DEANS AND DEANING IN A CHANGING WORLD

Much has been written about the threats to medical schools and teachin g hospitals, but less attention has been given to what these changes m ean to the individuals who lead these institutions. In the belief that the quality of leadership of academic medical centers, especially med ical schools, will help determine the future of these institutions, th e author assesses the situation of deans today. He first discusses the dramatic decrease in the tenures of deans over the last 20 years and reviews the evidence for some of the possible reasons that this has ha ppened, such as possible changes in the personal characteristics of de ans (not a factor), their salaries (not a factor), the inflated titles and increasing Fewer of deans, and the greatly expanded sizes of the operations that deans now govern (caused by the enormous increase in t he health care establishment and corresponding increases in medical sc hools). However, the author maintains that these reasons do not suffic iently account for the ''administrative distress'' that has affected t he deanery. Causes for such distress include expectations that are too high, a constituency that is too broadly based, the dean's stunted in tellectual life, unreasonable boundaries, a level of authority not com mensurate with responsibility, and a faculty prone to second-guessing. The author concludes by stating that the dean must set the agenda for action by the medical school indicates some main items of that agenda (such as promoting diversity in the physician workforce), and then of fers a variety of ''personal tips'' to help deans survive, such as get ting a good administrative assistant, talking to people one-on-one, nd following up on whatever one does. He ends on a lighter note with adv ice to deans for personal survival, such as taking breaks, rationing t ravel, and planning for life after deaning.