Patient Care First

[HighPriest]

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So I am at one of the lowly, $#T eating Army MEDCENS. We have a very stringent UA policy that as far as I can tell states that you will have a UA every 2-3 weeks. I'm on #13 now and I've only been here for 13 months (didn't get one a couple of months because of leave and TDY). Our company policy is that you have to show up at the UA start time and stay until the deed is done, regardless of (inset anything).

Generally, they call your cell phone or home phone at 0300, wake up your family, and let you know that you have a UA at 06:30. This happens every 2-3 weeks, usually when you're not on call (can't prove that is intentional).

At my last UA I was called at 06:30 and told to report immediatley. As I was already heading to work, I had already emptied the tank, so to speak. I also had an 18 month old child NPO and waiting for an elective surgery that morning. I explained that to the company commander (CPT so-and-so, who one would think would at least respect rank if not person), and his response was "that doesn't matter." I was told I needed to report immediately.

So I came in, drank at least a gallon of water, got my heart rate up, almost puked. After an hour of this, with no end in sight (or sensation, as it were), I cancelled my patient. I couldn't see keeping an infant NPO for an elective case for such a stupid reason. I encouraged Mom to make a complaint if she felt so inclined, as my mention of this possibility in the past has always been met with disdain and anger from the brass.

So she did. The complaint states pretty clearly that she was happy with her care before her date of surgery, she was happy with the facility, she was happy with me and with pre-op services. She was angry that the hospital considers a UA more important than her daughter's surgery. I couldn't agree more.

Today, I get an angry-gram with the complaint attached (as described above), asking me to make it right. I explained that there are a lot of ways to make it right, but none over which I have any influence. For example, let me pop in for my UA between cases. Or, perhaps, stop spending so much money on UAs since our hospital is bankrupt and you're testing the entire facility every month....
The hospital commander's reply is that we are expected to be at all mandatory military functions, regardless of other obligations. In other words, patient care comes second.

BTW, I didn't get out of my UA until 09:30. Could I have done the case? maybe. Only a 2 1/2 hour delay. But I had no idea how long I was going to be there.

 

[idq1i]

... In other words, patient care comes second...

Hooah. Trained to save. The army way.

 

[denali]

That's an unusual number of UAs for any given person, and seems statistically suspicious. Are they targeting OR people, or you in particular? Have you guys had diversion problems?

The whole "last minute" notification thing is unnecessary; they can notify "donors" the day or afternoon before without reducing the sensitivity of the overall screen.

 

[HighPriest]

It is a highly ridiculous number of UAs. Far more than anyone else I know, although 5-7/year is common here. I agree that it is probably statistically impossible to be random. I obviously don't use any drugs, nor do I drink on work nights, and I have only missed 1 UA for work-related reasons. So I have no idea what the hell is up their @$$.

 

[colbgw02]

This disgusts me. As a short-timer, I would have considered calling their bluff (potentially involving the media, if needed) and telling them to shove it. But I can certainly understand the desire to keep one's head down. They randomly decided to do a mid-afternoon UA on a doc in my department when he was working nights and he just didn't go. He didn't make a stink...just made it be known he wouldn't come. Magically, it didn't turn into anything.

 

[DrMetal]

So I am at one of the lowly, $#T eating Army MEDCENS.

This is draconian, I'm sorry you had to go through all that. I really don't understand why the Army (and possibly the USAF) has to make everything so much harder.

The Navy seems to have a much more reasonable approach. At my last command, you were exempt from the UA if you were on leave or TAD. If you had something important to do that day (like take a board exam, be at a local conference), you could get no cost TAD orders, to make you exempt should you be called for a UA. They were quite generous about giving such TAD orders (provided they were no cost, and you legitimately had to be somewhere).

If you did have to show up for a UA, you could do so between the hours of 7AM and 8pm, it was a decent amount of time, and they emphasized that you should show up doing the "pee pee" dance, so you could pee quickly and be on your way. Still, I'm sure it inconvenienced some. But you can't blame the mil for being the mil. At least the Navy tries to make it less painful.

