Category: Academic Medicine

In academic medical centers, deans, department chairs, and division directors are almost always filled by doing a national search. Even if there is an inside candidate at the institution that is the heir-apparent for the job, a search is done to adhere to preserve the integrity of the hiring process. Sometimes, the medical center will hire a professional search firm to seek out and vet candidates (often at a high expense) and sometimes the medical center will perform the search with internal resources. The first step is generally the establishment of a search committee which will consist of a diverse number of physicians and administrative leaders both from within and outside of the particular specialty of the person being sought. Candidate names are compiled from responses to advertisements in professional journals, requests for nominations sent to deans, department chairs, and division directors at other medical centers, and first hand knowledge of candidates by search committee members. Candidates are asked to submit a CV and usually asked to submit a letter of interest in the position. There is an initial screening of candidates by the search committee with elimination of those candidates that clearly do not fit the position’s requirements. The search committee chair (or the search firm or the dean/department chair)  will then have a phone conversation with each candidate to discuss the position in more detail and assess their level of interest.

When the candidate list is down to 6-10 people, the so-called “airport interviews” are done. During airport interviews, 3-5 candidates are brought in per day, one after another, for a group interview with the search committee and often a second interview with the dean or department chair. These are called airport interviews because they are typically held at a hotel close to an airport so that candidates can fly in and fly out on the same day. At this point in the interview process, the candidate names are kept confidential; this is one of the reasons for not having these interviews done on-site at the institution. Most of these candidates do not want their own institution to know that they are out interviewing, otherwise, it could hurt their career at their current institution if they do not get the job. The confidentiality is to protect the candidates, not to create a shroud of secrecy for the medical center that is looking for a new leader.

The search committee will then narrow the list down to 4-5 candidates who are brought for a second interview. This second interview is a much longer interview – typically lasting 2 days or more – and the names of the applicants then become more public knowledge. Each candidate is asked to give a lecture, there are interviews with many different physicians and administrative leaders, there is typically a lunch and a dinner with members of the faculty. For many second interviews, spouses are also bought along for dinner, meetings with real estate agents, etc. After the second interviews, the search committee will generally meet a final time to recommend finalists to the university president, dean or department chair. Importantly, the search committee does not choose the final candidate – that is the job of the university president, dean or department chair. The search committee’s job is only to present a final slate of candidates to the individual who will make the final decision.

At this point, a job offer will be extended by the president, dean or department chair to the top candidate and there will be negotiations about resources (start-up packages, office/lab space, administrative structure promises, etc.) as well as salary. If terms cannot be agreed upon, then the president, dean or department chair will go to the next candidate on his/her list.

Over the years, I’ve been on dozens of search committees and have chaired several. I think I’ve seen every mistake a candidate can make and have seen candidates who excelled and knew how to hit the interview process out of the park. Here are some of the points I’ve learned. First, about the initial submission of your CV and letter of interest:

1. Read the RFA (request for application) carefully and be sure that you send in the materials requested. If the RFA asks potential applicants to send in a CV and a letter of interest, then don’t just send in a CV without a cover letter.
2. In the letter of interest, check your grammar and spelling 3 times. The search committee members are mostly going to be people outside of your specialty and most of them are not going to know anything about you. So, the first impression you make on them will be the letter of interest. If the search committee members find spelling or grammar mistakes, then they are going to judge you as sloppy, no matter how many awards you have obtained, grants you have received, and papers you have published.
3. Make the right impression in your letter of interest. The letter should not just state why you want to be a leader (dean, department chair, chief medical officer, division director, etc.) but it should clearly state why you want to be a leader at that particular institution. That will require a little bit of research about the institution. If you have ties to the region or the institution make sure that those ties come through in your letter.
4. Organize your CV. Many academic medical centers will require faculty to use an institutionally-approved CV template. These are often terrible and generate CVs that look fine in the CV template computer program that they are generated in but are a mess when they are printed up. Make your CV easy to read and organize it logically. If you have grants, separate them into current active grants (that are actively funded) versus submitted grants, versus completed grants. If you have publications, number them and separate them into categories of peer-reviewed articles, non-peer-reviewed articles, book chapters, and abstracts. If you have national/international presentations, organize them by date. Do not editorialize about yourself in your CV – it should just be the facts.

The airport interview is the next big step in the process. This can be a high-stress time because the candidate will typically be surrounded by a dozen strangers who will be asking all sorts of questions.

