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With both palms on the table, eyes staring straight ahead, the candidate answers in measured terms. the search committee sits stone-faced, saying nothing.

candidates from around the country who receive the (a) rating are brought to campus and put through a whirlwind schedule with the committee and key faculty.

the dean won’t budge on one point—he won’t allow himself to get into a bidding war. “I’m not going to try and top another institution,” Miller says.

Search for Tomorrow

By Patrick Gilbert | Illustrations Jack Hornady

Choosing a new department head at the School of Medicine can be long, complicated and fraught with tension, but, says the dean, it’s the most important thing he does.

Where do you think neurosurgery is headed in the future?” Charlie Cummings, the easygoing head of Hopkins’ Department of Otolaryngology, poses the question to a fiftyish-looking man sitting with several other people around a long conference table. The man is a well-known neurosurgeon and department head from a southern medical school. He’s been selected as a candidate for the job of director of the Department of Neurosurgery at Johns Hopkins, and this is his first appearance in front of the search committee. Cummings, the chairman, wants to see how closely this neurosurgeon’s ideas about the future of his field match projections the committee has heard from a top consultant.

With both palms on the table, eyes staring straight ahead, the candidate answers in measured terms, describing rapid advances in technology that are making it possible to avoid operating in many cases without compromising care. The committee sits stone-faced, saying nothing. For almost 15 minutes, the neurosurgeon goes on talking about the changes taking place in his specialty. He finishes with a point: “But no matter how technological the field becomes, attracting the best neurosurgeons and marketing them is key to any program.”

The committee—several department directors, a couple of professors and an assistant dean—begins rattling off questions to the candidate: How has he handled the never-ending struggle to pay for both research and clinical activities in the department he now heads? How good are his department’s relationships with community physicians in his field? What activities does he take part in outside the university? After a half-hour or so of this, as if some silent signal has sounded, Cummings thanks the neurosurgeon for coming and adjourns the meeting.

The process of finding one more celebrated physician with management skills to guide a School of Medicine department is officially under way. It is, says Dean/CEO Edward Miller, the most important job he or any other dean handles. Department heads oversee big budgets and big staffs; they guide the hiring of a cadre of new faculty; and they determine the scholarly areas which their unit will focus on. To put it succinctly, directors hold in their hands the fate of their own small empires. The physicians and scientists named to these top positions at Johns Hopkins are recognized around the country. It’s an exclusive club, not easily entered.

Nerve-wracking Tension, Rampant Rumors

Filling a department chairmanship can take a year or more of calculated work by a search committee. (Department heads at Hopkins are officially called “directors,” but most people inevitably substitute the more common “chairman.”) Convincing the candidate of choice to take the job can be just as tough, despite the coveted aura that surrounds the role.

Early in 1999, Donlin Long, who’d led the Department of Neurosurgery at Johns Hopkins for 26 years, reached the age of 65 and announced he’d be stepping down. His department, he said, needed new leadership for a new millennium. Two months later, Miller gathered his vice deans to brainstorm about who should be on the search committee for Long’s replacement. This hunt for a department head would become one of three taking place simultaneously at Hopkins. Also looking were Orthopaedics, Anatomy and Cell Biology, and Dermatology. And though they’re not officially departments, Comparative Medicine and the prestigious new Institute for Medical Genetics also are in quest of directors.

Getting the right faculty member to lead the search for a new department head, Miller says, drives the whole process. “That one person [the committee chairman] creates the candidates’ first impression of the institution, so, if you don’t have the right person, you won’t get the right candidates.” In naming a search committee chair, then, the dean looks for a comfortable communicator from outside the department that’s looking, but who is familiar with that department and capable of complete objectivity.

Miller, who came to Hopkins in 1993 from Columbia University as head of the Department of Anesthesiology and Critical Care Medicine, is especially tuned into the subtle differences a search committee chairman can make to a person who’s recruited here from outside. Inevitably, the chairman builds a relationship with the leading candidate(s) as the search drags on. So, when one candidate finally gets the job, the search chairman just naturally takes on the role of organizing dinners and cocktail parties to introduce the person to his new colleagues. “I’ll always have a special bond with Mort Goldberg [director of the Wilmer Eye Institute],” Miller says “because he headed the search committee that recommended me as chair of Anesthesiology.”

Faculty members in several disciplines are selected for the search committee. Each gets a binder full of information about the department—everything from its strengths to its problems to its finances. Soon after the group’s first meeting, letters go out to deans and select faculty at other medical schools asking for recommendations of luminaries in the field who should be invited to apply for the job. Meanwhile, the committee and the dean decide if anyone in the Hopkins department is director material.

As the CVs roll in, committee members dissect them and give each a ranking: (a) a must interview (b) interesting, but let’s hold, or (c) thanks, but we’ll pass. Over the next few months, candidates from around the country who receive the (a) rating are brought to campus and put through a whirlwind schedule—dinner with the committee, a tour of the department, discussions with key faculty and the initial interview. This last exercise, says Cummings, who’s been part of three searches in the last decade, is really a sparring, a get-to-know-you affair, with a lot of importance resting on the proverbial first impression. “If a candidate is invited back for a second interview, we’ll dissect the person’s qualifications and responses, and see how it all fits with our needs. That’s when the rubber hits the road.”