 

[denali]

Metal: When I was in a line unit, SOP for UAs was alert roster call at 0300, quarantined in the company dayroom starting at 0400, NLT 0430, and you couldn't leave until you donated. When PT rolled around at 0630, those that still hadn't given a sample got segregated PT (and usually got smoked), then were back in the dayroom until mission accomplished. Failure to make 0900 work formation resulted in a counseling statement. I think Priest's CoC is repping a little of this mentality. Your unit's method seems eminently reasonable, and FWIW, most of the fixed facility medical units I've been in have been pretty reasonable, although when I was working nights I had the same problems colbgw02's colleague had. Fortunately, my department chief stood up for me and there was no fallout as long as I showed up to the next one.

Priest: It's been years since my commander's drug/alcohol training, but IIRC we were cautioned you could have only 100% or random sample tests following a strict methodology (D10 selects last digit of SSN was my method). IG investigation was the reported consequence. I've been picked to donate maybe 5 times in the past 3 years, so 13 times in as many months is pretty much winning the lottery. Do they do a lot of 100% UAs, because theoretically they could do that every month. If you were so inclined, perhaps a polite email to the troop cdr asking what's up with the statistical anomaly (with patient care fallout), followed by an IG inquiry if it continues.

 

[DrMetal]

Metal: When I was in a line unit, SOP for UAs was alert roster call at 0300, quarantined in the company dayroom starting at 0400, NLT 0430, and you couldn't leave until you donated.

Yeah, it's totally unit dependent. Most CONUS shore-based line units aren't running around 80 hrs/week taking care of sick people. They're power point warriors who PT 4 hours a day . . . so if they get stiffed a little bit, I'm ok with that. I'm glad the Navy has some sense to allow some latitude with medical personnel.

 

[HighPriest]

This disgusts me. As a short-timer, I would have considered calling their bluff (potentially involving the media, if needed) and telling them to shove it. But I can certainly understand the desire to keep one's head down. They randomly decided to do a mid-afternoon UA on a doc in my department when he was working nights and he just didn't go. He didn't make a stink...just made it be known he wouldn't come. Magically, it didn't turn into anything.

Here, if you don't show up for one UA, you're automatically slated for the subsequent two.

 

[HighPriest]

Metal: When I was in a line unit, SOP for UAs was alert roster call at 0300, quarantined in the company dayroom starting at 0400, NLT 0430, and you couldn't leave until you donated. When PT rolled around at 0630, those that still hadn't given a sample got segregated PT (and usually got smoked), then were back in the dayroom until mission accomplished. Failure to make 0900 work formation resulted in a counseling statement. I think Priest's CoC is repping a little of this mentality. Your unit's method seems eminently reasonable, and FWIW, most of the fixed facility medical units I've been in have been pretty reasonable, although when I was working nights I had the same problems colbgw02's colleague had. Fortunately, my department chief stood up for me and there was no fallout as long as I showed up to the next one.

Priest: It's been years since my commander's drug/alcohol training, but IIRC we were cautioned you could have only 100% or random sample tests following a strict methodology (D10 selects last digit of SSN was my method). IG investigation was the reported consequence. I've been picked to donate maybe 5 times in the past 3 years, so 13 times in as many months is pretty much winning the lottery. Do they do a lot of 100% UAs, because theoretically they could do that every month. If you were so inclined, perhaps a polite email to the troop cdr asking what's up with the statistical anomaly (with patient care fallout), followed by an IG inquiry if it continues.

I had a polite sit down with the company commander, and was told there was nothing he could do. Again, the idea of a UA isn't the issue, per say. It's the emphasis of this kind of crap over patient care. The hospital's mission is patient care, the company's mission is doing paperwork and meeting regs. So what's the right answer? In my opinion, keeping an infant NPO is not the answer. In any case, I'm the only provider in my clinic and the only one in my specialty, so it is not the same as a line unit. Pulling SPC. Snuffy out of his day-to-day routine of PT-Eat-Range-PT-Eat-formation-PT-Eat-Get hammered-Sleep is not equivalent. Failing to realize that is 50% of the military's problem, and is at least in part why military medicine is bankrupt. A hospital is not a line unit.

 

[psychbender]

It's not the Army as a whole, just his command. At my MEDCEN, I've only been tagged for random UA twice in the past year. When we do it, you are told to show up anytime between 0700 and 1230, ready to go. I was in and out in under five minutes each time. If you are not in the hospital that day (on leave, post-call, just off), someone in your department lets them know, and you're off the hook for that session.

 

[colbgw02]

Here, if you don't show up for one UA, you're automatically slated for the subsequent two.