1. The best preparation to do an airport interview is to have previously been on a search committee. Many physicians avoid being on search committees because they can be very time-intensive and it can seem like a lot of work for very little reward. But the education you get from being on a search committee will give you insight into the process that you just can’t get in any other way. You will also get a first-hand look at how successful candidates present themselves. So, if you are a junior faculty member, let your division director, dean, or department chair know that you’d like to participate on a search committee to familiarize yourself with the process.
2. The second best preparation to do an airport interview is a good night’s sleep. Think of doing the interview the way you would think of taking a board examination. You are going to need to think on your feet and be as mentally sharp as possible. Being well rested is critical. If your interview is on the east coast early in the morning, taking a red-eye flight from California to arrive that morning is a really bad idea.
3. Do your homework. Learn as much as you can about the institution before the interview. Draw from on-line sources, colleagues with first-hand knowledge, and alumni. But be careful in the interview – you don’t want to come across as bragging about how much you know but you do want to avoid sounding like a dummy when you are asked questions about institutional organizational philosophy, etc.
4. Google search committee members. You may or may not get a list of the search committee members before the airport interview. But if you do, then do your research on them. There is nothing worse than to make a joke disparaging endocrinologists, when unbeknownst to you, one of the search committee members is an endocrinologist. The interview room may be set up with the committee members’ names on name tags but if they are not, there is no way you are going to remember everyone during a brief introduction so if you know their names/faces/backgrounds ahead of time, you can personalize your comments to them.
5. Dress the part. If in doubt, over-dress rather than under-dress and be relatively conservative. You should be at least as well-dressed as the most-dressed search committee member – if only one other person in the room is wearing a tie, you need to be wearing a tie. Avoid flamboyant or provocative – all it takes is offending one search committee member and your prospects for the job are dead. You won’t know ahead of time if you are going to be seated at a large table or at an open desk so if you are a woman, avoid wearing too short of a skirt and if you are a man, leave your socks with pink bunnies on them at home.
6. Expresso, not coffee. The interview may only be for an hour or hour and a half but you are already going to have an adrenalin-fueled diuresis going on and the last thing your bladder needs is to be hit by the effects of a 16 ounce double mocha vanilla latte half way into the interview. Expresso will give you the caffeine you need without the fluid volume. Also, remember that the last thing you do before you go into the room is to make a trip to the bathroom. A wise man once said that you should always start a lecture, a presidential debate, a rush hour commute, or an airport interview on an empty bladder.
7. Everyone is either Dr., Ms., or Mr. Even if 9 committee members introduce themselves by their first name and 1 introduces themselves as Dr. so-and-so, address everyone equally and like clothing, it is better to be formal than risk being too informal. This is particularly true when it comes to gender. If you address all of the men as Dr. or Mr. and then address one of the women by their first name (or gender vice versa), then you have created a perception of gender discrimination that you likely will never get away from.
8. Make eye contact. Every search committee member is evaluating you on your communication skills. When one member of the search committee asks you a question, make direct and continuous eye contact with that specific individual for at least 20 seconds. If you look at the floor or the ceiling, the person asking the question will think you are aloof and if you look at someone else, they will think you don’t like them. If possible, try to work the questioner’s name into your answer to them so that you can make your response more personal.
9. Use your hands strategically. There are certain things you should never do with your hands during an interview: sit on them, drum your fingers with them, twirl your pen with them. Avoid crossing your arms or your posture will appear closed and defensive. Most of the time, keep you hands loosely folded on the table. But your hands can be great adjectives to emphasize key points you want to make. You don’t want to point or project your arm with the palm down. When you do want to use your hands for emphasis, position them as if you were holding an imaginary basketball in front of your chest.
10. There are certain questions you are always going to be asked. What attracted you to this job? What is your leadership style? What is your approach to improving diversity? What would others say about you? Tell me about a time that you failed at something? Tell me about a time you dealt with a disruptive physician? At many airport interviews, the questions will have been pre-scripted ahead of time so that each candidate is asked the same questions (often by the same person) in order to better compare one candidate to another. Think about these ahead of time – you don’t want your answers to sound rehearsed but you don’t want to have uncomfortable pauses while you think of something to say.
