments)

- They are components of multi- and interdisciplinary units (centers, institutes)

- They align organizational missions (research, education, service)

Leaders should desire to:

- Accomplish

- Make a difference

- Be involved in meaningful work

- Have challenges and complexity

- Enable others to develop and succeed

- Have power and influence

- Serve

Leaders should know themselves:

- Understand and remember their core as a person and professional

- Know what they enjoy doing

- Craft a career development plan

- Reflect on why they aspired to a leadership position

- Periodically consider if they want to continue in the position

Leaders should heed signs that it is time to transition:

- When the position has become that of a caretaker

- When one does not agree with the boss's decisions/values

- When one's position has been reorganized into an unworkable one

Leaders should develop transition plans with timeline for proactive change to:

- Non-administrative faculty position

- Another administrative position

- Position outside academic medicine

- Retirement

In transitioning, leaders should:

- Balance personal considerations against institutional ones

- Perform due diligence and seek advice from colleagues, friends, and family

- Listen to one's “gut” as well as “mind”

- Place family first

- Avoid “stepping-stone” positions

Discussion

Transitioning from academic positions is difficult at any time but is particularly challenging when the position involves significant administrative leadership. Cain et al. recognized the trauma that such transitioning may cause, indicating that one may forfeit professional identity and sense of purpose that has shaped one's life for a long period of time. The higher the position, generally the more difficult it becomes to transition, due to the responsibilities of the position, the institutional dependence on the position, and the high visibility of the position. Rayburn and others cautioned that transitions can prompt concerns about the stability and viability of the academic unit, especially if they are unplanned. Unplanned transitions due to health, family issues and “administrative discord” are particularly stressful, and the incumbent should make every attempt to construct a “soft landing” that will permit her/him to deal with these issues while feeling fulfilled. Depending upon the specific reason(s) for transitioning, this may include development of strategies for “face-saving.” Discussants also stressed the importance of knowing oneself and being proactive in planning transition while one still has support from those they serve and lead.

Importantly, before making the decision to transition from one's position, one should ascertain that the decision is not being made simply due to “burnout” and a desire to escape. Running from a situation is almost never good for the individual or the institution. If there is any sense that one is overwhelmed and just wants to exit, he/she should take a sabbatical or other leave to allow sufficient time for contemplation and self-reflection before making plans about transitioning.

An earlier report indicated that more than 60% of surveyed former pathology chairs indicated that they kept teaching and mentoring after transitioning from the chair while 40% assumed other administrative positions (e.g., dean, residency program director, academic health center chief executive officer), 31% continued research, 14% led professional organizations, 11% returned to clinical service, and 11% engaged in entrepreneurial activities. Most individuals engaged in a number of combined activities. The vast majority (57%) of those surveyed emphasized the importance of developing a clear plan and/or goals for transitioning.

Lees, advocated that department chairs negotiate with the dean for a support package to allow time and resources for personal “reinvention” of oneself after transitioning and also encouraged an inhouse sabbatical leave. Finding a teaching and/or research collaborator was also suggested as helpful during the transition.

The role of serendipity in presenting unsolicited and unplanned opportunities should not be overlooked during transition periods. A carefully constructed transition plan should not get in the way of this possibility. One should be open to new challenges and opportunities that suddenly appear and that may suit the individual very well. This can be very exciting and rejuvenating for one who is transitioning and can lead to a surge of innovation and creativity that perhaps was declining as the transition period unfolded.

Finally, academic pathologists who are transitioning from senior leadership positions are often a valuable asset to the discipline of pathology and laboratory medicine as well as to the healthcare community at large. Accordingly, they are frequently called upon to provide their expertise to professional organizations, scientific societies, healthcare organizations, and other groups.

In conclusion, transitioning from administrative positions is challenging both for the incumbent and for the university. Careful planning whenever possible may mitigate the trauma inherent in such transitions.

Declaration of competing interest

The authors declare no potential competing interests with respect to the research, authorship, and/or publication of this article.