To Diversify Leadership, Academic Medicine Should Implement Term Limits

At the rate things are going, it will be 50 years before an equal number of women and men are in leadership roles within academic medicine.

"It's critical to the mission of academic medical centers to have diverse and evolving perspectives among our leaders," says Reshma Jagsi, M.D., D.Phil., director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan. "Increasing diversity among leaders will help address issues of discrimination and harassment of women and minorities and transform the culture of medicine."

Jagsi is senior author on a commentary published in the New England Journal of Medicine that proposes one potential solution: Enact term limits for department chairs, deans and other high-level leadership roles.

It's an idea recently embraced by the National Institutes of Health, which announced 12-year term limits for its laboratory and branch chiefs.

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Currently, senior leaders in academic medicine are primarily white and male. Women account for 18% of medical school deans and minorities account for 12%. Among department chairs, 19% are women, even though women have comprised at least 40% of medical students for the last 25 years. When considering department chairs who have been in their position at least 12 years, only 7% are women.

"It's well-known that within academic medicine, women and people of racial or ethnic minority groups are underrepresented the higher up the chain you go," Jagsi says. "Term limits is one approach to open the academic pipeline."

SEE ALSO: Female Physicians Report Skipping Scientific Conferences Because of Child Care

Jagsi talks about how term limits could create more opportunities to increase diversity, equity and inclusion within academic medicine and why that's critical.

Why are term limits worth considering? How would this open up a pipeline?

Jagsi: In academic medicine, the lack of diversity among leadership is a major concern. One challenge to creating more diversity is the tendency for leaders, particularly department chairs, to remain in those roles for very long terms. Chairs marshal substantial resources to pursue their vision, so many individuals quite reasonably continue in those roles as long as they are allowed. Unsurprisingly, those who have been in leadership positions for decades tend not to reflect the demographics of the population or the modern medical profession.

Term limits would force change, which would provide opportunities to new generations who are more reflective of the whole profession. This approach would allow for fresh ideas and may bring valuable new perspectives.

Would turning over leadership more frequently create a lack of continuity or institutional knowledge?

Jagsi: Leadership roles within academic medicine are complex, and some degree of institutional memory and experience are very important to maintain within the cadre of leaders. Still, regular turnover (not all at once!) is possible, with reasonably long terms like the 12 years the National Institutes of Health recently implemented. At some point, there are probably diminishing marginal returns to what an organization gets from people remaining in a position – certainly well before the four decades that some current leaders have served in their roles.

Even with term limits, how do we ensure that women and minorities have the opportunity to compete for leadership roles?

Jagsi: Pipeline development and succession planning activities are critical to give all potential leaders with the desire to serve the skills they need to do so effectively. Strategic approaches to leadership search processes can ensure that job postings are written in ways that appeal broadly, that criteria are clearly articulated and prioritized, that members of selection committees receive training in unconscious bias mitigation, and that efforts are made to encourage applications from those who may lack access to traditional insider networks but nonetheless have tremendous promise as leaders.

SEE ALSO: Improving Equity in Academic Medicine, a Conversation with Christina Chapman, M.D.

How does diverse leadership benefit patient care and research?

Jagsi: Evidence clearly demonstrates that when individuals from different backgrounds and life experiences come together and interact, more innovative approaches emerge, different questions are asked, and better solutions result. Often physicians who are part of underrepresented groups are more likely to serve minority, poor or Medicaid populations. Studies have shown that patients from underrepresented groups respond differently to health care when they see themselves in their physician. Diversity has direct impact on the quality of care and research that academic medicine produces.

What are some other ways in which academic medicine is trying to create more opportunities for women or minorities?

Jagsi: As we open up more leadership positions, we need well-trained candidates. Leadership skills are not necessarily the same as the skills that lead to academic seniority, such as skill in attaining grant funding or publishing. Therefore, concerted programs focused on developing leadership skills are needed. One is the national Executive Leadership in Academic Medicine Program at Drexel University, in which I'm currently enrolled. At Michigan Medicine, we have the Rudi Ansbacher Advancing Women in Academic Medicine Leadership Scholars Program. These are wonderful examples of how to prime the pipeline for women and minorities.

Paper cited: "Unplugging the Pipeline – A Call for Term Limits in Academic Medicine," New England Journal of Medicine. DOI: 10.1056/NEJMp1906832

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