11. Be willing to acknowledge your shortcomings. There are a lot of pathways to becoming an effective leader – a successful researcher, a prolific publisher, an award-winning educator, a profit-generating administrator, an outstanding clinician. But few people, if any, are ever excellent at all of these. However, if you don’t have an RO1 grant, do make it clear that you value research and will be supportive of those who do research.
12. Skype effectively. Some of the initial interviews are done by Skype. I think in many ways, these are more challenging than an in-person interview. When Skyping, your tendency is to look at the video picture of the other people on your computer monitor and not at the camera. As a consequence, the people interviewing you never have eye contact with you. In other words, you think you are looking at them but they see you looking away at something else. Resist the temptation to look at the other people on the monitor and instead look directly into the camera. Also, be sure that the back-drop is appropriate, tidy bookshelves or walls with artwork work well. Think of yourself as an actor and everything behind you is the stage that you are setting. When you are Skyping, your movements are going to seem amplified so don’t sway or rock back and forth. Also, position yourself appropriately in front of the camera – too close and your nose will look fat and your head will appear weirdly shaped. The best thing to do is to practice with a family member so that you can get feedback on your appearance and camera presence and you can also have your family member in front of the computer you will be using so you will know the best way to position yourself and the room background for effect.
13. Avoid saying stupid things. A couple of examples from candidates I’ve seen in the past: “I like critical care because it is like internal medicine on crack.” Or, “As division director, can I put my name on the author list of all of the manuscripts that come out of the division?”. Or, “I’m debating on whether to retire or take on a new leadership job.”
14. Don’t be a potty mouth. Most people swear (with varying degrees of intensity of vocabulary) but during an airport interview, your swear words should be limited to “gosh”, “gee”, and “wow”. The only thing that will blow up when an F-bomb is dropped is your chances for getting the job.
15. Humanize yourself without self-aggrandizing. When asked about yourself, don’t come across as pompous or boastful but do present yourself as an interesting and well-rounded person.
16. Pace your answers. Limiting answers to just “yes” and “no” is ideal for giving court testimony but you will want to expound a bit more than one word answers during the interview. On the other hand, you do not want to make your answers so lengthy that some of the search committee members feel cheated if there is no time for them to ask their questions.
17. Project emotional intelligence. EI is all the buzzword these days in academic medicine. It turns out that this is a very difficult thing to teach or to prep for but it seems like some people naturally have it and others don’t. In an airport interview, questions that probe emotional intelligence often are grouped as questions that ask how you handle yourself and how you handle relationships with others. Examples are how you handle disputes, how you manage conflict, how you identify and overcome weaknesses in yourself and in others, how you handled a setback, and how you interact with others.
18. Shake everyone’s hands… at least once. The handshake often seems like a formality of social etiquette but the human touch can help establish a connection between 2 people that words cannot. But there is an art to the handshake – it should neither be too limp nor too firm. For search committee members who use their hands for a living (surgeons, gastroenterologists, anesthesiologists, etc.), an excessively firm handshake is a direct threat since even a small injury to the hand can derail their professional career. On the other hand, a flaccid handshake can make you come across as timid and a pushover. Use the same amount of force that it takes to pick up a glass of water with your hand.
19. Don’t clean out the hotel minibar. The institution will usually be paying the hotel bill if you stay overnight and that includes everything that you take from the minibar. Once, we had a candidate take everything from the minibar as she left the hotel, leaving the bill to the hospital. Needless to say, she was not asked back for a follow-up visit. What you take out of the minibar can reflect on your personality so if the institution gets a bill for 2 Snickers bars and 3 Budweisers, that is going to say a lot about you. If you order the lobster Thermidor with beluga caviar sauce and a bottle of champagne for a midnight snack from room service, that also tells a lot about you. If you want a beer the night before your interview, go downstairs to the hotel bar and pay for it in cash.
20. Send a follow up email. I get these all of the time, from medical students interviewing for internships, from physicians interviewing for jobs, and from leaders doing airport interviews. Most of the time, I ignore them but I do think that a follow-up email can sometimes make an impression. The ones that impress me the most are those that incorporate some personalized information. For example, a reference to something that we discussed or a reference to something unique about me or my career. In other words, avoid sending the same generic “Thank you for interviewing me” email to all of the committee members.

