The catch-22 of promotion: Is becoming department chair of surgery a threat to the triple threat?

Background: Despite the “fourth threat” of administrative demands, department chairs of surgery are expected to continue being a “triple threat”: productive in research, outstanding in teaching, and exemplary in practice. Increased demands despite limited time are the catch-22 of promotion. This study investigated the influence of becoming department chair on scholarly vigor. Methods: The surgeons listed in the Society of Surgical Chairs Membership Directory website (n = 118) were included in this study. Three measures were compared during the pre- and post-promotion phases: (1) research productivity (annual publications); (2) authorship position in publications (first-authorship, co-authorship, and senior-authorship); and (3) scholarly impact (m-index and National Institute of Health funding). Results: The median [interquartile range] number of publications per year increased post-promotion versus pre-promotion (7.64 [3.81–14.15] vs 4.12 [2.08–7.03], P < .0005). The median [interquartile range] number of first-authorship publications per year decreased (0.50 [0.00–1.00] vs 0.64 [0.32–1.22], P < .05), whereas the median [interquartile range] number of co-authorship (4.23 [1.98–9.70] vs 2.02 [1.02–3.95], P < .0005) and senior-authorship (1.87 [0.99–4.03] vs 1.00 [0.36–2.24], P < .0005) publications per year increased post-promotion. The mean ± standard deviation m-index increased post-promotion (1.67 ± 1.19 vs 1.23 ± 0.83, P < .01). The mean ± standard deviation annual National Institute of Health grant funding amount of 48% (n = 57) of the department chairs increased post-promotion ($365,000 ± $899,000 vs $98,000 ± $143,000 pre-promotion, P < .05). Conclusion: The fourth threat of administrative demands is not a threat to the triple threat. This study showed the department chairs’ continued scholarly vigor after promotion, providing insight into their tenacity, resilience, and dedication.