Lloyd Minor plans to take a strong department and make it stronger.

Not every new department chairman finds himself in a position as enviable as Lloyd Minor’s. He has inherited a rock-solid department, ranked No. 1 by U.S. News & World Report for four consecutive years and with more NIH funding than any other otolaryngology department in the nation.

“This department doesn’t have any clinical weaknesses,” says Johns Hopkins Medicine’s new chairman of Otolaryngology–Head and Neck Surgery. “All the bases are covered.”

Yet Minor is not about to ignore the three traditional missions of academic medicine nor rest on past laurels. “The reason we enjoy such a huge amount of success is because of the people here,” he says. “Our challenge is to keep it a place where people at every level want to be and stay.”

To accomplish that, Minor, who takes a disciplined approach to his department’s fiscal health, will focus on the economic and regulatory challenges of 21st-century academic medicine. One of his first acts as chairman, for instance, was to hold a weekend retreat for faculty on the topic of billing codes. “Our faculty are highly skilled at solving problems in the clinic, in the operating room and research laboratory. We need to apply that same kind of intellect to an analysis of our finances. I don’t see how we’ll survive as an academic institution if we don’t.”

Minor, 46, grew up an only child in a non-medical family in Little Rock, Ark., intent on becoming a doctor from the time he entered Brown University as an undergraduate. Still, he comes by his business instincts honestly. His father was an accountant (his mother was a kindergarten teacher whose most famous pupil was Chelsea Clinton), and it was Minor’s ability to use math to understand the workings of the ear that initially drew him to his specialty.

His methodical temperament served him well when he set out to create Hopkins’ vestibular disorders program, for which former otolaryngology chairman Charles Cummings (see sidebar) recruited him in 1993. Beginning with just a part-time office coordinator, he built a solid, self-sustaining research and clinical program with 13 staff members supported by $800,000 in grants. Along the way, he not only discovered a syndrome in which dizziness is brought on by loud noises, but devised a surgical technique to treat it. Together with colleagues, he refined a treatment using a toxin injected into the ear for Meniere’s disease—a syndrome marked by dizziness, hearing loss and ringing in the ears—that has proven effective in 90 percent of cases.

As Minor transitioned into his new role, the balance sheets beckoned to him, and he found that the department’s reimbursements for clinic visits and surgical procedures had been eroding significantly. To make up for the shortfall, he negotiated with Hopkins Hospital and University for more space, faculty and ongoing financial support.

To capitalize on the strengths of the department’s staff, Minor plans to even more aggressively nurture clinician-scientists, beginning by identifying mentors to shepherd junior faculty into independent academic careers. As an example, he cites his own collaboration with the Bloomberg School of Public Health to assess the outcome of his treatment for Meniere’s disease.

“People can develop investigative careers as straight clinicians taking care of patients,” he says. “The School of Public Health needs expert clinicians with numbers of patients to assess outcomes, and we always need to assess the outcomes of what we’re doing.”

In the future, Minor predicts he will spend his time looking at how to make his clinical enterprise more efficient, as well as building the department’s endowment.

But in the most important way, the principles of the department will not change. Even today, when Minor interviews medical students for a prized place in the department’s residency program, he echos Cummings’ words to him more than a decade ago.

“When I asked him what he was looking for in a faculty member, he told me, Someone who wants to push back the frontiers of the specialty, someone who takes the three missions to heart, and someone who realizes the whole of the department is greater than the simple sum of its parts. His vision is just as applicable today. It’s a great one to adopt as we move forward.”

—MEM

Lloyd Brooks Minor Born: May 25, 1957, Little Rock, Ark. Education: Sc.B., Brown University, 1979; M.D., Brown University, 1982; internship, Duke University Medical Center; research fellowship and residency, University of Chicago Medical Center; clinical fellowship, the EAR Foundation, Nashville, Tenn. Career Highlights: Director, Laboratory of Vestibular Neurophysiology, Johns Hopkins; director, Fellowship Training Program in Otology and Neurotology, Johns Hopkins; triple professor in departments of Otolaryngology, Biomedical Engineering and Neuroscience. Current Position: Andelot Professor and Director, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine. Family: Wife: Lisa Keamy, M.D., two children: Emily, 12, Samuel, 10. Hobbies: Avid reader, especially political nonfiction; plays the cello.