On the treatment of the young: Part 2 of 2
If a trainee is fortunate enough to find a consultant's position, usually they will be ill-equipped to deal with the difficulties and hazards of starting a practice. Very little is taught in this regard during training. If you are fortunate enough to work in a group, salaried practice, most details may looked after for you. The reality is that most will go into some sort of "private", fee-for-service setting.
In many circumstances there is little systematic help provided by other consultant colleagues, or the institution, to help a new consultant set up a practice. Details abound, including how to hire and pay a secretary, setting up a structured office, taxation issues, billing, etc. You may get occasional curb-side advice, but there is very little investment in helping you set it all up.
Another situation that demonstrates the poor treatment of new consultants is the inequitable distribution of call. The "new guy" often gets more call days or more weekend call or more holiday call. What is the justification for this? If a group has taken on someone just to be another set of hands to lessen the workload, then the priorities of that group should be reviewed. I believe that call should be distributed equitably and fairly among all the consultants in a practice group, regardless of seniority or academic status.
Operating room time and cases should be distributed fairly among all the consultants in a practice group. The "new guy" may get less operating room time without any justification given other than they are more junior in the group. This is the pay-your-dues attitude that is pervasive and, in my opinion, not justified. Colleagues should help the individual fill his/her operating room time by sending them cases. This is providing a helping hand to the one that is starting out.
The distribution of cases is a more problematic discussion. If a surgeon was hired because of special expertise in a certain field, this expertise should be supported by sending appropriate cases. However, more experienced colleagues, especially the division head, should watch out for the less experienced. In cardiac surgery, for example, a reputation and career can be destroyed if someone has a high morbidity and mortality early on in practice. Therefore, "easier" cases can be sent to the new consultant, for them to gain experience. Furthermore, when more difficult cases are encountered, they should be assisted in the decision-making and the execution of these cases. This in no way should undermine their authority as the consultant on the case. Help should be provided as just that, help. They continue to be in charge of the case. The relationship between the senior and junior consultant should be one of mentor-student and not one of supervisor-subordinate. Assistance can be provided to a junior consultant, while giving respect for their earned position and title.
What may happen is that a junior consultant is given only the easy cases. This does not allow for professional growth. The other end of the spectrum is that the junior person is give all the undesirable cases. These may not be necessarily difficult, but may be undesirable for other reasons. Again, this is unfair. A potentially disastrous scenario occurs when the junior person get the most undesirable cases because they a the most difficult and complicated and no one else wants to do them. This is the most insensitive and callous behaviour on the part of senior colleagues.
Income should be distributed fairly. There is no justification that a junior consultant earn less simply because they are "junior". Again, this is a "pay your dues" attitude.
The arrogance and misplaced pride that some senior consultants have and direct towards the young consultant who can only be met with contempt and disdain. Is it a form of insecurity or jealousy on their part as they observe young new talent surpass them?
The young new consultant should be supported. They are an investment in the future of the "company". Help them establish their practice; be egalitarian; protect them from their inexperience; treat them with respect, as they have worked hard to achieve their position.
In many circumstances there is little systematic help provided by other consultant colleagues, or the institution, to help a new consultant set up a practice. Details abound, including how to hire and pay a secretary, setting up a structured office, taxation issues, billing, etc. You may get occasional curb-side advice, but there is very little investment in helping you set it all up.
Another situation that demonstrates the poor treatment of new consultants is the inequitable distribution of call. The "new guy" often gets more call days or more weekend call or more holiday call. What is the justification for this? If a group has taken on someone just to be another set of hands to lessen the workload, then the priorities of that group should be reviewed. I believe that call should be distributed equitably and fairly among all the consultants in a practice group, regardless of seniority or academic status.
Operating room time and cases should be distributed fairly among all the consultants in a practice group. The "new guy" may get less operating room time without any justification given other than they are more junior in the group. This is the pay-your-dues attitude that is pervasive and, in my opinion, not justified. Colleagues should help the individual fill his/her operating room time by sending them cases. This is providing a helping hand to the one that is starting out.
