Becoming a department chair in otolaryngology represents a significant leadership milestone. The rise to this key role, as well as the role itself, requires a unique blend of clinical excellence, academic achievement, and administrative skill. Otolaryngologists who have traveled the path to department chair acknowledge that the learning curve in preparing for this level of leadership can be steep and the challenges formidable. Those who are currently thriving at the helm, though, say they would do it again in a heartbeat.
The Holes in the Swiss Cheese Lined Up
In July of 2025, after serving as chief and fellowship director of rhinology and skull base surgery, as well as vice chair for faculty affairs, during his 11 years at Vanderbilt University in Nashville, Rick (Rakesh) K. Chandra, MD, MMHC, was well prepared to take over as chair of the department of otolaryngology–head and neck surgery at the University of Mississippi (UM) Medical Center in Jackson.
It was a position he had thought about back in 2018. Circumstances for such a move were not ideal at the time. however. “I couldn’t really pursue it at that point because I had kids still going through high school,” Dr. Chandra said. “I did get some calls from search firms, but between the timing for my family and the fact that the positions I thought I would have fit with best weren’t the ones I was getting recruited to, it went nowhere.” Years later, just as the timing improved, direct contact from institutions and recruiters started coming in, including the one from UM. “It’s like the holes in the Swiss cheese lined up just right,” he said.
Also instrumental in making the leap to chair was the business degree Dr. Chandra earned after he first got to Vanderbilt. “There were others who had done it, and I knew it had helped them, but it wasn’t until my late 40s that I had the bandwidth to take it on,” he said, emphasizing that the additional education has been invaluable in his new role. “It takes a lot of time just learning to speak the language of administrators,” he said, noting that doctors are “woefully undertrained in business.” The position at UM felt like a good fit. “I just knew it was suited to me and that I could make a meaningful contribution,” he said.
I Had to Be ‘Bootstraps’ Lady
Sandra Lin, MD, current chair of head and neck surgery at the University of Wisconsin (UW) School of Medicine and Public Health in Madison, had no early inclination toward an academic career. Circumstances, logistics, timing, and a desire to help others steered her right into that unintended direction, however.
“I thought I was going to go into private practice near my hometown in a Chicago suburb,” she said, “But I married another physician, and we never got done quite at the same time. He had just finished his residency when I was looking for my first job. Then, a few months into my job, he matched for a fellowship, and I needed to look for another job in a smaller city. There were no opportunities there, except as chair of otolaryngology at Southern Illinois University (SIU) where the chair, Ron Konrad, kindly offered me a position after hearing of my family situation.”
One year later, Dr. Lin was charged with starting SIU’s allergy clinic. “As I dipped my toe back into academics, I found myself enjoying working with residents and mentoring them,” she said. Within this time frame, the couple also became the parents of twins. Subsequently, Dr. Lin’s husband, a vascular surgeon, finished his fellowship and resumed job seeking. The couple ended up in Baltimore, where Dr. Lin met the chair at Johns Hopkins University and was ultimately brought onto the faculty.
“I was poorly prepared for an academic career,” Dr. Lin said. “I had to be ‘bootstraps lady.’ Fortunately, being in that culture and environment at Hopkins, you see the amazing things that your colleagues are doing, and you are encouraged and inspired. At the time, they did not have a sublingual immunotherapy or allergy program, so I created that for the department, and did research in that area that led to national recommendations for immunotherapy. In addition, I ran our DEI [diversity, equity, and inclusion] program. There had been almost no women on the faculty when I started. By the time I left, otolaryngology had the highest number of women professors of all the surgical departments, and we had also mentored dozens of students through our program. They were kind enough to name an endowed lectureship after me for my DEI contribution.”
Dr. Lin became the vice chair of clinical operations, growing the number of Johns Hopkins’ clinical sites from two to five. By the time her children were ready to go to college, she was a tenured full professor. “By then, I felt that my job was to make other people successful in academic medicine, and I felt that I could do it to a much greater degree if I was a chair. So, I started looking at available positions.” She took on the chair role at UW in July 2025.