Once finalist candidates are selected from the initial airport interviews, there is a whole new strategy involved for the next round of interviews. I will write more about that in a future post.

April 19, 2019

Brett Favre was one of the greatest quarterbacks in NFL history. As physicians, we can learn a lot about the legacy we leave and about how we will be remembered from Brett Favre. After a rookie year with the Atlanta Falcons, Favre joined the Green Bay Packers where he spent the next 16 seasons amassing one football record after another. In Wisconsin, he was a hero: parents named their new-born sons Brett, Green Bay jerseys with #4 quickly sold out, and he was awarded the NFL’s most valuable player three years in a row. On March 4, 2008, he announced his retirement but then a few months later, he changed his mind about retirement and asked to be traded so he went to the New York Jets for a year and then announced his retirement (again). A few months later, he signed with the Minnesota Vikings, the arch rivals of the Green Bay Packers. And Brett Favre went from being the most beloved man in Wisconsin to being the most hated man in Wisconsin.

So, what does this have to do with physicians? We do not have the fame of a Brett Favre, but we do build up a reputation in our hospitals, our communities, and our medical schools. If you look around at medical centers and colleges of medicine, buildings are named after those locally famous doctors who stayed at their institution for years or decades and then retired from that institution. They don’t name buildings after doctors that practice at a hospital for 25 year and then leave to go practice somewhere else.

It is because our brains are wired to dislike someone more if we initially thought that they liked us but then later disliked us. As an example, think about the last ugly divorce that a neighbor, co-worker, or family member went through and how the former spouses now see each other. It also works the other way: we like someone more who we initially thought disliked us but then later liked us. As an example, think about every military sergeant and every high school coach that ever existed.

When a senior colleague, a mentor, a department chairman, or a division director leaves for a similar job elsewhere, they become a persona non grata. We perceive that the physician is leaving because he or she no longer likes us. Consequently, we no longer like him or her. Institutional history is always written by those who remain and not by those that leave and so those physicians who leave are remembered by institutional history not for all of the good that they did while they were here, but rather remembered just for leaving.

There are exceptions. For example, for a bona fide promotion, such as a division director who leaves to become a department chairman elsewhere else. Or for family reasons, such as a physician who moves to a different city because his/her spouse’s job got transferred. Or for internal transfers, such as a physician in a large multi-hospital medical system who is asked by the corporate leadership to transfer to fill a clinical void at one of the other hospitals.

But it is the physicians who depart for seemingly lateral moves who we perceive as rejecting us and thus we in turn reject. And the longer a physician has been at one hospital before leaving for another, the more strongly we reject him/her. We tend to erase and forget all of their accomplishments. We find other physicians to elevate to the level of celebrity to replace those who left. The students, residents, fellows, and junior physicians who came to the institution because of them feel as if they were lied to. The physician’s patients feel betrayed. To all, the departing physician becomes a pariah.

You can measure the qualifications of a physician by how he/she is recruited for a job. You can measure the integrity of a physician by how he/she leaves a job. It is better to leave an institution after only a few years than to leave after a few decades when you have become the face of that institution.

I want to be remembered not like Brett Favre but like Cal Ripken. He was born in Maryland and played every one of his 21 seasons with the Baltimore Orioles. His player number was retired by the Orioles in 2001 and the in the state where he was beloved as a player, he is still beloved.

July 2, 2018

Leadership change in a healthcare organization is inevitable but every time it happens, it can be a bit unsettling to the physicians. If there are a lot of changes that occur simultaneously with sweeping changes in multiple leadership positions, then it can shift from being a bit unsettling to being a lot unsettling. And much of that arises from uncertainty of values.

In medical centers, leaders such as Deans, Department Chairmen, CEOs, and Division Directors can be roughly divided into two groups: those that are recruited from within and those who are recruited from outside. Those that are recruited from within are physicians and leaders who have worked at the institution and are “known entities” to the rank-and-file physicians and other employees. Those that are recruited from outside are largely unknown to most of the physicians. There is an often-overlooked difference between these two groups of leaders: The former are known whether they have shared values with the rest of the physicians and the latter are not.

Those shared values can mean many different things in different institutions. They can be dedication to clinical excellence, dedication, to educating the next generation of physicians, dedication to organizational financial health, dedication to creating new knowledge through research, dedication to improving diversity, dedication to care of the underserved, dedication to improving public health, etc. With leaders who are recruited from within, you know what you are getting because those leaders have shown what their values are as they have risen from one of the rank-and-file physicians to leader. And therefore, you know from personal experience and history whether that leader shares your own values.

It is harder to know what values are held as most important to leaders who are recruited from outside. You can get an idea from their curriculum vitae and from what they say in presentations and meetings. But you never really know until you experience that leader’s actions first hand.

