Ask The Experts

I had the opportunity to interview Dr. Angela Mills, Chair of Emergency Medicine at Columbia University, and Immediate Past President of the Society for Academic Emergency Medicine (SAEM). She provided amazing insights into the path to promotion and advancement in emergency medicine. This article will be very valuable to anyone wondering about how to jumpstart their career.

Tell us about your path that led you to becoming a Chair. I understand your trajectory began with operations and quality.

AM: I began my career at Penn. As a new faculty member, I was hired into the research track. My job was 65% clinical and 35% academic. I was tasked with a mission: I had nine years to publish enough research to show that I had a national presence. On average people had 40-50 publications when they went up for promotion. If I made it, I would get promoted. If I did not make it, I would lose my job. It was very stressful.

At the time, I had no training on how to do research. I hadn’t done a research fellowship. So, I worked hard. I collaborated with other people in my department. It was recommended to me that I do research on abdominal pain. So, that is what I did. Ultimately it worked out and in nine years I got promoted.

Around that time there were some changes in the operational leadership of the department, and I was asked to take on the role of Medical Director. And I said, why me? I was really doing research. I had never done operations. But they told me that I got along with everyone and that I was a great leader and they thought I would do a good job in the role. I was sort of at a crossroads at the time and I thought it would be a good challenge for me and allow me to develop new skills. So, I agreed to become the medical director.

Once again, I had no training for the position, I was in. I took some leadership courses and tried to learn as much as I could from various colleagues. I had to work hard and collaborate with others to learn what I needed to do. Then I was promoted to Vice Chair of operations. I noticed that I really enjoyed mentoring other people and advocating on behalf of the department. My mentors eventually recommended that I apply for Chair jobs. So, I did. I felt like in leadership I could impact patient care and our team members in a bigger way.

If I was doing this today, I would have completed an administration fellowship and gotten an advanced degree. I always thought about obtaining an MBA, but it never worked out. You can learn a lot by doing things on the job and having great mentorship, but completing a fellowship or obtaining a degree provides you with dedicated time to focus on that area. For example, doing an administrative fellowship may give you an opportunity for an administrative role in your institution.

What is the role of a medical school Chair and how does it differ from being a Chair in a community site?

AM: There are really many more similarities than there are differences. In both roles, you need to lead the group. You oversee the mission. You are responsible for hiring and developing your faculty. You may also be overseeing multiple sites which are all affiliated with the health system or medical school. In a medical school, there are also some academic pieces, and you oversee the education and research missions. For example, you have trainees including students, residents and fellows. A Chair is responsible for faculty development and academic and professional advancement. You are also expected to produce research in your department.

As a Chair you may have various responsibilities and roles with the medical school. You may be on search committees for Chairs of other departments or other leadership roles in the school. That may not be the same at some community sites.

You also have opportunities and may be asked to lead committees or serve in roles for the hospital or the medical school. For example, I am currently the Vice Chair of our health system medical board and I chair the operations committee for our faculty practice organization.

As a chair in an academic medical center, I am also focused on our research mission. As a specialty, emergency medicine is ranked last in some academic parameters such as NIH funding and numbers of PI’s with NIH-funded grants. In emergency medicine, we care for a vast array of medical complaints and greatly impact the population and public health. Our experience and expertise is critical in scientific discovery and it is important that we perform emergency medicine centered research to improve patient care.

What were some of the surprises you encountered when you took the job?

AM: I really researched the job well. I spoke to many people, and I understood the job of an Academic Chair well. However, there were some details about my specific job that I did not find out until I showed up. For example, we had many open lines that had to be filled. I had to do a lot of recruiting to staff the department which took a great amount of time.

Also, I was coming from an institution which was much more centralized with many administrative functions occurring at the University level. Columbia was more decentralized with the department being responsible for many of these administrative functions. As a brand-new department, the administrative infrastructure needed to be built and so I spent a significant amount of time focused on building this foundation.

What was it like being the inaugural Chair of a new Department in an Ivy League institution?

AM: It was very exciting to be starting a new department, but it was also daunting and very challenging.

Prior to my coming to Columbia, Emergency Medicine was under the Department of Medicine, and Pediatric Emergency Medicine was under the Department of Pediatrics. When I came, we formed a new Department of Emergency Medicine and those two divisions merged to become one.

It took time to get the other departments to recognize that emergency medicine was now its own department. For example, sometimes institutional data for different departments would be presented and emergency medicine was not included. Other departments had to recognize what a department of emergency medicine truly was. Many subspecialties had to be built. We needed to recruit fellowship trained people to develop various divisions such as ultrasound. This allowed us to start new fellowship programs and increase our teaching for our trainees. We really built a lot.

