I am Dr. Nino Chiocca. I have been practicing neurosurgery for almost 30 years. Although I am known primarily as a neurosurgeon that specializes in brain tumors, I also see patients with spine and peripheral nerve disorders and other common neurosurgical conditions. I have been the chair of neurosurgery at two separate academic medical centers, or AMCs, for the last 20 years, first at The Ohio State University and now at the Brigham and Women's Hospital. Although I do not have an exact count, I estimate that I recruited and hired about 50 neurosurgeons in my career to each of these AMC practices. If you are considering an academic institution to practice in, it is important to understand the mission and values of the AMC. I also think that neurosurgeons have always distinguished themselves as seekers and discoverers of innovation. We must continue to educate our residents in being the innovative thinkers and researchers that distinguish our specialty from the others. AMCs are also research institutions for basic, translational, clinical, socioeconomic, and global health research. This is a critical function of our departments in that our research improves our future practice and knowledge. Finally, advocacy efforts at academic medical centers can span local, regional, national, and even international arenas. This is becoming more of a key objective since communicating effectively about what we do and what we are about is highly important for various stakeholders, from other AMC leaders to government regulators to patients and insurance companies. Compared to other types of institutions, AMCs are unique because of their governance structure and how the various components are aligned. The three main AMC components include the School of Medicine, the Primary Teaching Hospital, the Academic Health System, and the Faculty Group Practice. Usually, your department of neurosurgery will belong to a faculty group practice. And now this relates to the main hospital leadership and School of Medicine can vary between different academic medical centers. So in this graphic, I provide you with some examples of the alignments of each one of these components. We start off where the hospital and faculty group practice reside in a single structure. And this can take one or two forms where they are not the only ones residing in a single structure, but this also includes the School of Medicine. What that really means is that there's really one board of directors and one president, CEO, or dean that really is the chief responsible for all of these institutions in an integrated system. An example of this is the University of Michigan. Next is the example where the hospital and the faculty group practice are aligned. Again, what this means is that they respond to one president, one CEO, one director, who then responds to a single board. But the School of Medicine is a separate entity who has its own dean and its own board. You'll get good alignment, but the alignment to the School of Medicine may be more limited. An example of this is Vanderbilt University. And next, we talk about the examples where the hospital and the faculty group practice are independent. And so the three forms of this could be where the School of Medicine and the hospital faculty group practice reside within one entity with one board, and usually a dean that runs both, but the hospital is a separate entity. An example of this could be Columbia. And then you have the opposite example where the faculty group practice is completely independent and the medical school and the hospital are one system. An example of this would be the University of Virginia. And finally, you have the example where all three parts of the system are separately independent with three separate directors, deans, or presidents, three separate boards, and your clear alignment is going to be a little bit more difficult to obtain. An example of this is George Washington. As you join an academic department, understanding how the system is aligned and where are the lines of governance can greatly help you figure out how decisions get made, who makes the decisions, and in response to whom. Regardless of the governance and alignment, usually, for faculty appointments, the academic department chair will report to the dean of the medical school. Titles and academic ranks within the department are determined by a process that begins with a chair's recommendation. The dean then usually uses a promotion and tenure committee to evaluate the candidate's rank. At most places, there may be several tracks for promotion. The usual ones are clinical tracks, research tracks, or institution-based factor tracks. The clinical track is based on clinical metrics, such as quality and safety of patient care, clinical scholarly activities such as published papers, clinical trials conducted, books authored, the number of talks given locally, regionally, nationally, or internationally, and other metrics may include clinical innovations such as patents or clinical guidelines. The research track, which in some places is called the investigational track, is really based on peer-reviewed funding, with NIH and R01 grants being preferable, published papers that have a high citation impact, measured by the H-Index or iCite, and also on the number of invited national or international talks. Some of the institution-based tracks may include things such as education to medical students, residents and fellows at your institution, or leadership and administrative responsibilities. In the end, particularly a neurosurgery department needs to be financially viable and is actually expected to be a highly positive contributor to the financial well-being of an academic medical center. As a faculty member, in addition to your clinical, academic, and institutional accomplishments and achievements, there will be an expectation that you will also be a positive contributor to financial health. Personally, my biggest joy is to see a new faculty member whom we have hired and provided resources for her or his success, and then three to five years later, this faculty member is actively contributing to the department's and AMC's financial well-being, such as securing outside funding for their scholarly activities, and providing exceptional clinical care.

Dr. Nino Chiocca

neurosurgeon

academic medical centers

AMCs

neurosurgery