A Pivotal Time for Family Medicine Leadership Development

Effective leadership is one of the most critical and valued assets to successful departments of family medicine and to the discipline as a whole. Leadership positions, including chair roles, pose great challenges and offer extraordinary rewards. At this pivotal moment in history, the Association of Departments of Family Medicine (ADFM), recognizes that we need to discover, educate, and support our leaders as departments of family medicine play a vital role in reshaping health care delivery, education, and research. The central question that has faced us in this effort is how to do it.

The rapidly accelerating transformation of health care payment mechanisms, characterized by a tightening link between, quality, efficiency, outcomes, and dollars received, is having an important impact on departments of family medicine. The repercussions of substantially expanding health care coverage haven’t even been considered yet but are certain to bring still greater emphasis to primary care. As reported in a recent survey conducted by the ADFM, department chairs in every region are being asked to help academic centers steer through this changing landscape. Some are being asked to accept new titles and leadership positions, often on top of their chairmanships, but occasionally in lieu of them. Chairs are trying to figure out how to respond to these extraordinary but daunting requests.

This exciting but real strain on chairs and other family medicine faculty members risks exacerbating a pre-existing shortage of leaders. Two years ago, an ADFM survey found that nearly one-half of departments were anticipating a possible or probable change in leaders within 3 years. In fact, interim or acting chairs already comprise over 10% of ADFM members. As the nation grapples with federal health reform and struggling state and federal economies, financial strains on departments have not lessened. The scope of work and the stresses associated with doing that work remain high. The risk of rapid chair turnover poses a risk to the stability and function of academic departments, just as the opportunities for national change are becoming paramount.

In 2008, responding to the perceived need to rapidly identify and nurture future department chairs, ADFM launched the ADFM Fellowship, a program targeting individuals who were ready to seek chair positions. The fellowship focuses on developing leaders who are interested in becoming chairs and has the goals of strengthening their candidacy, enhancing their readiness for the myriad issues they will confront, and building a network of colleagues around the country. ADFM accepted its first class of 4 fellows into the 1-year program in 2009. Since completing the fellowship in February, 2010, 1 of the 4 individuals has become a department chair. Of the 6 individuals in the second fellowship class, 2 have already become interim chairs. A third class has been accepted. An evaluation of the program conducted last spring confirms that the fellowship is meeting a clear need for this unique leadership niche and that ADFM is perfectly positioned to provide the right types of education and experiences.

Another key strategy to meet growing departmental demands is to delegate aspects of mission-related work to a broad spectrum of leaders, such as vice chairs, division and center directors, medical student directors and residency directors. As can be seen on the Family Medicine Leadership Programs Web site housed by the Society of Teachers of Family Medicine (STFM), http://www.stfm.org/leadership/leadershipuser.html, across the organizations of family medicine exist a range of leadership programs. STFM offers a wonderful opportunity to develop the next generation of leaders in our discipline. In light of burgeoning chair responsibilities, ADFM perceived a need to offer other leaders additional insights into the functioning of departments. Accordingly, a few years ago, ADFM started its Senior Leader program. Senior Leaders must be identified and nominated by their chairs. They are invited to ADFM’s Winter Meeting and can participate in a special preconference targeting their unique roles and challenges.

The future of family medicine hinges, in part, on having great and plentiful leaders in all areas of the discipline, working in an effective and integrated strategy with family physicians and staff across the country. We believe that efforts to train future leaders hold a key to the discipline’s growth. ADFM supports and is committed to focused and coordinated efforts that effectively address this need.

• © Annals of Family Medicine, Inc.