Managing Up in Academic Medicine
Your Chair Has 47 Problems Right Now. You Are Not One of Them.
That is not a slight. It is the reality of managing up in academic medicine. Your department chair, division chief, or dean is juggling accreditation deadlines, budget shortfalls, and whatever crisis walked through their door this morning. Your career development is on their radar. It is not blinking red.
If you wait for your leader to proactively manage your career, you will wait a long time. The physicians who get the resources and the support are the ones who learn to manage the relationship upward.
What Managing Up Is (and Is Not)
Managing up is not flattery or political maneuvering. It is taking ownership of your half of a professional relationship so that the person above you can support you effectively.
John Gabarro and John Kotter defined this in their Harvard Business Review article "Managing Your Boss". The relationship with your superior is a mutual dependency, and the most effective people manage it deliberately. Your chair needs things from you — clinical coverage, teaching, scholarship output — and you need things from them. It works when both sides are explicit about those needs.
Make It Easy to Say Yes
The single most powerful physician career strategy for working with your department chair is this: when you need something, do the homework before you ask.
Do not walk in and say, "I need more protected time." Walk in and say, "I have an R01 resubmission due in November. If I shift one clinic half-day to Dr. Martinez for three months — she has agreed — I can protect the time I need. The revenue impact is roughly $12,000, which the grant's indirect costs would recover in the first year."
You have framed the request as a business case. You have proposed the solution. You have addressed the obvious objection.
Think of it like a point guard running an offense. Your job is not to demand the ball. It is to put your teammates in a position to succeed. When you make your chair's decision simple, you both win.
Schedule the Relationship
Do not rely on hallway conversations. Request a standing meeting — quarterly at minimum, monthly if your chair is willing. Come with an agenda every time.
Here is a format that works:
- What I have been working on (two to three bullet points, not a monologue)
- What I need from you (specific, actionable)
- What can I help with? (this question alone will set you apart)
That last bullet matters more than you think. Mary Abbajay makes this case in Managing Up: How to Move Up, Win at Work, and Succeed with Any Type of Boss -- the most effective upward management starts with understanding your leader's pressures. When you ask what they need, you get intelligence about departmental priorities that helps you position your own work.
Keep a Paper Trail (the Good Kind)
Your chair will eventually need to write promotion letters or advocate for your resources in a dean's meeting. They cannot do that from memory.
Send a brief update once or twice a year. Not your full CV. A one-page summary:
- Key publications and grants submitted
- Clinical volumes or quality metrics
- Teaching and mentoring contributions
- Service and leadership roles
This is not self-promotion. It is professional documentation. When your chair can pull up a clean summary instead of reconstructing three years of your work from scattered emails, you are the faculty member they remember as organized and easy to support.
Read How Your Leader Operates
Not every chair communicates the same way. Some want data. Some want relationship. Some prefer email. Some want you to stop by.
Pay attention and adapt. If your chair responds to concise emails, do not send a five-paragraph essay. If they value face-to-face conversation, do not hide behind Outlook. Matching their style is not manipulation. It is professional competence.
When It Is Not Working
Sometimes the issue is not communication style. Sometimes you have a leader who is disengaged or actively unsupportive.
Before you escalate or give up, try one more round of direct conversation. Put your specific request in writing. Give them a reasonable timeline. If the response is still silence, you have data — not just a feeling — and you can make informed decisions about next steps.
Document everything. Not as ammunition, but as clarity for yourself.
The Bottom Line
Managing up is not about changing who you are. It is about taking ownership of a relationship that directly controls your access to time, money, and opportunity. The physicians who do this well are not the loudest. They are the ones who show up prepared, communicate clearly, and make it easy for their leaders to say yes.
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