Medical school deans’ resignations are relatively common, yet there is limited data on why deans resign. Although statistics on forced versus voluntary resignation by medical school deans are not available, an internet search for medical school dean terminations spans many pages and includes lay press articles detailing many cases of involuntary resignation.
Despite common misconceptions, there is no significant difference in the length of deans’ tenure between men and women, although fewer than 30% of current medical school deans are women.(1) With an average U.S. medical school dean tenure of only 4.3 years for all deans from 1959 until 2019, and a mode of 3 to 4 years (less in some circumstances; public institutions, West Coast schools, non-research-intensive institutions), dean turnaround is a national concern.(2)
The time it takes to become an expert in anything varies within fields, but Malcolm Gladwell popularized the 10,000-hour rule in his book Outliers.(3) Considering this rule and the average tenure of a U.S. medical school dean, most U.S. medical school deans leave their roles either just before or just at the time that they become experts, leading to the unnecessary costs of hiring a new dean and the loss of time investment the institution afforded to developing the former dean. This perspective will discuss the reasons for the short tenure of medical school deans and the next steps after a medical school deanship.
The Short Tenure of Medical School Deans
Why do U.S. medical school deans have such short tenures? Medical school deans resign or are asked to resign for several reasons, including scandal and misbehavior, conflicts with stakeholders, lack of autonomy, changes in university leadership and governance, or the dean’s decision to retire or move on to another position.
Medical school deans are judged on more than just performance metrics such as practice plan finances, research funding, philanthropic support, and student success. For deans, metric-based performance is often an expectation but does not guarantee retention of the decanal position.
Most medical school deans have attained their roles through a meritocracy model, built on a series of career successes: promotion, tenure, becoming a department chair, securing external research funding, acquiring philanthropic support, creating new programs, and developing a reputation far beyond the university. Therefore, it is expected that once hired, a medical school dean would continue to meet these benchmarks of success.
Unfortunately, these successes are seldom solely responsible for a medical school dean’s job stability. Although failure to perform job responsibilities can lead to dean dismissal, a dean can be terminated even if benchmarks of success are met. This is because the success of a medical school dean is intimately dependent on maintaining both internal (faculty, students, university leadership) and external (donors, elected officials, community leaders) relationships.
Studies have found that divorce rates are highest in years 1-2 and years 5-8 of marriage.(4) It is during these times that couples recognize each other’s shortcomings and begin to have more disagreements, questioning their relationship. It is also during these time periods that the downstream consequences of medical school deans’ decisions begin to be realized. Such decisions may be unpopular or may create adversarial relationships that lead to conflict within a dean’s internal and external spheres of influence. As in marriage, questions arise as to the suitability and fitness of the medical school dean for the role.
Effective relationship management is necessary to build consensus in support of the dean. Unfortunately, not all relationships are within a dean’s control. Considering the complexity and interrelatedness of the many relationships a dean experiences, keeping everyone aligned can become impossible. As a result, decisions to replace the dean often begin in earnest.
In addition, when there is university presidential turnover, there is typically a reset in university priorities, and medical school deans can become vulnerable.
Studies indicate that “responsiveness” is a necessary component of good relationships.(5) Responsiveness is defined as a dynamic process of reciprocation and projection where both parties in a relationship move toward similar and compassionate goals. In the case of a medical school dean, such a process is impossible to comprehensively implement, given the vast number of relationships a dean encounters. Further, distance makes responsiveness more difficult, as donors and elected officials are often more distant, and therefore the relationship with the dean is less responsive. Nevertheless, building consensus with these stakeholder groups is critical to decanal success.
An additional factor affecting medical school deans’ tenure is the business cycle. The Corporate Finance Institute divides the business life cycle into five phases: launch, growth, shake-out, maturity, and decline.(6) All medical schools, depending on their maturity and financial situations, exist at various points along the business cycle curve. Additionally, leaders have varied skill sets.
Being a good leader in a time of crisis may not translate into being an effective leader in times of growth or during the maturity phase when maintaining financial viability and the status quo are equally important.
The dean hired during the launch phase of a new medical school may not be effective in the growth or maturity phases, as the skills required for success differ across these stages. Boards and presidents realize this and sometimes change leadership to recruit a dean better able to set a vision given a school’s current fiscal and political circumstances.
Ramifications of Turnover
A medical school dean’s departure affects faculty, students, and the institution itself. The average tenure of a medical school dean is four years. For students, although their exposure to the dean may be limited, they can expect to have a change in dean during their medical school education, making getting to know the dean even more complicated. For faculty, a change in the dean can shift priorities, leading to stress and potentially turnover. For the institution, the knowledge held by the dean can be lost under a new administration.
For many medical school deans, being asked to step down is the first time they have been told that they have failed at something. From a rational perspective, failure is relative, and despite a forced resignation, most deans can readily point to successes in their roles. Fortunately, networking with other deans who have faced similar circumstances can help process a sudden change in position.