That stinks. I feel like at my post if you frame it as a patient safety issue, there is enough CYA attitude/patient-first lip service being paid to make this refusal work. In a totally assbackward way, it works out best for all involved, even if everyone gets to the end result by a circuitous route. Obviously, this only works if the command isn't totally tone deaf regarding patient care.

Oh, and welcome back to Tired.

 

[HighPriest]

Pretty much the same thing at my place. Exception is when you return from an extended TAD, and then the DAPA rule on "all Sailors must be tested twice yearly" kicks in, and you can count on peeing two days in a row.

His command sounds unreasonable, but I still think there are a variety of options that could be explored here: (1) File a patient safety report or call the IG, (2) take a passive-aggressive approach as detailed in my previous post, (3) recognize that a "company CO" in an Army hospital is a toothless nobody (at my command, residents who have been asked to leave their program will often rotate through that position) so request mast and sit down with the hospital CO to detail the problems with the current policy, (4) write and forward a white paper on the clinical problems with the current protocol, and frame it in terms of AMEDD priorities on providing excellent patient care, (5) bring it before one of the myriad of hospital committees dealing with the OR and patient safety.

Basically, the options are limitless. But you have to kind of suck up your nutsack, set aside your MD for a minute, and spend a little time being an officer.

1: I filed a PSR. But as I said, I was already told by the hospital command that mandatory Army functions were mandatory. 2. I tried that. Believe me that's the first thing I tried. They leave a message, and you're still considered responsible for the contents of that message. They just continue to call until you either answer or show up at work, where they get you by calling the office. I suppose I could have not answered and then taken care of the kid first, but that doesn't necessarily solve the problem for my subsequent patients. 3. The hospital commander, upon hearing about the cancellation, sent out a mass e-mail stating that Mandatory Army functions are mandatory. This isn't just the company CO pulling crap, he's backed up. In fact, I was told by one of my colleagues that the hospital commander came to the OR looking for me when she had heard that I made a stink with the Company CO about this (apparently she thought I hadn't shown up). Yes, it's a small MEDCEN, and yes she should have had better things to do. 4. No one cares about that. 5. The hospital committee? At my hospital that's two non-clinical civilians and an O-3 who's last position was in a line unit. And they all report to the hospital commander, who doesn't feel that this is a problem. Have I mentioned that she's not a former physician?

The options are doing a lot of crap that ultimately isn't going to matter. The only way I see this changing is: a new command or someone gets hurt and someone higher up the food chain finds out.

I have no doubt that this is an extreme case, and definitely not Army wide. But it is exactly the -type- or crap I've come to expect from the Army.

 

[pgg]

My god, that place is screwed up. I'm sure it's someone's fitrep bullet though: "Most aggressive and comprehensive urinalysis program of any command, guaranteeing patient safety."

I've been random UA'd about four times in the last five years, plus a couple more command sweeps and PCS-check-ins. What a waste of money and time.

In the Navy / USMC, at least at the last 3 commands I've been at, UAs don't involve lockdowns or 3 AM calls. Round about 6 AM the list is emailed out so departing night shift people can do it before going home. Then it's open until about 10 AM or noon for you to show up whenever is convenient. If you're busy doing clinical work, the UA office stays open. If you're on leave, TAD, or previously approved special lib, you're exempt. Doctors go head of line. It's painless and really doesn't get in the way of patient care.

 

[denali]

Ouch. You're hosed.

Start your paper trail yesterday.

I assume you justified the cancelled case in the chart, but you need a paper trail of your own. When it happens again (and it likely will given your specialty), every time it happens, explain the situation to the commander and have him/her make the decision. Comply with the order and mitigate the impact on your patient as you've done previously. Then while you're waiting to urinate, type up your MFR with names, dates, times and phone numbers. Save the MFR as a PDF, and digitally sign/certify it with your CAC within 24 hours of the event happening. CC the MFR to the company cdr, chief of your department, patient safety officer, risk management guru, and to your personal email account. Save personal copies off-site of any emails you've gotten so far, especially the one from the hospital CO.

ETA: Only other option is to wait until you're in-house before your first morning void.

 

[Monty Python]

Ouch. You're hosed.

Start your paper trail yesterday.

