Deans and deaning in a changing world.

Much has been written about the threats to medical schools and teaching hospitals, but less attention has been given to what these changes mean to the individuals who lead these institutions. In the belief that the quality of leadership of academic medical centers, especially medical schools, will help determine the future of these institutions, the author assesses the situation of deans today. He first discusses the dramatic decrease in the tenures of deans over the last 20 years and reviews the evidence for some of the possible reasons that this has happened, such as possible changes in the personal characteristics of deans (not a factor), their salaries (not a factor), the inflated titles and increasing power of deans, and the greatly expanded sites of the operations that deans now govern (caused by the enormous increase in the health care establishment and corresponding increases in medical schools).