Studies of job loss, although few in number, have shown, not surprisingly, that involuntary job loss contributes to a decrease in psychological, physical, and social well-being.(7) Lists of the most stressful life events typically include job loss in the top five most stressful life situations. Interestingly, studies indicate that feelings of grief following involuntary termination are driven less by loss of income and more by feelings of a loss of self-worth.(8) Grief reactions following job loss are also more pronounced when a dismissal is abrupt, leaving an employee unprepared.(9)
For a former medical school dean, recognizing that being asked to step down is not a sign of failure, but an almost-expected part of the job can be helpful as they pivot to the next stage of academic life.
Next Steps for a Former Dean
Given the relatively short tenure of U.S. medical school deans, those in these roles need a plan for life after deanship. The literature supports the idea that successful medical school deans develop management and leadership skills such as visioning and building constituency, as well as acquiring key content knowledge (the medical education process, academic medical center governance), and forming attitudes that commit them to the success of others and appreciate institutional cultures.(10)
Ideally, former medical school deans should capitalize on the skills, knowledge, and attitudes they gained during their tenure as deans. Hopefully, while in the dean role, they sought opportunities to be visible, accepted and excelled at senior roles within the university and developed a network to attest to their skills and abilities.
Former deans have several options:
1. Retirement. As most deans are in the latter stages of their career, retirement is typically an option. However, retirement brings its own set of challenges for people who have been driven by work and titles throughout their careers. Finding value in nonacademic and nonmedical aspects of life (family, health, and relationships) rather than the more familiar and comfortable academic achievements takes time to process, making retirement a potentially difficult transition.
Although longitudinal studies have shown retirement to be beneficial for mental health,(11) those who have unplanned retirements can suffer from Sudden Retirement Syndrome, which is associated with a 28% prevalence of depression.(12) With nearly a third of those forced to retire showing signs of depression, retirement may not be the best option for many former deans.
2. Return to faculty. Some contracts and offer letters include a provision allowing a resigned dean to return to the faculty. Although it is a difficult transition, deans can be effective teachers, mentors, and even healthcare providers.
In his bestselling book From Strength to Strength, Arthur Brooks discusses life transitions.(13) He eloquently makes the distinction between fluid intelligence and crystallized intelligence as two different types of cognitive abilities. Fluid intelligence is the ability to reason and solve novel problems; this type of intelligence peaks early in life and declines with age. Consider mathematicians who typically have their greatest breakthroughs by age 30.(14) Crystallized intelligence, on the other hand, is the ability to reason through assimilation of past experiences. This type of intelligence increases as we get older and gain experience.
Former medical school deans have a wealth of experience spanning their entire careers. The extent of these experiences makes them ideal teachers or mentors to students, residents, and faculty. Teaching and mentoring allow prior deans to maximize their usefulness to contribute meaningfully to their institutions.
3. Look for another job. Of course, former deans have the prestige and a developed skill set to consider a new job in senior leadership. That job may be another deanship, but it may also be an administrative position in a foundation, on a board, in a hospital, or even in a nonmedical field. Having experience managing many people in difficult, complex situations with budgets ranging from $100 million to $1 billion, former deans can be attractive candidates for organizations seeking leaders who can manage people and budgets.
The role of the medical school dean has evolved from a patriarch to a CEO.(15) Due to the complexities inherent in the medical school dean role, getting help from an executive coach both during and after a deanship is beneficial. Coaches can help improve communication skills, increase self-awareness, and hone decision-making skills.(16) In the case of a forced resignation, executive coaching can improve resilience and the sense of self-efficacy, both of which are important for promoting positive personal development.
Hewlett and Luce describe “extreme jobs” as high-intensity, demanding careers that require long hours with unpredictable schedules, tight deadlines and significant responsibility.(17) Such is the job of a U.S. medical school dean. They also describe the “dangerous allure” of these jobs, including health risks, strained relationships, and the stigma against leaving these jobs.
Whatever path is taken, after resignation, a former dean needs to take a personal inventory of what really matters. The notion of career adaptability is important, especially in its ability to adapt to changing career circumstances, be open to change to ensure employability, remain optimistic, remain willing to learn and maintain an internal locus of control.(18) After an initial period of grieving, considering the importance of relationships, family, travel, and leisure helps in the post-dean recovery process.
Final Thoughts on Leaving a Deanship
A medical school dean’s success is largely measured by their ability to manage complex and multiple relationships, an endeavor that inevitably becomes more difficult over time. Serving as the dean of a medical school is an honor and a privilege. Still, in the current environment, the position should be considered part of an academic journey rather than a final destination in a career. All medical school deans should plan for their next step, as a career change is inevitable.
Former medical school deans should cherish the relationships formed, relish the lessons learned, and look forward to a future in which they can remain productive in the next phase of their lives.
References
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