Reminiscences and reflections on leadership.

When I arrived as Chair at the University of Louisville in 1991, I did not have a single gray hair. So, here I am, 20 years later, with less hair and lots of it gray, sharing my thoughts on leadership. What I know comes from my experience, very good advice, and a plethora of articles and monographs written on this topic. One of the best overviews is a series by the American Association of Medical Colleges (AAMC) (1). The first paper I ever read about being a department Chair was during my residency at the University of Cincinnati (OH), in a course on group processes. Written by the former chair of the department of psychiatry there, Maurice Levine, M.D. (2), it was called “Oedipus, Cain and Abel, and the Geographic Full-Time System.” Levine argued that a full-time academic system fostered the intensity of both Oedipal and sibling rivalry feelings within a department. His recommended solution, used at Cincinnati at the time, was the “geographic full-time system,” in which faculty were paid a full-time salary equivalent to about 75% of the going rate, with the understanding that they could use university facilities and resources to conduct independent practice for the remainder of their time and income. Levine believed that this measure of clinical autonomy reduced conflicts with the Chair and among faculty. For better or worse, the faculty appointment system Levine advocated is just about extinct. My next 15 years at the University of Connecticut assured me that, to Levine’s credit, all of the phenomena he described were still alive and well. I remembered Levine’s paper as I arrived, in 1991, as Chair at the University of Louisville. I hoped that because I had run a milieu-oriented inpatient unit, served as a director of medical student and residency education, completed training as a psychoanalyst, and believed in a more flattened hierarchical-management style, I knew a little bit about managing transference. I thought that perhaps during my tenure, perceptions of me as Chair would be based more on reality than on transference. Of course, these hopes were immediately challenged within the first week of my new position, when a faculty member unexpectedly chastised me for disliking him and the work he was doing. In fact, not only had I no such feelings (the opposite, in fact), but also I had no idea where that perception had originated. About 6 weeks later, I attended my first meeting of the American Association of Chairs of Departments of Psychiatry (AACDP). In 1990, John Romano, former chair at the University of Rochester, had given an address titled “The Battered Chair Syndrome” (3), which discussed the wide range of forces that regularly buffet the Chair, and how they affect the perceptions of faculty and others. I was surprised when a speaker, in 1991, began his talk by saying he sincerely believed that, in his many years as Chair, not one of his faculty ever really knew who he actually was. Determined not to follow in this path, and believing that reality was the best antidote to transference, I thought that the best policy with faculty and staff was to be myself and to be as clear, fair, and equitable as I could. I believed that this would minimize, if not render irrelevant, any irrational feelings about faculty toward me or each other. Stress, of course, stirs up all kinds of group processes, and part of the stress in an academic department comes both from the reality that the faculty’s livelihood comes from their faculty appointment and from their aspirations for success. When I arrived as Chair in Louisville, I learned that there was a significant budget deficit. Because the faculty had been completely unaware of it before I arrived, many of them seemed to believe that I had invented the whole thing just so that I could ask them to work harder. Luckily, my mother put this into perspective for me early on. I told her I thought many of the faculty were upset with me because of the budget problem. She responded, “Allen, you can’t Received November 13, 2009; revised February 22, 2010; accepted March 23, 2010. Dr. Tasman is affiliated with the Department of Psychiatry & Behavioral Science at the University of Louisville School of Medicine in Louisville, KY. Address correspondence to Allan Tasman, M.D., Department of Psychiatry & Behavioral Science, University of Louisville School of Medicine, 401 E. Chestnut St., Ste. 610, Louisville, KY 40292; allan.tasman@louisville.edu (e-mail). Copyright © 2011 Academic Psychiatry