I assume you justified the cancelled case in the chart, but you need a paper trail of your own. When it happens again (and it likely will given your specialty), every time it happens, explain the situation to the commander and have him/her make the decision. Comply with the order and mitigate the impact on your patient as you've done previously. Then while you're waiting to urinate, type up your MFR with names, dates, times and phone numbers. Save the MFR as a PDF, and digitally sign/certify it with your CAC within 24 hours of the event happening. CC the MFR to the company cdr, chief of your department, patient safety officer, risk management guru, and to your personal email account. Save personal copies off-site of any emails you've gotten so far, especially the one from the hospital CO.

ETA: Only other option is to wait until you're in-house before your first morning void.

The above advice will also help in the event the uninformed non-clinical bean counters question your dip in "productivity" or increase in cancellations. All they see is numbers. You'll have a ready-made objective answer for why unused OR time increased, something which the hospital is most likely monitored for by higher HQ. You would think that would make the CO very sensitive to anything (such as UAs) which decreased OR utilization.

 

[Homunculus]

wow.

the worst i've experienced was at my MEDDAC stint where the UA was "show up between 0800 and 1300" and they'd start calling me at 1030 telling me i'm the only one left and to go do it. which i then tell them i'm in clinic and will get there before the previously set end time. premature shaming is one of the army's fortés. like when you get notified multiple times to get some training done when the deadline is still 2 days away.

anyway, this is nuts. you did the right thing in having the patient complain, but i agree that documentation is the key. as soon as you cancel someone important it will make a difference.

--your friendly neighborhood wait til they start cathing us caveman

 

[HighPriest]

My god, that place is screwed up. I'm sure it's someone's fitrep bullet though: "Most aggressive and comprehensive urinalysis program of any command, guaranteeing patient safety."

I've been random UA'd about four times in the last five years, plus a couple more command sweeps and PCS-check-ins. What a waste of money and time.

In the Navy / USMC, at least at the last 3 commands I've been at, UAs don't involve lockdowns or 3 AM calls. Round about 6 AM the list is emailed out so departing night shift people can do it before going home. Then it's open until about 10 AM or noon for you to show up whenever is convenient. If you're busy doing clinical work, the UA office stays open. If you're on leave, TAD, or previously approved special lib, you're exempt. Doctors go head of line. It's painless and really doesn't get in the way of patient care.

That is essentially how it was at my last station. It made sense.

 

[i want out]

I've always joked about keeping copies of toilet paper to prove your bowel is functioning, I didn't realize it had all gone digital!

 

[orbitsurgMD]

If this is a command policy, it is excessive enough to constitute waste and abuse. As a U.S. taxpayer, I object to it and to having to pay for it.

 

[vamedrnr]

I am a former company commander, Infantry, so in theory my/our policies should have been more restrictive since we always operate on the premise that everyone is simply a living piece of Army equipment. UA get people all fired up because they think that any influence whatsoever on the completely random nature of them is completely off-limits and that they themselves will get in trouble if they interfere. That said, a couple of points for everyone to chew on for future use in this situation:

1) almost for sure this means that they are working with CID to nail someone for drug abuse. As a commander you cannot give an individual or the unit a drug test without probable cause, nor can you just randomly schedule a drug test when you just think someone is coming to work high. So you have to establish a pattern within your command of frequent drug tests so that it doesn't look as if the UA was used to target a specific individual. So, my guess is either your command is trying to nail someone specific or they are paranoid that they will be the next clinic to show up in the Army times as having an issue securing controlled substances and thus COs career is over. That part is not the issue in my opinion, the next part is...

2) Just because you are doing "mandatory" training event X does not mean that every part of the event is completely standard for each person. If we were going to the range and I knew at 1700 the night before that there would be a UA the next morning and that my ammo NCO had to be at the depot in line at 0530 or we would lose a critical 4 hrs of training time, you bet your ass that I got with the HHC 1SG and then the UA to ensure he was there at 0445 to get my guy tested. I then told my ammo guy that I needed him to meet me there at 0445 to get some extra equipment to take to the range and he then takes the test. I haven't in any way infringed upon the randomness or validity of the test but still took care of my guy and our missing. The point is that some people/missions are more important than others. If the UA NCO has to come in at 0430 so you can do a surgery on time, thats his damn job.

