The Academic Chair: Achieving Success in a Rapidly Evolving Health-Care Environment: AOA Critical Issues

How to Run an Academic Department

Customarily, academic chairs have embodied the triple role of excellence in clinical work,education and research. With the rapid changes in healthcare, it has become clear that surgical expertise and academic achievements do not necessarily translate into leadership greatness. Currently to successfully run an academic department the chairperson must also be an experienced manager, with an understanding of business administration, financial restrictions, productivity goals, and medical ethics. A successful chair needs to be able to balance variable tasks and diverse people, and be proficient in managing uncertainty and change. In this review we summarize the clinical, academic and administrative challenges associated with running an academic department.

AOA Critical Issues: The Status of the Vice Chair Position in Orthopaedic Surgery Departments in 2023

ABSTRACT

The vice chair position in orthopaedic surgery departments has become increasingly prevalent over the last 10 years. Prior to this development, there were few, if any, vice chairs to support the chairperson position. The vice chair role has increased in importance as a result of increasing practice size and the increasing complexity of the health-care environment. The goal of this review was to summarize the current status of the vice chair position within orthopaedic surgery departments and to share the variety of vice chair roles that exist today.

Analysis of Academic Accomplishments and Demographics for Elected Presidents of National Orthopedic Surgery Organizations in the United States

This study analyzed the academic accomplishments and demographics of elected presidents of the American Academy of Orthopaedic Surgeons (AAOS), American Orthopaedic Association (AOA), and American Board of Orthopaedic Surgery (ABOS). Curriculum vitae and internet-based resources were reviewed to collect demographics, training characteristics, bibliometrics, and National Institutes of Health (NIH) research funding of contemporary presidents (1990-2020). Eighty presidents were included. Most presidents were men (97%), and 4% of presidents were non-White (3% Black and 1% Hispanic). Few had an additional graduate degree (4% MBA, 3% MS, 1% MPH, 1% PhD). Ten orthopedic surgery residency programs trained 47% of these presidents. Most had fellowship training (59%), and the top three were hand surgery (11%), pediatric orthopedics (11%), and adult reconstruction (10%). Twenty-nine presidents (36%) participated in a traveling fellowship. The mean age at appointment was 58±5 years, which was 27 years since residency graduation. The mean h-index was 36±23, resulting from 150±126 peer-reviewed manuscripts. Orthopedic surgery presidents had more peer-reviewed manuscripts (150±126) than chairs (73±81) and program directors (27±32) (P<.001). AOA presidents had the highest mean h-index (42±21) compared with AAOS (38±27) and ABOS (25±16) presidents (P=.035). Nineteen presidents had NIH funding (24%). More presidents had NIH funding in the AOA (39%) and AAOS (25%) than the ABOS (0%) (P=.007). Orthopedic surgery presidents possess high levels of scholarly output. AOA presidents had the highest h-index values and prevalence of NIH funding. Females and racial minorities remain underrepresented at the highest levels of leadership. [Orthopedics. 2024;47(1):e45-e51.].

Trends in Medical Training and Leadership at Academic Orthopedic Programs

Introduction: When deciding on which programs to rank or fellowships to enter, medical students and residents may assess the program's prestige and specialty training opportunities. This report aimed to analyze the demographics of orthopedic department chairs and program directors (PDs), focusing on the prestige of their orthopedic training and medical school. Secondary data included fellowship, higher-level education, sex, professorship, years of practice, and total published research.

Methods: We used U.S. News and Doximity to rank 192 medical schools and 200 orthopedic residency programs based on prestige rankings, respectively. We searched for the department chair, vice-chair, and PD via program websites, Council of Orthopaedic Residency Directors (CORD), Orthopedic Residency Information Network (ORIN), personal websites, LinkedIn, and Doximity. Subsequently, we searched for each individual’s demographic information, education and research history, employment history, and medical school attended.

Results: We gathered data on 268 orthopedic surgeons with leadership positions at academic hospitals. Of the 268, 115 were department chairs, 15 were vice-chairs, 126 were PDs, 11 were both the chair and PD, and one was vice-chair and PD. Of the 268 physicians, 244 physicians were male (91.0%), while 22 were female (9.0%). The average residency reputation ranking overall was 59.7 ± 5.7. More specifically, for chairs, the average was 57.0 ± 8.3 (p < 0.005), and for PDs, the average was 63.6 ± 8.0 (p <0.005). There was no significant difference between chairs and PDs (p = 0.26).

Conclusion: Orthopedic leaders were found to have trained at more prestigious programs. This trend could be explained by increased research opportunities at more prestigious programs or programs attempting to increase their own reputation. 9.0% of the leaders identify as female, which is comparable to the 6.5% of practicing female orthopedic surgeons. However, this further demonstrates a need for gender equity in orthopedic surgery. Assessing trends in the training of orthopedic surgeons with leadership positions will allow a better understanding of what programs look for in the hiring process.

