The Path to Department Chair: Arriving and Thriving (Part 2)

In the January issue of ENTtoday, ENT department chairs shared stories of how they rose to their esteemed positions. This month in Part 2, chairs talk about what it has been like to serve in these roles and offer their advice to otolaryngologists who wish to follow in their footsteps.

Most otolaryngologists do not launch their medical careers with the clear intention to become a department chair in an academic setting. More often, the ascent to the role occurs organically as their professional achievements accumulate and their experience broadens. Even so, the transition to the job can be an eye opener.

An Evolving Role

With nearly 20 years of experience as a department chair of otolaryngology–head and neck surgery, Mark Varvares, MD, is exceedingly familiar with the job. He held the position at the St. Louis University School of Medicine from 2003 to 2015. Then, in 2020, he became interim chair at Harvard Medical School, Massachusetts Eye and Ear, and Massachusetts General Brigham in Boston. One year later, after a nationwide search, the arrangement became permanent.

Dr. Varvares emphasized the all-consuming nature of the job and the personal commitment required to make it work. “The scope of the department chair role encompasses oversight of all aspects of the department,” he said. “This takes priority over all other professional interests that I have.”

While the broad scope of the job is a given, some of its unique challenges tend to morph with the times. Over the years, advancements in science and technology, as well as ongoing changes in the structural framework of the healthcare system, public attitudes toward health, and governmental policy, have all had an influence on the nature of the job.

Sandra Lin, MD, who took over as chair of head and neck surgery at the University of Wisconsin School of Medicine and Public Health in Madison in the summer of 2025, underscores the impact of such changes on the role of department chair over the past several decades. “Of course, [department chairs] have always needed to be leaders,” she acknowledged, “but now, we must understand chain management. We must understand the dynamics between health systems and academic departments, and how to strategize to maximize our clinical mission. We must consider the importance of building a widely diverse workforce. And finally, we must deal with a lot of pressure related to research and research dollars— especially recently.”

This last point cannot be overstressed. It has been widely reported that the current administration’s recent funding cuts to the National Institutes of Health (NIH) have directly affected the ability of medical institutions to conduct potentially life-saving research (J Adv Pract Oncol. doi: 10.6004/jadpro.2025.16.4.1). As of November 2025, the proposed federal budget for 2026 included a 40% cut in the NIH research budget (American Medical Association. https://tinyurl.com/53wv3fdh). Although universities are fighting back in the courts, academic leaders still face difficult resource challenges resulting from these devastating cuts.

The Challenge of Leadership

“Leadership is hard if you’re doing it right,” said William O. Collins, MD, who has served as chair of otolaryngology– head and neck surgery at the University of Florida College of Medicine in Gainesville since February 2022. “There is often a need to step in and be the ‘bad guy,’ to have hard conversations, to deliver bad news, and in some cases, to set boundaries.”

No matter the decade (or decades) in which a chair serves, leading an academic department is essentially a people-based, relationship-driven venture. For new chairs, just the prospect of learning who everyone is and how they function in their roles can be daunting. However, building relationships with those individuals is a key aspect of the job, stresses Yuri Agrawal, MD, MPH, chair of the otolaryngology department at the University of Colorado Anschutz School of Medicine in Denver since 2023. “It is hard for a single individual to attain and sustain the required depth of connection with everyone, so [as a chair] I have to be very intentional about that,” she said. “I also try to be a team player, not only departmentally but institutionally, supporting our dean and our chancellor—to be a partner in that regard.”

The role is complex and multilayered, agreed Dr. Lin. “You can’t just be a thought leader nowadays; you also must understand how to effectively implement and execute your ideas. You must know how to inspire people and create a cohesive and effective team,” she explained. “In some ways, it reminds me of being a mother or a teacher or coach, especially for the younger faculty—you’re always trying to help them develop within the overall academic mission. Knowing that you’re developing future leaders is a big ‘pro’ of the job.”

One of the most challenging aspects of department leadership, said Dr. Agrawal, is having to make decisions for the greater good that are not necessarily in everyone’s best interests, and then handling the communications around that. These are skills that aren’t taught,” said Dr. Agrawal. “I’ve noticed that leaders develop different ways in which to handle this.”

Indeed, leadership styles do vary with the individual, and it is up to each chair to determine what works best for them. The keyword here is “authenticity.” “People know when you’re trying to take on a persona that is not native to who you are,” Dr. Lin said. “If someone determines that you’re not ‘for real,’ then they can’t connect to you. I’ve had to figure out what works for me as a person, and to pay attention to what resonated with my team and what didn’t.”

Despite their best efforts and intentions, a department chair will inevitably and repeatedly encounter pushback. “I always prided myself on getting along with everybody, and in the past usually avoided conflict,” Dr. Collins said. “In leadership, however, I have realized that you will often get challenged. Those challenges may come from within the department, but they also come from other departments, the hospital, or external competitors. It took me a while to realize that my job is to advocate for the department, and that might mean standing up to others. There have been a few instances in which another department chair or institutional leadership tried to ‘slip one past us,’ and I had to push back, which is historically not my nature.”

Whether a leader can calmly navigate such curveballs is a key prerequisite for the job. Still, Dr. Varvares expressed a positive point of view. “In the end, the most challenging aspect of the position is also the most rewarding: to manage and solve issues that arise—even when you think you have seen it all—while at the same time trying to guess where the puck is going to go next,” he said. “What has surprised me is just how enjoyable it is. I knew it would be a lot of work, but I didn’t realize just how much the job, the department, and its people give back in return.”

Parting Advice

Serving as department chair is not a part-time venture, and ENTs who are interested in assuming the position should be prepared to sacrifice their time and other professional pursuits while holding the reins. For all intents and purposes, the chair is the department, and vice versa. One cannot thrive without the other.

“As academic otolaryngologists, we all develop personal metrics of success. In my opinion, however, once one becomes chair, the marker of success is the success of the department,” Dr. Varvares said. “One’s own clinical and research interests take a back seat to this priority.”

Regardless of previous experience, department chairs who are new to their role will likely be faced with some unfamiliar challenges, noted Dr. Agrawal. “There are decisions made by the department chair that someone new has never had to make before. That person doesn’t yet have that necessary and vast playbook. They may have an instinctive, gut response, but they can’t just go by what they think,” she said. “This is why it is essential to carefully and intentionally cultivate a network of people within the institution who can help.”

Dr. Varvares’ circumstances were unique in that his very first leadership role was also his first experience as a chair. “I had to learn on the job, and I made many mistakes,” he recalled. “My advice for young faculty members interested in pursuing leadership is to begin early, start small, and build incrementally with larger leadership roles. Consider engaging a coach.” He also recommended reading as much as possible about great leadership and looking out for examples of inspiring leadership in everyday life.

It is important to try out different roles early in one’s career, agreed Dr. Collins. “Some of these roles might be unfunded, but the result of doing good work is the opportunity to do more,” he said. “Ultimately, the goal of leadership is to have a great impact and leave things better than you found them. That is what led many of us into medicine. Whether working as a clinician or as a leader, that goal does not change.”

Linda Kossoff is a medical journalist based in Los Angeles.