Before we were a department, there was limited involvement of emergency medicine in the medical school. Medical students did not have a required rotation in the emergency department. They really did not interact much with emergency medicine and were learning about emergency care from other specialties.

Now emergency medicine is viewed as a department just like all the others. We have expanded a great deal and contributed in huge ways. We own a lot of the teaching in the medical school. For example, we now run a required first responder class in the first year, a required clerkship in emergency medicine in the third year, a ready for residency course in the fourth year, and several electives. We also participate in many of the required courses in the medical school. And because of this, we have seen more medical students going into emergency medicine.

One of your priorities has been to promote women and under represented minorities. What led you in that direction?

AM: When I was at Penn, where I “grew up” in emergency medicine, I was in a group that was likely more diverse than many groups at the time. I benefited greatly from that. I had many mentors who were leaders and people who “looked like me” who I felt comfortable going to. Diversity in all aspects is critical in creating smarter and more productive teams and improved patient outcomes. All the articles I read about the value of diversity really resonated with me. So, I work to be intentional in promoting a culture in the department where everybody is accepted for who they are, and everyone feels welcome. I believe you have to be deliberate about it. You have to think about creating that culture and then go about making it happen.

So, you just spent a year as the President of one of the largest national organizations in Emergency Medicine, namely SAEM. What was that experience like? What surprises did you encounter? What value did that role bring to your career?

AM: I have been involved with SAEM for a number of years. The presidential role is only one year, however there is a leadership structure that includes being a member on the board and then a member of the executive committee of the board which is a four-year process. The experience on board overall has been very rewarding. It has given me the opportunity to support our members and shape academic emergency medicine, which is something I am very passionate about. I have been able to help develop ideas and opportunities for people and allow them to build and grow programs which benefit members and the specialty.

I have had a sense of awe at seeing all the amazing work that members of SAEM are doing. One example that stands out is the Stop the Stigma campaign which we were able to accomplish as an “All EM” initiative. This was really borne out after the passing of one of our faculty members, Dr. Lorna Breen, and realizing that we should be working in this space. It was the membership and staff of SAEM that really created this campaign and made the collaborations with other organizations to make it so successful.

What are the future challenges for EM?

AM: We are definitely facing challenging times in our specialty. One challenge is that we have seen less applications into emergency medicine. There are also more programs and positions. If more positions continue to be developed, even if the number of applicants stays the same, we will have more vacancies. So, what does that really look like and how does that impact students and those who mentor them?

Our job as emergency physicians is hard. We work in a difficult environment. But we went into this specialty because we are passionate about this incredibly rewarding specialty and want to deliver the very best patient care by the mantra of anyone, anything, anytime. We want people entering the specialty who are passionate about emergency care as well. How do we share that joy? As a specialty we need to come together to figure this out, moving forward becoming even stronger.

A second challenge is increasing the scientific discovery and research in emergency medicine. How can we get early medical students interested in emergency medicine research? If you are interested in areas like health justice, equity, and population health, emergency medicine is a great space to engage in related research. Emergency medicine has not traditionally been looked at as a research specialty. We need to change that. We need to be at that table.

You have accomplished so much. Where does Angela Mills go next?

AM: I have been in this position for five and a half years. About two years into the role, the Covid pandemic hit NYC and as a department, that consumed us for quite a while. At times we were working to stay afloat. So there has been a delay in many of the initiatives we have wanted to implement. So, there is still a lot more that I want to accomplish.

I love being a Chair. It gives me a great balance of academic development and administration. I enjoy mentoring the faculty and trainees towards academic advancement, and also focusing on strategy, vision and administrative areas such as finances, human resources issues and all the other things that come with working at a big academic medical center. I truly enjoy this balance that allows me to contribute to something which I am passionate about, which is academic emergency medicine.

What words of advice would you have for a young woman faculty member who is looking to replicate the career that you have had?

AM: I would say seek out a great mentorship team. Mentors can be people who are senior to you, but also your peers and people who are junior to you. Be open to various opinions. Look for people who can sponsor you, coach you and also give feedback. Be open to that feedback and be flexible. For example, when I was offered the Medical Director position, that was not the path I was originally headed in. But I was open to it and it led me to great places. Work hard knowing how to integrate your personal life with your professional life. Mentors can really help guide you with these things.

Any parting words you would like to leave our readers with?

AM: I would say don’t be afraid to ask for mentorship and advice. Don’t be afraid to talk to people, even those with leadership positions who may be in different departments or institutions. Most people will be willing to help you. Even people in other departments were willing to mentor me on research. Look for those opportunities and you will find them.