Dr. Mirvis is the Editor-in-Chief of this journal and a
Professor of Radiology, Diagnostic Imaging Department, University of
Maryland School of Medicine, Baltimore, MD.
Although I relate
the following comments from personal experience, I have perceived from
numerous conversations over many years with faculty at other
institutions that the issue discussed is universal within large academic
After giving a lecture about 7 years ago, I was
stopped outside the lecture hall by a young radiologist. She had a
question about a certain computed tomography (CT) procedure I had
mentioned in my talk. I answered her question as best I could and then
asked her how she did the study in her department. Much to my
embarrassment she said, “What do you mean? I am in your department.” I
did not recognize her or her name. She had been on the department
faculty for 2 years at that point.
More recently, one of the
faculty in our section got into a rather acrimonious discussion with
another physician about why a certain CT study had not yet been
reported. They had exchanged names before things became heated.
Ultimately, it came out that the two were both radiologists in our
department who had apparently never met, or if so, did not recall each
other. One was about to take over reading cases for affiliated community
radiology departments and was concerned that one or two CTs were “left”
unread before his coverage shift was to start.
My wife and I were
having dinner with good friends. They mentioned the name of someone
they knew who worked in my department,but as far as I knew, this person
could just as well have been employed in Outer Mongolia. Clearly, my
lack of recognition was confusing to them.
At an event to which
the entire department is invited, like the annual graduation party, I do
not recognize about half the people in the room, at least a quarter of
whom are faculty or fellows working in the department. I cannot
attribute this to introversion (something no one has ever accused me
of), faulty memory, or lack of attention skills. If I ask any of my
section colleagues or faculty from other sections I do know well, they
all have the same sense that they may be at the wrong party given all
When I started in practice as an academic
radiologist, there were 16 other faculty in the department. For better
or worse, I knew them all quite well. I knew who was married, who had
children, what their hobbies were, what their habits were, and who to
steer clear of. This was true becauseI had done residency and fellowship
in the same department, but I believe everybody was very familiar with
all their colleagues, except the 1 or 2typical recluses.
years, the staff has swelled to about 60, and we have moved physically
farther away from one another. Our section is quartered in another
building rather distant from the main department. I think I know where
the mammographers work, but have never actually been there. I doubt the
folks in Nuclear Medicine know where our section works or perhaps even
that we exist. Besides physical separation, our subspecialties have
become more narrowly focused providing less overlap between the types of
cases interpreted by the various sections.Case material is chopped up
rather finely to make sure each body part gets assigned to the right
place. As emergency radiologists, our section covers many
subspecialties, so we probably exchange opinions more with other
sections than they do among themselves.
So why does this happen,
and what difference does it make? OK, gone are the days when we had an
official department welcoming party at the beginning of each academic
year. Not everyone came, but many did, and you always got to meet a few
new staff and usually their families. Now, new faculty members are asked
to stand up at the first staff meeting of the year, their names and
sections are mentioned, and they sit down. Not a lot of detail there.
The section heads meet regularly, but there are few opportunities for
other faculty to hang out together.Staff meeting attendance can be
pretty spotty. The Christmas party is still the best venue to meet each
other, but once the music starts, having a conversation becomes
challenging. I used to think the idea of faculty retreats was pretty
phony and forced, catching colleagues (or not) as they fall backwards to
develop trust. Now, I wonder if retreats would in fact be a good idea.
sense is that subspecialty sections maintain a low-level, or not so
low, animosity towards other subsections for a variety of real or
perceived reasons. Salary (that information gets out), workload,
academic productivity, equipment, space, number of fellows, reputation,
recognition, and so on are among many of these factors. The notion that
different sections are the“other people,” the “outsiders” whose
interests are not aligned with ours, takes hold. Sections evolve into
little fiefdoms with towers and moats surrounding them. It is never a
good thing when the interests of individual sections compete with the
interests of the entire department. The best way to verify this
phenomenon in academic departments is to ask residents who hear a lot
about politics as they rotate through various sections. With a lack of
personal interaction, common goals, mutual respect and support, the
entire enterprise suffers, and the potential for departmental success
recedes. This situation is not pervasive, but probably exists to some
extent in most, especially large, academic departments.
types of competition among department sections may have positive
overall effects, my belief is, to the extent that such smoldering
antagonism exists, it stifles collaboration, wastes energy, impairs and
delays achieving department objectives, and sours the work atmosphere. I
do not know the best solution to this problem; maybe consultation with a
social psychologist is one answer. I do believe that being well
acquainted with co-faculty and the types of challenges and circumstances
they face in their particular work would move those people from
the“them” into the “us” category.
More opportunities for social-
and work-related interaction should help. Perhaps each faculty member
should spend a few days a year working or observing in another section.
Emphasizing shared goals, collaborative research, involvement of all
faculty members interacting on a variety of committees, and creating
incentives for cooperation to achieve specific operational improvements
would help resolve divisive issues. At least for some people, just
getting together routinely at “happy hour” might suffice.
construction of towers and moats within departments reflects human
nature, but they can be torn down and filled in only if we admit they’re