Sometimes, new leaders are recruited specifically because they hold different values than what the existing institutional culture holds. Maybe a board of trustees wants to “change the culture” of the medical center – this really equates to changing what is valued by the medical center. This can be particularly difficult if the medical center is constantly trying to be something different than what it actually is. For example, a medical center that historically prides itself on care to underserved patients that tries to reinvent itself as a research powerhouse is going to face a lot of challenges. Nevertheless, such value disruption is often necessary to correct perceived institutional deficiencies.

The half-life of medical institution leaders is relatively short, particularly for deans and department chairmen in academic medical centers. An organization that primarily recruits its leaders from the outside can find itself in a state of perpetual value uncertainty, leading the physicians wondering whether or not the values that they hold and that brought them to that medical center originally are the values that will be used to define institutional success in the future. Such efforts to “change the culture” too frequently can result in a sense of on-going value disruption can result in non-alignment and disengagement by the physicians.

On the other hand, recruiting leaders exclusively from within the medical center can result in maintaining a sense of shared values but can also result in stagnation of values. For example, if a hospital in poor financial shape brings in a medical leader who values improving clinical productivity over everything else, then over time, the institutional shared value will become one that fosters high productivity; recruiting successors to that medical leader from within the organization will perpetuate that emphasis on high productivity rather than other values, such as education, enhancement of diversity, research, etc.

A healthcare organization can afford value disruption only so often. Too frequent of leadership changes with leaders recruited exclusively from outside the organization leads to uncertainty of institutional values that then results in high physician turnover. A goal of a healthy healthcare organization should be to create a pool of potential future leaders that have a track record of shared values with the rest of the physicians. These shared values can result in the physicians having a sense of security that what they personally value will be aligned with the values held by the next healthcare organization leader.

Hospital leaders recruited from outside are often aspiring leaders that want to be a leader somewhere and your hospital had an opening coincident with when that person was looking for a leadership job; these leaders are often effective when you need institutional value disruption. Hospital leaders recruited from within are usually aspiring leaders that want to be a leader at your hospital specifically; these leaders are often effective when you need institutional shared values. Therefore, it is on each hospital and health system to create leadership training programs to ensure a steady pipeline of future physician leaders from within who are known by the rest of the physicians to have shared values. This gives leadership search committees the luxury of being able to decide whether at that moment, what is needed is value disruption or shared values. A health system that relies too heavily and too frequently on recruiting leaders from outside of the organization will have a difficult time developing and maintaining a culture of shared values.

The true value of shared values is in improved physician alignment/engagement and in institutional stabilization.

April 5, 2018

I think that every search committee assembled for nominating academic medical center leaders should be required to watch the movie The Replacements before starting their search.

In the movie, Gene Hackman is the coach of the Washington Sentinels, a fictitious professional football team. In the midst of a player’s strike, the team has been repopulated with a group of has-beens and want-t0-be football players, led by Keanu Reeves. Reeves plays the character Shane Falco, a former All-American quarterback from the Ohio State University whose football career crumbled after playing a horrendous Sugar Bowel game and who ends up living on a houseboat and doing boat repair work rather than playing professional football. What makes Falco successful with the Sentinels is not so much his quarterback skills but the fact that he brings out the best in all of the other replacement players, making the team win games as a consequence.

In the last game of the season, the Sentinels’ regular quarterback, Eddie Martel, crosses the picket line to return to the team, sending Falco back to his regular job as a boat mechanic. Martel is one of the best quarterbacks in the country but is a bit of a prima donna and looks down on rest of the team’s replacement players, who he considers rejects and inferiors. Meanwhile, the all of the regular players on the opposing Dallas team have crossed the picket line and returned to work. The first half of the game is a disaster for Washington because even though Martel is an all-star, he can’t relate well to the rest of the Washington players and consequently, they do not play well as a team. As the team is walking into the locker room for half time, Gene Hackman is asked by a reporter what it would take for Washington to get back into the game and he looks at the reporter and says:

“You’ve gotta have heart. Miles and miles of heart.”

That was a verbal signal to Falco, who was watching the game from his houseboat, that the team needed him and so he suited up and returned to the locker room where the rest of the players kick Martel out. Falco and the rest of the Washington replacements then go on to win with a touchdown in the final seconds of the game.

