My experience spans 10 years as Chairman of the Radiology Department at the University of Maryland (UM), Baltimore, MD. It was an honor and a privilege to serve in that capacity. As chairman, one gets to work with others on not only defining but also implementing the vision of the department. You are a leader who gets to work with some of the most talented and dedicated people in the field. There were good times, and there were many challenges, but the sum total of the experience was amazing and exciting--an experience of great personal growth and development that has left me with no regrets.

As a new leader, one plans how things are structured: for us at UM that meant a predominantly "organ-systems approach" of faculty subspecialists, working with all the tools of the trade. One gets to recruit (and retain) great people to be on your team. Resources are also made available to upgrade or expand radiology capital and research equipment. To stretch those resources, we developed corporate partnerships in each modality with many manufacturers, creating win-win scenarios for both groups around research initiatives, customer visits, international training, and the opportunity to be the first to work with cutting-edge technology. On the corridor walls throughout the department, large displays acknowledging the joint programs and technology between corporations and the department are a testament to the value of those partnerships. We created an all-digital enterprise and hosted a major meeting to showcase our academic medical center. Over time, we expanded our volume from 200,000 to 500,000 examinations per year, expanding our operation to other hospitals and outpatient centers.

How does one go from being a radiologist to being the CEO of a multi-million dollar organization, responsible for more than a hundred physicians, technologists, and support staff? The model in medicine is a bit unusual. Plenty of people in the medical school and in the hospital will help and guide you; there are meetings specifically designed to help train you, and you'll have talented administrative support. You'll also learn as you go, and you'll realize there is no one formula, as each medical center, its personnel, and its environment is different from every other. What works at one will not work at another. You get to design the path, sometimes by trial and error. Be open and honest in your plans and communications, and the errors will usually create little difficulty.

In this new role of chairman, you are seen differently, especially by trainees and faculty. Realize there is power in the office, but keep a personal touch and be supportive of others. Because you hold many confidences, it can be lonely at times since you cannot share information with others or easily be friends with your faculty. It is harder to know the residents and fellows, but this burden is offset by all the good you can accomplish in your role. Your successes are now realized as you help others and the department achieve success.

As time moves along in your tenure, your role in the larger organization expands and you have less and less time to focus on your department. During my last two years as chairman, I was President of the Medical Staff, served on numerous committees, and ran major programs for the institution. Other radiology chairmen I know serve as GME directors or vice-deans for various roles in the school and practice plan. Basically, you start out busy and get much busier.

To help me administer the department, I created a structure of support with vice-chairmen for clinical, academic, financial, and research affairs, in addition to having a dedicated residency program director. The days of the chairman doing all these things are over. At first I wanted to protect my faculty's time from administrative duties, but I found they wanted to help, were talented, had great ideas, and enjoyed taking on additional responsibility.

There are many open chairs in radiology today. Many cite the difficulty in recruitment during a radiologist shortage, the financial challenges due to the large discrepancy between academic and private practice, and battles for practice turf as some of the reasons these chairs remain unfilled. These challenges are real, but one must realize that there have always been challenges of one sort or another, and those who entered academic radiology always did so realizing their compensation would be less than in the private sector--that is not what drove them to their choice in the first place.

While there are new challenges, there are also new positive influences in our field now that did not exist in the past. To begin with, we have more interesting modalities today (PET, multislice CT, advanced and 3T MRI, new interventional techniques and devices, ultrasound contrast, CR/DR, and PACS to name a few), and continued growth in imaging volume. Electronic, digital solutions allow us to be more efficient--in practicing radiology, in teaching radiology, and in covering multiple locations.

At the same time, the NIH is now led by a radiologist; we have a new imaging institute at the NIH; and the ACR, RSNA, and many other radiology organizations are training radiologists in research methods and supporting them with research grants. Also, grant funding has increased significantly.

The chair is an opportunity for individuals who want to make a difference to creatively address the problems facing academic radiology. There is a great opportunity to work with your team--to get medical students interested in your program; to create new schedules and smarter methods of working to make the practice more attractive; using your talent and subspecialty expertise, to develop new income streams to help recruit and retain faculty and create programs; and to take advantage of powerful technology to be more efficient.

After ten years, with all the extra responsibilities in the organization and having built the new department--faculty, physical plant, capital equipment, digital solutions, and our business expansion--I decided it was time for someone else to come in with new energy and develop the department anew and to improve it in areas in which I did not have the talent to do so. I also wanted a new challenge, and some rest.

The radiology chairman position was a tremendous and special opportunity. It was a chance to develop a great department, and I believe it remains so for those willing to put in the hard work and take the challenge of keeping our field and training programs alive and well for the future. Was it a hard job? Absolutely! Was it a fulfilling job? Absolutely! Would I recommend it? Absolutely! For those ready to make a difference, I say go and create a successful team and department and help keep our field of radiology flourishing.