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

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.”