Gender differences in faculty rank among academic physicians: a systematic review and meta-analysis

OBJECTIVE

Many studies have analysed gender bias in academic medicine; however, no comprehensive synthesis of the literature has been performed. We conducted a pooled analysis of the difference in the proportion of men versus women with full professorship among academic physicians.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Education Resources Information Center and PsycINFO were searched from inception to 3 July 2020.

STUDY SELECTION

All original studies reporting faculty rank stratified by gender worldwide were included.

DATA EXTRACTION AND SYNTHESIS

Study screening, data extraction and quality assessment were performed by two independent reviewers, with a third author resolving discrepancies. Meta-analysis was conducted using random-effects models.

RESULTS

Our search yielded 5897 articles. 218 studies were included with 991 207 academic physician data points. Men were 2.77 times more likely to be full professors (182 271/643 790 men vs 30 349/251 501 women, OR 2.77, 95% CI 2.57 to 2.98). Although men practised for longer (median 18 vs 12 years, p<0.00002), the gender gap remained after pooling seven studies that adjusted for factors including time in practice, specialty, publications, h-index, additional PhD and institution (adjusted OR 1.83, 95% CI 1.04 to 3.20). Meta-regression by data collection year demonstrated improvement over time (p=0.0011); however, subgroup analysis showed that gender disparities remain significant in the 2010-2020 decade (OR 2.63, 95% CI 2.48 to 2.80). The gender gap was present across all specialties and both within and outside of North America. Men published more papers (mean difference 17.2, 95% CI 14.7 to 19.7), earned higher salaries (mean difference $33 256, 95% CI $25 969 to $40 542) and were more likely to be departmental chairs (OR 2.61, 95% CI 2.19 to 3.12).

CONCLUSIONS

Gender inequity in academic medicine exists across all specialties, geographical regions and multiple measures of success, including academic rank, publications, salary and leadership. Men are more likely than women to be full professors after controlling for experience, academic productivity and specialty. Although there has been some improvement over time, the gender disparity in faculty rank persists.

PROSPERO REGISTRATION NUMBER

CRD42020197414.

Orthopaedic clinical research: building a team that lasts

Medical progress, including in the orthopaedic surgery field, depends on the interaction and collaboration between: physicians, with their expertise on the clinical setting; scientists, with their expertise on the research setting; and professionals who are skilled in both settings (clinical scientists). This leads to the need to develop research approaches which involves people who are committed and support the process, strategic planning, and a cohesive team that can execute the tasks. All these interactions must be supported financially in order to maintain the long-term viability of such team.

Time management is crucial for the clinical research team. To ensure success, the research team must be flexible in order to adapt to dynamic clinical and surgical schedules. It is especially important that surgeons have regular, dedicated quality research time to maintain a consistent interaction with the team.

Building a successful and productive orthopaedic clinical research programme involves many challenges in creating proper leadership, obtaining funding, setting proper resources, establishing necessary training, and providing guidance and insight around the importance of each role that every member plays on the team.

Cite this article: EFORT Open Rev 2021;6:245-251. DOI: 10.1302/2058-5241.6.200058

The Current State of Orthopaedic Educational Leadership

INTRODUCTION

It is important to understand the current characteristics of orthopaedic surgery program leadership, especially in the current climate of modern medicine. The purpose of this report was to describe the demographic, academic, and geographic characteristics of current orthopaedic chairs and program directors (PDs).

METHODS

Orthopaedic surgery residency programs were obtained from the Accreditation Council for Graduate Medical Education website and cross-referenced with the Electronic Residency Application Service, identifying 161 residency programs for the 2018 to 2019 cycle. All data were collected in January 2020 to best control for changes in leadership. Demographic and academic information were collected from public websites. For geographic analysis, the United States was divided into five regions, and training locations were categorized as appropriate.

RESULTS

A total of 153 chairs and 161 PDs were identified. 98.0% of chairs were men versus 88.8% of PDs (P = 0.001). Chairs had been in practice and in their current position for longer than PDs (26.4 vs 16.8 years [P < 0.005] and 9.1 vs 7.1 years [P = 0.014], respectively). Chairs had more publications and were more likely to be professors than PDs. PDs were more likely to remain at both the same region and institution that they trained in residency. The most common subspecialty was sports among chairs and trauma among PDs, although when compared with national averages orthopaedic trauma and orthopaedic oncology were the most overrepresented subspecialties.

CONCLUSION

Orthopaedic chairs are more likely to be men, have had longer careers, and have more academic accomplishments than their PD counterparts. Geography appears to have an association with where our leaders end up, especially for PDs. Subspecialization does not notably influence leadership positions, although orthopaedic trauma and orthopaedic oncology surgeons are more commonly represented than expected. This report serves to identify the current state of orthopaedic leadership and may provide guidance for those who seek these leadership positions.