3) Your command sucks. I get that they might need to do the tests that often for a variety of reasons that you may not know. But the ENTIRE PURPOSE of command is to equally balance taking care of your guys and accomplishing the mission. When you are a med command, its really easy as your men (doctors) ARE the mission (provide healthcare). I apologize if you already did this and I missed it, but go to IG. If that doesn't work, I promise that your hospital/post commander both have anonymous programs to file complaints. Use that. Trust me. Explain at each point that you have no problem taking the tests, nor are you trying to shirk your responsibilities as a Soldier, but that the command's failure to properly plan and utilize its resources is resulting in significant waste (fraud, waste, and abuse will get attention every time right now) and possibly patient safety.

-all of the advice above is great if your command was competent. But they clearly aren't. You need to blow this crap up so that higher can see the absurd effects of their poor leadership. Many times I personally arrived at 0330, 0430 etc to ensure things were right for my ammo/range/whatever key NCO for training that was not even that critical. For these guys to let a surgery get cancelled and not take care of the equipment most critical to their mission (physicians) is just damn nuts and even though I am out now, nothing pisses me off as much as selfish, short sighted leadership. If I were in your shoes, I would go to IG tomorrow morning first thing -a complaint with waste and possibly patient safety will almost certainly hit the CGs desk within 24 hrs and your commander will have hell to pay for basic incompetence.

 

[colbgw02]

When you are a med command, its really easy as your men (doctors) ARE the mission (provide healthcare).

For these guys to let a surgery get cancelled and not take care of the equipment most critical to their mission (physicians) is just damn nuts and even though I am out now, nothing pisses me off as much as selfish, short sighted leadership.

Nice post, vamedrnr. I think the above comments really highlight a fundamental issue with military medicine. To wit, our leaders don't recognize that the delivery of healthcare is our mission. The severity of this mismatch varies based on location and the CO, but it's systemic and pervasive. I realize that it's not our only mission, but when two goals conflict, the physician will (should?) always side with providing the right care for the patient. That doesn't mean UAs or military training should be ignored - just that it must bow to patient care when the two are at odds. Leadership talks out of both sides of its mouth. On one hand, it likes to talk about the touchy-feely side of patient care, but its actions repeatedly demonstrate that's not the actual priority.

 

[denali]

1) almost for sure this means that they are working with CID to nail someone for drug abuse. As a commander you cannot give an individual or the unit a drug test without probable cause, nor can you just randomly schedule a drug test when you just think someone is coming to work high. So you have to establish a pattern within your command of frequent drug tests so that it doesn't look as if the UA was used to target a specific individual. So, my guess is either your command is trying to nail someone specific or they are paranoid that they will be the next clinic to show up in the Army times as having an issue securing controlled substances and thus COs career is over.

Yeah, the level of over-the-top craziness (hospital CO personally looking for the OP in the OR?!) and gross deviation from what seems to be otherwise standard practice for UAs in most MTFs makes me think some sort of investigation or significant external emphasis is involved. It could very well be incompetent leadership, but even incompetent hospital COs have self-preservation and political instincts that helped them to attain the position they did. The recent events at Womack and the jump-through-hoops data call that followed reminded every commander of the career consequences of a bad outcome with allegations of inadequately prioritizing patient care/safety.

Regardless, the OP is in a bad situation (BTW, has the DCCS weighed in on this?), and needs to make sure his ass is covered while doing the right thing for patients. The personal paper trail I advised is necessary, in my mind, for three main reasons: 1) document the situation to protect the OP for the specific episodes, 2) document a potential pattern of command behavior should future episodes with similar or more dire implications occur, and 3) provide documentation for investigative relief from the IG, higher command, specialty consultant, TJC, NY Times, etc. should the OP decide to go that way. Just the act of documenting and letting the right people know about the MFRs may make a difference; most administrators, and especially nurses, understand the potential ramifications of a paper trail.

 

[vamedrnr]

sadly this is one of the main reasons why I want to come back after I graduate... I know the system and feel like I can help both other Soldiers and providers. I admit that it may just be that I am a glutton for punishment.

 

[colbgw02]

sadly this is one of the main reasons why I want to come back after I graduate... I know the system and feel like I can help both other Soldiers and providers. I admit that it may just be that I am a glutton for punishment.

An admirable goal, but unfortunately, likely a futile one.

