Journal of Higher Education Management 34,1 (2019)

individual institutions and broad societal expectations for the value of a university degree.

Lawrence (2006) describes the change and uncertainty facing university presidents that call for a new approach to university leadership.

Based on the current literature, we contend that it is worth exploring whether having academic medicine background and experience might be increasingly welcome for leaders in broader venues of higher education and university administration than academic health centers.

Many of the demands and challenges facing higher education today mirror those faced and addressed by academic medicine and healthcare leadership over the past three decades including: 1) a greater demand for accountability; 2) an increasing need for outcome measurements and transparency; 3) a higher need for innovation, decreasing reliance on state and/or federal support; and 4) increasing reliance on non-tenured full-time faculty lines (Frenk et al., 2010). Consequently, the experience and traits of leaders in academic medicine in addressing these challenges could be of benefit to the broader higher education world.

University presidents with academic health experience may be beneficial given the changing economics of the US. There is an increasing demand for health professions education, as the US Department of Labor projects that employment in the healthcare occupations will grow 19 percent from 2014 to 2024, much faster than the average for all occupations (Bureau of Labor Statistics, 2016). This growth is attributable in part to an aging population and increased access to health insurance through federal action. Consequently, higher education institutions of all types might benefit from leaders with an academic medicine background to better understand and manage a growing health professions education portfolio.

We have explored the unique nature of medical education as preparation for entrepreneurship in its broadest form. The trade publication University Business Magazine has had several articles on the need for entrepreneurial leadership in higher education since 2008 (Hutton, 2008). A blogpost by Arlen Meyers, MD, MBA describes 10 Reasons Why Doctors Make Great Entrepreneurs, including the ability to research and experiment, having a bias toward action, ability to assess risk and spot cost-benefit decisions, as well as other entrepreneurial characteristics.

Considering the challenges and conditions in higher education, we focus our study on the growing diversity in university leadership and where the diversity matters. Rutherford (2017) finds that heterogeneity in top management teams in higher education improves decisionmaking processes and consequently, organizational performance. Hattke and Blaschke (2015) find that disciplinary and educational diversity among top managers in higher education has the most positive impact on organizational performance.

Given this trade and scholarly literature and what might be considered a natural progression from medical degree to leadership position in higher education, we find that of those university presidents/chancellors responding to the 2012 American Council on Education (ACE) American College President Studies survey, only 1.3 percent reported having a Doctor of Medicine (MD) degree (American Council on Education, 2017). Furthermore, in the 24 years between the 1988 and the 2012 ACE surveys of college and university chief executives, the profile of the American college president changed very little (Ross & Green, 2000).

We find this to be an interesting research opportunity. In an effort to explore the engagement of academic health leaders in broader higher education administration, we used secondary data from a variety of sources to study the prevalence and characteristics of recipients of Medical Doctorate (MDs) as university presidents. We used a compilation of secondary data sources to examine potential barriers and opportunities to engagement as a university by 13