Length of Service of Medical School Deans: The Long and the Short of It

The median length of service for medical school deans has remained at approximately 4 years since 1959. This relatively short duration of leadership may limit growth and innovation in the academic and clinical missions. Several factors may account for short deanships, including a mismatch between the institution's selection criteria and the requisite personal characteristics that promote successful leadership, divergence in the institution's expectations and the resources and structures it provides to the new dean, and problematic relationships and misaligned priorities of the medical school and its primary clinical partner organization or organizations. The relationship and personality match between the dean and the chief executive officer (CEO) of the major clinical affiliate or affiliates is vitally important in advancing the goals of each organization. In instances where a single individual serves as both the dean and the health system CEO, it is essential that their direct reports share a degree of responsibility for the overall success of both the clinical and academic portfolios. Otherwise, the all-too-common tension between dean and health system CEO simply moves downstream to the clinical and academic portfolio leaders.Despite the challenges confronting academic medicine, service as a medical school dean remains an incredibly satisfying opportunity to make a profound difference to the patients and populations served by academic medical institutions. The author offers a few personal reflections on how to develop a relatively long and hopefully impactful deanship and, more importantly, promote progress in advancing the medical school's mission and vision.