Leading academic departments of psychiatry.

Academic departments of psychiatry have three missions—training psychiatrists and other clinicians, advancing scientific knowledge, and providing state-of-the-art patient care—and, together, these serve as the basis for the profession’s overarching goal: to ease the suffering of those afflicted with psychiatric illnesses. To fulfill these missions departments of psychiatry must have effective academic leadership. With the global economic downturn and the emergence of national healthcare reform, the imperative for excellence in leadership is particularly evident. Such leadership is rare, and leaders who are willing to take on the complex challenges faced by academic departments are important to our profession’s future. The time is right for greater understanding of the adversity and opportunity that academic departments of psychiatry face and for renewed efforts to cultivate faculty leadership in our departments. This special issue of Academic Psychiatry is dedicated to illuminating these issues and exploring in depth the strategic circumstances of academic psychiatry departments. Throughout this collection, key aspects of leadership, the need to protect all academic missions, the value of faculty development, the role of resilience and flexibility, and the necessity for clear strategic focus are recurring themes. These themes, pertaining to leadership of academic departments of psychiatry, should be seen in the context of the rapid evolution in our field. Research in psychiatric neuroscience has brought about great insights, for example, in the identification of genetic and neuroimaging markers of psychiatric illness. Despite this progress, the academic medical center within which the departments reside has for decades been increasingly dependent on the growth and profitability of the clinical enterprise for the support of the research and training missions. Throughout the 1990s, academic medical centers vigorously pursued mergers and physician acquisitions in order to buffer the effect of the changing paymentand caresystem model. Although some of these mergers succeeded, many failed. Psychiatry, despite large, brilliant research portfolios and wide and deep clinical need, was often an afterthought, and almost never was psychiatry considered a source of the clinical capital sought by deans and hospital CEOs. As Sun Tzu suggests (1), first having a clear vision of the strategy we need to flourish in a changing environment is essential to achieving our academic and clinical goals.