The system is set up to reward and promote activities and qualities that are, at best, neutral and, at worst, damaging to patient care. So, in order to reach a position of sufficient authority to effect change, one must set aside many of the reasons that one went into medicine in the first place. Very few people who undergo the length and rigor of medical training are willing to make that trade. And for the few who do, not many have the wherewithal to maintain the perspective of a practicing physician. That is, they buy into the non-medical stuff that the Army is selling, thereby reinforcing the system.

If you can do both, then more power to you.

 

[jabreal00]

It's definitely command driven. I did training at Walter Reed (before the merge) and they were very reasonable. The three years I was there I think I had 2-3 UAs. There was a time range from 0630-1500hrs. Often times if one was in a case it was excused. As a staff at a MEDDAC (part of hoah real army base) they were a bit stricter. 0630hr everyone had to be there after a call the evening before or zero dark thirty morning of. We could leave after doing the deed. I got tagged three time in the two years I was there.

It sounds like there is a diversion or ongoing problem that the command is trying to squash. This is the only thing that makes sense.

 

[BigNavyPedsGuy]

Oh c'mon, it's not nearly as terrible as you make it sound. Our practice is a balance between our officer responsibilities and our physician responsibilities. As you move up the officer food chain, it requires a reduction in your physician responsibilities. As you say, most physicians prefer to stay clinical, which is why we have abandoned executive medicine in droves. Unfortunately, this necessarily results in non-physicians becoming our commanders (because someone has to be in charge).

I have worked for several truly excellent commanders (physicians and non-physicians) who really "got it" when it comes to patient care and the demands placed on physicians. Those commanders support our mission, and ensure that the care provided in their institutions is up to their standards.

There is a lot of really great medicine being practiced in the military, and there are a lot of really great commanders. The existence of lower-quality commanders is not an indictment on the whole system.

I would say that you've been lucky to have good commanders. One terrible CO with an emphasis placed on hoo-rah BS rather than patient care and you'd likely be singing a different tune.

 

[Chonal Atresia]

Oh c'mon, it's not nearly as terrible as you make it sound. Our practice is a balance between our officer responsibilities and our physician responsibilities. As you move up the officer food chain, it requires a reduction in your physician responsibilities. As you say, most physicians prefer to stay clinical, which is why we have abandoned executive medicine in droves. Unfortunately, this necessarily results in non-physicians becoming our commanders (because someone has to be in charge).

I have worked for several truly excellent commanders (physicians and non-physicians) who really "got it" when it comes to patient care and the demands placed on physicians. Those commanders support our mission, and ensure that the care provided in their institutions is up to their standards.

There is a lot of really great medicine being practiced in the military, and there are a lot of really great commanders. The existence of lower-quality commanders is not an indictment on the whole system.

While I agree that there is good medicine being practiced in the military, it is in spite of current MEDCOM priorities rather than because of them. Emphasis on military "professional" education, rotating hospital commanders every 2 years and the continued ban on funded CME certainly does not promote high-quality clinical care. Please tell me how 9 weeks of CCC helps improve patient care? Running hospitals and a large medical system is not like making a line unit function efficiently and shouldn't be treated as such. Add a nurse being put in charge of physicians just to kick you in the b...s, and is there any wonder that there is so much dysfunction? How many nurse CEOs of major hospitals are there out in civilian medicine?

 

[pgg]

Good COs are out there. I guess I've had more than my share. My last CO was a nurse and was possibly my best so far, unless I count the Marine LtCol (now a general) who was my CO during my GMO days.

 

[Perrotfish]

How many nurse CEOs of major hospitals are there out in civilian medicine?

You're making it sound like the civilian standard of care is a physician CEO whose only priority is the wellbeing of the hospital's patients. In the civilian world a normal CEO is an MBA/MHA who has never stepped foot into clinic and has less than an average biology major's knowledge of medicine, and whose main priority is the bottom line.

 

[notdeadyet]

I am always puzzled by the notion that a physician should be running a hospital. The head of GM didn't work on the floor. The head of Coca-Cola was never a bottler. Medicine is one of the only fields in which there is the idea that you somehow gain knowledge about how to run a business surely through sticking around long enough.

Civilian hospitals are just better run than what I've seen of military ones. The reservations I would have about a nurse running the hospital is the same I would have about a physician running the hospital. Large complex organizations need to be managed by people with extensive training in managing large complex organizations. Night classes and online learning don't cut it.