So what does a sports comedy movie have to do with selecting academic medical leaders? Over the past 30 years, I’ve seen good leaders and bad leaders. I’ve seen effective leaders and ineffective leaders. I’ve seen leaders with a long tenure and those with a short tenure. And all too often, I’ve seen leaders selected for the wrong reasons.

We often select our leaders based on their previous personal successes – because they’ve become famous doctors on their own right, because they’ve gotten a lot of research grants, or because they’ve published lots of papers in medical journals. And often what we get is the Eddie Martels of the academic world, people who have had enormous individual success but no track record of making those around him or her successful.

Former Ohio State quarterback Shane Falco was successful with the replacements not because he was the best quarterback himself, but because he brought out the best in all of the other players around him. Or, as his coach said, he had heart.

I think that is what is often missing when we select academic medical leaders. We overlook their passion for the institution and their passion for those who work at the institution. The rank and file faculty and physicians at any given academic medical center are mostly “lifers” – women and men who spend all or most of their careers at that single institution. They take pride in being a part of their university. They’re die-hard fans of their university’s athletic teams. They have jackets, ties, sweatshirts, scarves, and hats with their university’s mascot on them. They bleed (name your school colors). And if they are asked what they do by someone sitting next to them in a bar, they’re more likely to say “I’m on the faculty at the university” rather than “I’m a cardiologist”.

For a leader at an academic medical center to be truly successful, she or he has to have passion for that university. And I think that passion is the overlooked quality that leadership search committees overlook when they are evaluating candidates. A successful leader has to have more than just passion but passion is the catalyst that brings out the best in all of the rest of us. Passion doesn’t show up on a CV. Passion isn’t something that a hired recruitment company looks for. Passion isn’t something you can measure by number of grants or publications.

The best leaders are not the ones who accept your job offer because it was the best of the 4 or 5 that he or she has at the moment. The best leaders are those who accept your job offer because it is what they have always aspired for. Skills are what makes us succeed as individuals; passion is what makes those that we lead successful.

February 17, 2018

A few years ago, I took a tour of the USS Midway, an aircraft carrier that is now a museum anchored in San Diego. One of the things that I learned was that the Chief Petty Officers are the people who really run the ship from an operational standpoint with the Captains making the tactical and strategic decisions. There are a lot of analogies with hospital leaders.

Two weeks ago, we had some turmoil at Ohio State when the Vice President for Health Sciences and CEO of the Medical System resigned under pressure from the physician faculty. It caused me to examine who our medical system leaders are and I realized that there are really two tiers of leadership, a lot like the Chief Petty Officers and Captains.

At the top, are the executive leaders: the Chief Executive Officer of the Medical Center, the Dean, the Chief Financial Officer, and the Chief Operating Officer. These are professional leaders; by that, I mean that they are either leaders with a business background who have specialized in overseeing large health systems or they are physicians who have evolved into  leadership roles and no longer are doing clinical care. These are like the Captains. Of note, at Ohio State, all of them are people who were recruited from outside of the University.

In the middle, there are all of the operational medical directors: The Chief Medical Officer, the Medical Directors of each of the hospitals in our health system, and the Medical Directors of every procedure area and clinical program. Every one of these individuals are physicians who have been at our Medical Center for many years who started off as regular clinicians and then were home-grown into their leadership roles. I’m one of them – we are like the Chief Petty Officers.

In academic medicine, the captains have differentiated themselves so much that about all they can do is be full-time leaders. The chief petty officers are generally a lot less differentiated and they typically are also doing clinical care or teaching; in other words, they are not full-time leaders.

Because so many of the captains come from outside of an institution, they are by definition geographically mobile. Because they are mobile, you are always at risk of them leaving to go to some other academic institution, much like the Medical Rock Stars that I wrote about in a previous post. On the other hand, the chief petty officers tend to be geographically fixed, loyal to a single institution, and are less mobile.

In the navy, the chief petty officer is the highest rank that an enlisted sailor can achieve. Because they started off as regular sailors, the rest of the ship’s crew knows and trusts them – the chief petty officers have “been there” and the crew considers them to be one of their own. In medicine, the chief petty officers are the same – they started off as regular doctors and at their core, they still identify themselves as clinicians. They hold the institutional memory of the past years and decades and they are the ones that the rest of the physicians know and trust. They also know all of the bad things that have happened in the past that were swept under the carpet; in other words, they have institutional wisdom.

An academic medical center needs both captains and chief petty officers. For me, I’m very comfortable being a chief petty officer.

June 12, 2017