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Thursday, August 23, 2012

Two ways to hire doctors

The following is a guest post from Will Lessons, retired RRT

One of the nice things about being a retired RT is I can now come out into the open and say some of the things I've been holding back for fear that the truth might get me fired.  So this will be the theme of a series of posts I've chosen to write for RT Cave.  This post is about how a hospital hires doctors.

I think I'm a credible author on this subject because I worked for a very large hospital and a small hospital.  Out of respect for both I won't name them here.  Also out of respect I will say that both hospitals are fine institutions with many wonderful people, and I also would like to add that most, perhaps as many as 90 percent, of the physicians I've worked for over the years are great team players and wonderful people.  Yet the premise of this post is that you are more likely to find the flub, arrogant, egotistical doctor who's a control freak working for a small town hospital as opposed to a larger, teaching institution.

The reason is because each such hospital has a unique method of hiring physicians.  The smaller hospital has trouble drawing doctors to the region.  The larger hospital has no such problem.  The smaller hospital has to hire any doctor who comes asking for a job, the larger hospital can choose from an array of doctors. The large hospital has a large pool of doctors to choose from, the small hospital usually gets the rejects.   Right there lies the problem.  (No, I am not saying all doctors in small town hospitals are rejects, yet the percentage is higher than larger hospitals.  I want to be clear here, hence the parenthesis).  

Try this.  The small town hospital doctor has to be on call 24-7 because there are no similar such doctors, or the pool of such doctors is small.  An example is the local urologist.  He's the only one.  He has the unfortunate task of taking call for himself even when he's on vacation to Europe.  The large city hospital only has to take call once a week, and in some cases once a month.  So you can see there is a huge incentive for a doctor to work for the large town hospital right there.

So because of this the hiring process for each institution is unique.  The small town hospital I worked for had an idiot doctor working in the ER. This doctor quit and we were all excited because the hospital now had an opportunity to get a good doctor.  Yet he was aptly replaced by another idiot doctor.  It seemed at times we were getting large hospital rejects.  And, for lack of a more sophisticated way of saying it, we probably were getting other hospital's rejects.

So that said, the types of doctors working for smaller hospitals tend to be more of your "I want to have complete control," type doctors.  They don't want RTs making changes without telling them first.  They often go on power trips.  If you do something wrong -- even though we are all humans and are all likely to make mistakes -- they will treat you like you are a moron, idiot buffoon.  They will put you in your place at the bottom rung of the totem pole.  They will drive your ego right up your butt, and hopefully -- they think hopefully not me -- your confidence too.

Larger hospitals are more likely to have doctors up to date on their doctor wisdom, such as newer ideas that the hypoxic drive theory is a hoax, and that breathing treatments are only for bronchospasm and not for all that makes an annoying wheeze.  They tend to be more in favor of protocols because they know respiratory equipment exceeds the bounds of their medical knowledge.  They want to be team players, and part of being a team player is keeping up the morale of the RT staff.

Yet the opposite is true of small town hospitals.  Totalitarian control freaks are not welcome in most larger hospitals, and therefore have to work for the smaller hospital run by people who've decided they have no choice but to hire said doctor.  They hire doctors who may be but aren't necessarily up to date on the latest doctor wisdom, and for this reason may be more prone to order IPPB therapy that was proven useless back in the 1970s and proven useless back in the 1970s.  They may be more likely to not fit the personality of said hospital, and may not even pass the hospital's personality test for hiring that all other workers have to take.  

So there you have it.  Allow me to state again that I love every place I've worked.  I love the people.  I love the bosses.  I even love the doctors.  I even love some of the idiots.  However, there comes a time when honesty must be spoken.  It's kind of like Rick wrote once that by not allowing RTs to use their thinker they are becoming apathetic.  This is not good because an apathetic RT is not at the top of his game.  Institutions must work to improve morale of RTs, and how to do this is the subject of my next post of which Rick says he'll publish next week.

Thanks Will.  See part II here.

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