The structure of the schedule is the key to the professional and personal satisfaction of faculty and residents. The actual clinical activities of the ED are those that we all know and do. The CD is also the major liaison between the ED and the other hospital departments. The CD represents the ED for clinical issues, and will sit on interdepartmental committees. While a manager can choose to be formal or informal in style, there is no replacement for simply being around and available.
Presence sets a tone and expectation for others.
There is also the matter of clinical time. Academic performance is required as well, and is of course the reason that any of us choose an academic career. Collaboration is the key to success. Planning to become the CD in an academic center can take one in various directions. A prerequisite to managing a department's care is clinical competence, and importantly clinical confidence.