Sent from my iPhone using Tapatalk

 

[Chonal Atresia]

You're making it sound like the civilian standard of care is a physician CEO whose only priority is the wellbeing of the hospital's patients. In the civilian world a normal CEO is an MBA/MHA who has never stepped foot into clinic and has less than an average biology major's knowledge of medicine, and whose main priority is the bottom line.

I didn't say that physicians dominate CEO positions in the civilian world - they obviously do not as you pointed out. I only asked the rhetorical question of how many nurses run hospitals in civilian medicine? The answer is none. Only in the screwed up MEDCOM will you find this. Not even any of the other sister services have sunk to this level.

BTW, I have no problem with MBAs running hospitals. I am now part of a 30+ multi-specialty surgical clinic. Our CEO is a non-physician Harvard business grad. If you enjoy having a nurse making decisions that can seriously affect your future career (see brigade surgeon initiative - the brainchild of Horoho), more power to you.

 

[Perrotfish]

I didn't say that physicians dominate CEO positions in the civilian world - they obviously do not as you pointed out. I only asked the rhetorical question of how many nurses run hospitals in civilian medicine? The answer is none. Only in the screwed up MEDCOM will you find this. Not even any of the other sister services have sunk to this level.

BTW, I have no problem with MBAs running hospitals. I am now part of a 30+ multi-specialty surgical clinic. Our CEO is a non-physician Harvard business grad. If you enjoy having a nurse making decisions that can seriously affect your future career (see brigade surgeon initiative - the brainchild of Horoho), more power to you.

I guess my question is, is a nurse particularly bad for some reason? Or is a physician just as bad? Do you always want the MBA in charge? Do you think the military would be a better place if we put the MSC exclusively in charge of hospital administration and never promoted a physician higher than department head?

 

[HighPriest]

I think there's something to be said for the differences between the civilian and military sectors as well, in relation to leadership positions. I think that a lot of military docs feel like while a physician may be a very rare or even an impractical choice to run a civilian hospital, things have a chance to be different on the military end. Theoretically (very theoretically), we have a chance to make decisions rooted in patient care first, rather than hospital profit. Most of us (from my experience) feel that another physician has the most insight into what needs to happen to achieve that goal, because of our experiences running clinics and ORs. So far I have had very bad experiences with nurse commanders, and better experiences with physician commanders, and I feel that it was because of their perspectives and their priorities.

We are very quick to defend military medicine's shortcomings by saying that it is different than the civilian sector, but yet we never seem to hold it accountable for its mistakes for that very same reason.

Military medicine is not well run, from a fiscal perspective, a professional perspective, or an organizational perspective. That is, in my opinion, not an argument but a fact. That's why hospitals are nearly all in the red, with massive attrition rates, poor patient satisfaction, intense scrutiny from the public eye, and worse outcomes on average. Of course there are shining exceptions to the norm - there always are. But as averages are what they are, for every great commander at a great station, there are two terrible bizarro versions out there.

Yes, some of that is the nature of the system and it's limitations. But I know I had expected more from a patient care perspective, and thus far my expectations have greatly exceeded the reality.

 

[HighPriest]

I guess my question is, is a nurse particularly bad for some reason? Or is a physician just as bad? Do you always want the MBA in charge? Do you think the military would be a better place if we put the MSC exclusively in charge of hospital administration and never promoted a physician higher than department head?

There will always be qualified and under-qualified people in any pool. If the MSC has an MBA or a degree in hospital administration, and is held accountable for his failings as well as his successes, I would be ok with that. Presumably, that choice would be made to place a focus on fiscal responsibility, and I am ok with that. A closed hospital is not good for patient care.
I would hope (and my experience has been) that a physician commander is concentrated on patient care. I have had decent experiences with that as well.
My experience with nurse commanders thus far (only two) is that they are primarily interested in checking boxes (of the line-unit kind), meeting regs, designing new and increasingly arbitrary forms of training and additional paperwork, none of which seems to benefit patient care OR a bottom line. It's work for the sake of an OER, and neither of them really understood why their providers might be strapped for time or under pressure. A nurse can have her patients covered and take care of incidental work, most physicians cannot. Somehow that fact always gets lost.

 

[notdeadyet]

Well put, HighPreist


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[Gastrapathy]

Nurses are taught to grossly underestimate doctors (after all, they are the only ones who really care, etc). Nurses in charge treat doctors poorly.


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