I Was an Internal Successor
William O. Collins, MD, chair of the department of otolaryngology–head and neck surgery at the University of Florida (UF) College of Medicine in Gainesville, appears to have traveled a straightforward path to his leadership role. “I was an internal successor,” he said. “I took over as chair in February of 2022, with a rather quick succession from our previous chair.”
There are no shortcuts when it comes to qualifying for the top job, however. After completing medical school, as well as his internship, residency, and fellowship in rhinology and advanced endoscopic sinus surgery at UF, Dr. Collins completed a second fellowship in pediatric otolaryngology at the Children’s National Medical Center/ George Washington University School of Medicine in Washington, D.C. He then returned to Florida to join the faculty at UF.
Despite having spent the lion’s share of his time at one institution, Dr. Collins notes that he never specifically sought, nor prepared for, the role of chair. “There were a number of roles that led me to this point—first and foremost, I have always had a busy clinical practice in pediatric otolaryngology, so that allowed me to gain a greater understanding of all facets of patient care and build valuable relationships with colleagues,” he said. Dr. Collins served for close to 10 years as residency program director at UF. “In that capacity, I dealt with a multitude of issues, including resident education, curriculum design, and human resources/personnel issues. I worked closely with hospital and GME [graduate medical education] leadership, navigating regulatory agencies, etc.”
Dr. Collins served as chair of the institution’s operating room block committee and later in a role that would be considered “surgeon-in-chief” at other institutions, he explained. “Both of these roles helped broaden my network of relationships and allowed me to learn more about how a hospital really works, with all of its interdependent parts,” he said.
The Seed Was Planted in Residency
With two years as chair of the otolaryngology department at the University of Colorado Anschutz School of Medicine in Denver under her belt, Yuri Agrawal, MD, MPH, described her rise to leadership as organic. “In terms of thinking about being a department chair, the seed was planted at Johns Hopkins, where I matched in ENT as a resident,” she said. “I did my residency and fellowship in Baltimore, so I was there for a long time. I met faculty that I was interacting with as a resident who then went on to become department chairs.” Indeed, during her years at Hopkins, Dr. Agrawal saw her program director hired as chair at Oregon Health and Sciences School of Medicine, and the subsequent program director became chair at Duke University.
The environment at Hopkins, Dr. Agrawal recalled, featured an emphasis and mentoring around research. “It was understood that this was going to be your career trajectory. It was encouraged and inculcated, even during residency,” she said. “So, when I started as faculty at Hopkins, I had a couple of grants. I was able to apply for NIH [National Institutes of Health] funding, which I received. It was not anything distinctive, because everyone does it there.” Thus, by the time Dr. Agrawal was promoted to professor, she was one of the few people in the country who had a portfolio that included clinical practice and NIH funding— factors that are pertinent when being considered for department leadership.
Mentors and Role Models
It is one thing to be well educated, highly skilled, and professionally experienced; it is quite another to evolve into a viable candidate for leadership. In that regard, positive mentors and role models are essential on the journey to chair.
Dr. Agrawal stressed the impact of her mentors at Hopkins, especially department chair Lloyd Minor, MD, who served in that role from 2003 to 2009, and who is currently dean of Stanford University School of Medicine in Palo Alto, Calif. “Dr. Minor showed me that you could use that role to have a positive impact on people’s career development by giving them opportunities they might not otherwise have pursued, or even seen in themselves,” she said. “That had a profound impact on me.”
“Probably my No. 1 role model was Robert Kern, MD, chair at Northwestern [Feinberg School of Medicine], where I did my residency,” Dr. Chandra said. “He had a very sharp upward trajectory not only to leadership, but also in integrating clinical practice with translational research. I saw some of the things he did to advance the department and began to realize how different pieces fit together, as well as the organizational and institutional politics—things I wouldn’t have understood on my own if he hadn’t taken the time to explain his decisions and the reasons behind them.”
