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Sun Dec 30 13:50:17 GMT 2007

      Dr. Ursic,

   I started my career as a firefighter in 89 and at the time, in my area, we were involved in the process of integrating the fireservice into EMS. This was something the old school firefighters wanted nothing to do with. The response to the idea was they put forth the minimum effort when it came to medical care. It sounds like you face a similar issue. It has been a long count of years since I worked in the fire service, as I decided I like the medical aspect of life better, but I think the lessons are still valid. 

  Instead of carrots and sticks, it might be better to appeal to their pride. If they are old school surgeons they probably believe they are the masters of the universe. Obviously their knowledge, skill and dedication should be respected, but I am sure I am not the only one who notices the "my way or no way" of the older generations. Why not make the pride work for you? Urge them to show you what they can really do when they put their mind to it.

  That said, if I faced the same problem, I would hire a young guy (to say a less professionally established.) Unless it is me, they are probably more youthful than the people you describe working with. They are not set in their ways, may actually be interested in trauma. Not to the trauma surgeon level, but somebody who in their mind would like to do some good who has not become complacent and disillusioned. There has got to be somebody who would like the community hospital feel and would be interested in improving the abysmal care I have come to expect of trauma cases prior to being transferred to the ivory towers. As this young guy starts seeing positive results of his efforts, I would bet the others would react one of a few ways. 

  1. They would say good for him and carry on how they are. In wich case as they retire they can be replaced by the person you want. 

  2. They would want to show they are better than this new guy. (this would be the golden trophy) 

  3. They could complain to administration, which will probably not do anything. 

  4. They could quit and you could hire somebody else. But if they are happy with their practice and life, I very much doubt they would. 

  5. (always consider there is a possibility you didn't think of) 

  It sounds to me like your issue is going to have to be solved over years. The people you describe are not going to change overnight. 

  But truly, it seems very straight forward. You cannot fire or threaten people, you can not entice them with money. Which never works long term anyway. The only options is to change their perspective (impossible on established people in my opinion) or to add somebody. Maybe the idea that if you have to get somebody new it will cut into their patient load, and consequently their income because they are not fulfilling the role the hospital needs. In any business, if the employer or employee do not mutually benefit each other, trouble will not be far off.

  I know I make it sound simple. Hire somebody (with no regard to economic feasability or recruiting difficulty) who is interested in small town life and trauma, without working at a major trauma center. (interested, not specialized)

  A couple of other options, which are not more or less feasable that I can think of include:

  Asking an outside trauma specialist to take call for a meager amount, appealing to his good heart. 

  Partnering with a teaching facility for residents or creating your own residency. (I do not like this option because I have worked at a place where surgical residents who did not like or want trauma were forced to do this, and it is just like you describe with older ones, so all you would be trading was experience.) 

  As a last option, divide and conquer. Pick the weak link of them and work on him with all you can muster. Economically, position of power or authority, "helping those who really need it, isn't this why you got into medicine? " That kind of thing. If you can pursuade one, the others are more likely to follow suit. With much less stress on your part. Especially try to build comraderie. Maybe you could sell them with if they are in the trauma room when the patient gets there they have a greater role in decision making. (ie: usurping the ED docs authority, what surgeon doesnt like that?) 

  This sounds like a team building issue, not a medical one.

  Sincerely,
  Mike

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