With each successive call to campus, the questions put to a strong candidate get tougher and more specific as the committee aims to make sure it’s not missing any hidden problems. “We’re looking for someone who is resourceful as well as innovative,” Cummings says. “If the candidate insists that he or she needs a whole new building to support the department’s future plans, that person’s probably not the right fit for this institution.”

Occasionally a search committee hits on a hot candidate early. In such cases, Miller may choose to “fast-track” the search by meeting the person on the first visit to campus instead of the second. This is especially true if the candidate turns out to be a contender for a chairmanship somewhere else.

Faculty often grumble about the secrecy of the search process, but confidentiality is vital, committee members say. Discussions may turn to departmental weaknesses or candid observations about individual department members. If a piece of information gets out in the wrong context or at a sensitive point in the process, it can be disastrous. Search committees are briefed to refuse to be influenced or questioned about proceedings.

But despite all the tight lips, gossip about who’s going to get the top position runs rampant as the search lumbers along. For faculty in the department that’s looking, the anticipation can be nerve-wracking as mystiques and fears about each rumored candidate permeate their ranks. As faculty line up in support of either an internal candidate or someone from the outside, the wait for the announcement of “the winner” can be torturous. Departmental staff can become convinced a search is stacked from the get-go in favor of one person or biased either for or against an internal candidate. There can be panic that the committee will recommend someone from the outside who will want to introduce sweeping changes in the department. “But that’s one apprehension I’m not very sensitive to,” Miller says. “Our mission, whomever we choose, is to come up with the right person for the job.”

Bringing Home the Prize

Landing a top candidate to lead a department, Ed Miller contends, has taken on the competitive trappings of pursuing a major league baseball star. As dean of the School of Medicine that job falls to him once the search committee has sent him its top choice(s). And despite the prominence that comes with a Johns Hopkins directorship, Hopkins doesn’t always win out over the huge piles of money and limitless perks that other medical schools might be willing to fork out to bring in a star. Even when Hopkins prevails, the dean may face another obstacle that surfaces these days: More than ever, candidates are weighing the effects a move will have on spouses and families.

It should come as no surprise then that Miller doesn’t like to put all his eggs in one basket. “When your hopes rest on one person for the job, and that person decides not to come, you’re setting yourself up for failure,” he says. “I like to have the names of two people that the committee thinks could do well.”

“What will it take to get you here?” is the dean’s question to his top candidate after they’ve been through the pleasantries at their first negotiating session. It’s his signal to the person that it’s time to put pen to paper and rough out the particulars of the offer. Miller recalls one candidate of choice who when faced with the question began rattling off details of offers pouring in from other medical schools. The dean cut off the person mid-sentence with, “I’m not interested in what others are offering you, I only want to know what it’s going to take for you to feel good about coming to Hopkins.” A few awkward minutes later, Miller says, “we rolled up our sleeves and got down to negotiating an offer that would work for the candidate, for me and, most importantly, for the department and the Institution.”

Closing the deal can take from six weeks to three months. It’s common knowledge at universities that anyone tapped for a department directorship should secure all promises for resources up front. Once in the position, it’s rare they’ll ever again have such leverage.

But the dean doesn’t budge on one point—he won’t allow himself to get into a bidding war. “I’m not going to try and top another institution,” Miller says. “I’m not going to promise what I can’t deliver. We may lose people as a result, but if it’s not done this way, all you get is a disgruntled chief and a disgruntled faculty. Once we make an offer, we make sure we deliver, no matter how financially painful it may become.”

And it’s not always laboratory resources or a flexible budget that seal the contract. Assistance in finding a house and the right schools for the children of someone moving to Baltimore from another city can be just as important. Well-placed Hopkins trustees can make this easier. “We can offer real estate help in locating a house, and we know a lot of people at private schools,” Miller says. “We’ll help a spouse get a job in the area, or with Hopkins, if we can. We use our influence to grease the skids.”

It’s rare, but sometimes all the best efforts of the search committee and the dean go for naught. Take, for example, the case of a recent top scientist who received the enthusiastic recommendation of a search committee. “I knew 10 minutes into our first discussion that this person was the perfect candidate,” Miller remembers. “We made a generous offer, and everything seemed right on schedule.”

The committee, the dean and the faculty couldn’t wait for the new director to arrive and start work. It never happened. In the end, strong family considerations won out in this candidate’s emotional tug of war. In this case it was a question of balancing a husband’s and a wife’s career opportunities. “Saying no to Hopkins was a tough decision for this person, I know,” Miller says. “Because she admitted frankly that coming here would have been the best career move she could have made.”

As for the search for the top job in neurosurgery, the decision is still out. “The committee has given me a name,” the dean says, “but we’re nowhere near a decision. There’s still a lot of negotiating to get through.”