“I learned different things from different people,” Dr. Lin said. “There was nobody who really looked like me who would be available to be my role model, but I learned so much from many of the leaders I had the chance to work with. My first boss, Horst (Ron) Konrad, MD, who hired me at SIU, told me to pay attention not only to my career but to the importance of my family. This was 1999, so he was progressive for the time. Now I think about whether my faculty is having enough time for their families and relationships. It’s hard for people to be productive at work if they’re missed at home.” Dr. Lin’s first mentor at Hopkins, Charlie [Charles W.] Cummings, MD, “had a magic about him. If you were talking to him, you felt like you were the most special person in the world,” she said. “What I took from that is that people want to be recognized and treated as important members of the team.” Like Dr. Agrawal, Dr. Lin cited Lloyd Minor, MD, as a major influence on her professional growth. “I saw how he moved people through change, gave them the right opportunities to grow,” she said. “Also, he really thought about what kind of leader he was and, therefore, what type of team he needed.”
Dr. Collins credited numerous people who have been strong role models for him on his path to chair. “In retrospect, I have even more respect for my former chairs because now I know what they were dealing with behind the scenes,” he said. His partial list includes retired Drs. W. Jarrard “Jerry” Goodwin, George T. Singleton, and Nicholas J. Cassisi, as well as Thomas J. Balkany (deceased), and Patrick J Antonelli, who is still at UF. “I also learned a lot from other academic leaders I’ve had the good fortune to cross paths with, including Drs. George H. Zalzal, a pediatric otolaryngologist at Children’s National Hospital in Washington, D.C., and Roy R. Casiano, at the University of Miami. “As I’ve transitioned into more administrative and leadership positions, I’ve sought out the guidance of some local UF leaders, such as vascular surgeon and former CMO, Timothy Flynn, MD, and pediatric subspecialist, Douglas Barrett, MD, who is also former dean and vice president of health affairs at UF.”
Advice for Chairs-To-Be
The first thing that otolaryngologists who are thinking about becoming department chair should do is decide whether they really want to do it, said Dr. Chandra. “This is a 24-hour job,” he said. “I go to bed and wake up thinking about it every day. I don’t know of any chair positions where you just go to ribbon-cutting and get your picture in the school newspaper. This position occupies a lot of your bandwidth, so think about how that expenditure of time and effort matches up with your family life.”
It is also important to examine your reasons for wanting the position, suggested Dr. Lin. “I feel that my role as chair is to facilitate the success of each of my faculty in their academic missions,” she said. “It isn’t about me, it’s about the team. So really look at why you want to do it.”
Dr. Collins also issued a friendly warning to those who aspire to the position. “Understand that leadership is not for the faint-hearted,” he said. “It is important early in one’s career to try out different roles. Don’t be afraid to take on some smaller roles to see if you like them and to prove your value. The result of doing good work is the opportunity to do more, and 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, and whether you are working as a clinician or a leader, that ultimate goal does not change.”
Although every department chair has their own style and approach to the job, current chairs stress the importance of certain attributes in becoming an effective leader:
Ability to see the big picture. “Know your own importance as well as your department’s role in the bigger institution. As a chair, you have many competing missions and you must decide which of them rise to the top,” Dr. Collins said. “Is pure clinical productivity more important than resident surgical training? It is the leader’s job to see that big picture, have established principles, and lead according to those principles.”
Strong listening skills. “We all get so tunnel-visioned, so siloed into the nuances of our individual practices, especially in academics, and there are things you are not going to know off-hand,” Dr. Chandra said. “You need to listen, ask questions, and pay attention, because as a chair you must have a darn good grasp of how the entirety of the specialty is practiced.”
Empathy and respect for others. “As a leader, you want to support everyone to the greatest extent, but it isn’t always possible. Sometimes you have to make difficult decisions that you wouldn’t have to make in an ideal world,” Dr. Agrawal said. “I think that being respectful and empathetic by acknowledging how people feel and not minimizing those feelings is an important skill.”
Authenticity. “You may not be the same type of leader as someone else, even if you have the same goals,” Dr. Lin said. “You need to be authentic to yourself, to understand your own strengths and weaknesses and how to use what you have to get from A to B.” In a job where interpersonal skills are so clearly essential, Dr. Lin has come up with an acronym that she has dubbed CHARM. “You need to be Collaborative, Humanistic, Authentic, Realistic, and to Make an effort,” she explained. “Sometimes by doing all these things, you can turn a difficult situation around.”
Linda Kossoff is a medical journalist based in Los Angeles.
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