Careers in Family Medicine: Department Chair

We are continuing our blog series Careers in Family Medicine. Each week, I will highlight a family physician and their career path. Each one will share their pearls. So far, we have highlighted examples of Rural Practice, Value Based Care, Academic Medicine, US Department of State, Multi-specialty group and Leadership, Direct Primary Care, FQHC practices, Hospital Medicine, Tribal Health, Military Medicine, Concierge Practice in an Academic Setting, Traditional Private Practice, and Academic Leadership. Today, I have the privilege to highlight Dr Deborah Clements - who has served and innovated in the role of Chair of Family Medicine for over a decade.

Dr. Clements, Deb, please give the readers an overview of your career in family medicine.

My path in medicine was non-traditional, beginning medical school at age 33 with three children. As the first high school graduate in my family, I had little understanding of what a career in medicine entailed. Along the way, I was fortunate to have mentors, sponsors, and advisors who encouraged and challenged me.

I completed my medical school and residency training at the University of Nebraska and, from there, went directly to the American Academy of Family Physicians as the Assistant Director of Medical Education. This position allowed me to use the skills I’d learned from my career in healthcare administration prior to entering medical school, as well as giving me the 50,000-foot view of organized medicine and medical education. Because it was critical to me to continue to practice medicine, I negotiated clinical time as a part of my contract and worked immediate care shifts when I was able. Over time, I missed having a true continuity practice, inpatient care, deliveries, and being involved in direct education of students and residents. After about six years, I transitioned to the University of Kansas Medical Center, where I served first as APD, then PD. 

Unexpectedly, I received a call from Northwestern assessing my interest in the Chair position and opening a new residency program in the northern suburbs of Chicago. While I was not looking for a career change and was happy in my current job, the opportunity was intriguing. Leading a department of family medicine and designing a new residency program were exciting (and daunting) challenges! As a Chicago native, this was also a chance to relocate closer to my aging parents and my sisters—although it would take me farther away from my children and grandchildren and would require a sacrifice in career growth from my husband.  Together, we weighed the opportunity against the significant changes the job would mean for us as a family, and six months later, we moved to Chicago. That was more than 10 years ago!  Since then, our department has grown from one family medicine residency program to three programs, sponsoring 72 residents in three separate hospitals.   

What would you say to women in medicine who receive conflicting societal messages - “It’s too hard for women in medicine to lead” vs. “As a woman in medicine, we need you to step up and lead"?

Both can be true at the same time. It’s hard for anyone to lead, not just as a woman, but the landscape is gradually changing as more women and people traditionally underrepresented in medicine are stepping into these roles in greater numbers. I’m optimistic that we’re making progress in understanding that our most precious resource is our workforce. The more we are able to broaden our perspectives and bring diversity of experience and leadership style to our organizations, the better we can serve our colleagues and our patients. We can do hard things.

What have been the challenges in serving as chair?

While this has been the most rewarding job I’ve ever had, I recognize that the job wouldn’t exist if it weren’t for challenges. Resources are always limited, and people are complex in their needs and responses.  I believe it’s critical to give faculty autonomy in their work while providing a framework that gives as much clarity as possible to our shared vision. Ultimately, tough decisions fall to the chair. My decisions haven’t always been popular with everyone, but my responsibility is to ensure the future of our department and the best opportunity for success for everyone.

In a role where everyone reports to you, the job can be lonely. My trusted circle of friends tends to be chairs in other departments and other places. There isn’t a roadmap for this work other than understanding the long game, appreciating that managing competing priorities is a daily reality and that effective communication is the most important tool we have.

What have been the greatest rewards in your role?

The rewards have been countless! I’m motivated by being able to make decisions that support faculty in a positive environment. Creating a culture of wellness and watching others grow in their ability to lead and care for our communities as we expand our primary care base at Northwestern is an amazing journey. 

When I think about the multiplier effect of training future family physicians, the impact we have is mind-boggling. For every physician we place in a community, thousands of lives are positively affected. In my career, I’ve been able to work with roughly 200 people who’ve gone on to be phenomenal physicians, many of whom have become leaders in programs and departments of family medicine—that’s nearly 500,000 patients impacted each year. 

What specific approaches do you take to enhance your personal and professional fulfillment and joy?

Enhancing joy in practice is always a work in progress. As we all know, our ability to find and sustain fulfillment and joy is really about managing our thoughts about our circumstances. Making time to reflect, to be intentional about my thoughts, to live in gratitude, and to take care of the basics (sleep, exercise, nutrition, spirituality) is essential. Even on the toughest days, I remind myself how fortunate I am to do this work.

Do you have any tips for those looking at their first job (or those looking to pivot) on deciding?

You’ll never feel entirely ready for anything, so make the best choice possible for yourself at the time. If you’re pivoting, be as objective as you can and be honest about both the pros and cons of making a change. Without exception, the factors I knew would be challenging in a job always were. Identify your “must haves,” then don’t be afraid to ask for what you need and negotiate. It’s impossible to know the range of options you might have unless you ask. You should never wonder what might have been possible if only you’d asked. Once you have a job, continue to make connections with others through your own institution and organizational networks. Medicine is really a very small community, and these relationships will be important for your entire career.

Are there any tips or perspectives you'd like to share with readers considering academic leadership? 

We need more diversity in leadership. Find a sponsor; don’t be shy about letting others know of your interests.  Get involved, share your passion, and help us achieve a better future for our colleagues and patients. 

Are there any other things you’d like to share?

Thanks so much for featuring these stories, Dr. Caylor. Many of us, including myself, had no clear understanding of the possibilities for our careers. I appreciate your passion for this work. I’m open to any questions or feedback and can be reached at [email protected].

Amazing, right?! Read more about her story and impact. I feel like this blog may have been the final touch to all the wisdom and mindset approaches to career joy given by so many truly inspirational family physicians. Next week, I'm going to give you my take-aways on this blog series. Don't worry - somewhere down the road, I'll still deliver to you the promised highlights of palliative care, sports medicine, global health, the C-suite, and a few others. 

Until then, have a joy-filled week!  Tonya