The distribution of cases is a more problematic discussion. If a surgeon was hired because of special expertise in a certain field, this expertise should be supported by sending appropriate cases. However, more experienced colleagues, especially the division head, should watch out for the less experienced. In cardiac surgery, for example, a reputation and career can be destroyed if someone has a high morbidity and mortality early on in practice. Therefore, "easier" cases can be sent to the new consultant, for them to gain experience. Furthermore, when more difficult cases are encountered, they should be assisted in the decision-making and the execution of these cases. This in no way should undermine their authority as the consultant on the case. Help should be provided as just that, help. They continue to be in charge of the case. The relationship between the senior and junior consultant should be one of mentor-student and not one of supervisor-subordinate. Assistance can be provided to a junior consultant, while giving respect for their earned position and title.
What may happen is that a junior consultant is given only the easy cases. This does not allow for professional growth. The other end of the spectrum is that the junior person is give all the undesirable cases. These may not be necessarily difficult, but may be undesirable for other reasons. Again, this is unfair. A potentially disastrous scenario occurs when the junior person get the most undesirable cases because they a the most difficult and complicated and no one else wants to do them. This is the most insensitive and callous behaviour on the part of senior colleagues.
Income should be distributed fairly. There is no justification that a junior consultant earn less simply because they are "junior". Again, this is a "pay your dues" attitude.
The arrogance and misplaced pride that some senior consultants have and direct towards the young consultant who can only be met with contempt and disdain. Is it a form of insecurity or jealousy on their part as they observe young new talent surpass them?
The young new consultant should be supported. They are an investment in the future of the "company". Help them establish their practice; be egalitarian; protect them from their inexperience; treat them with respect, as they have worked hard to achieve their position.
posted by Luis G. Quiñonez, M.D. at
9:30 PM
2 Comments:
I generally agree with your position here, junior members of any profession and/or job should be treated with respect and helped along early on.
They should not be abused as you describe, and not made to share an inequitable share of certain workloads (e.g., undesirable cases). Yet this has its limits.
Functionally, 'paying your dues' has at its very root the idea that junior members need more exposure relative to their lack of experience.
And like you say, this should be done in a measured way, and not simply by dumping undesirable cases on the junior consultant.
So in short, no one loses as a mentor or a student, but as you effectively point out, they do as ruler and subordinate (I believe using the term supervisor is inadequate, as supervision is key to any mentor/student relationship).
Yet as I inferred, I am hard-nosed enough to tendentially disagree with you as per the increased workload of a junior consultant relative to call.
My deeper critique lies with your analysis as too simplistic and too ideal.
In a sense, you naively reject any notion of social stratification, or the reality (in ALL cultures throughout history) that someone who has undergone or is undergoing a formative process (like a warrior, a shaman, or a surgeon) will necessarily be in a position to divest themselves of responsibilities associated with that process, usually and most often to someone who is new or newer at that same process than them.
Everyone has to 'pay their dues' in this sense, so there appears to be some necessity towards stratification relative to status (as defined by that cultural group).
So to dismiss what appears to be anthropological and sociological necessity, much less an ontological one, may not be analytically prudent. And I dare say, socially devastating as well.
Think about it, you did it as an intern, and it is clear that if you are expected to do it as a new or newer consultant in practice. As such, you have been deemed by tradition and history to be only so far along in a process. As such, your argument should really be more concerned with when one should be considered done their training, as opposed to a moral or emotional reaction (we will come to this later).
And this is not an argument that attempts to maintain the status quo (i.e., the abuses you describe), it is one that simply observes a quality of human existence that will not be taken on (rightly or wrongly) by a single person. Such things represent the conditions of possibility for one's life in a group, and those are bounds that no one can break, they simply are.
I am reminded here of Don Quixote, wishing to fight the wind, and thus not being able to grow and advance naturally.
In this sense too, your argument is immediately emotional and reactionary as well. You're just beating your chest as much as the arrogant senior surgeon with misplaced pride, making this an issue of power. Clearly, why else would you react with contempt and disdain? Such reactions are never useful when one is trying to change something for the better, especially when it involves a group.
And finally, you should never expect anything. You should be proud of what you've earned, but you should not think that this somehow merits you something. Everone is equal. Clearly this is what you think when wanting to see processes unfold in an egalitarian way.
Ouch!
:)
But like I said, I generally agree with your ideation on this issue.
So keep them coming, they're getting better!
:)
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