On Vulnerability

When I interviewed for my last position in academic medicine I didn't expect to accept the position. I went because a colleague and mentor asked me to look at the job. He had gone to the Institution a few years before, and although he was in another department, the opportunity to work with him was a draw. During the interview process, I warmed to others in leadership. The Institution was in desperate need of my expertise and the Cancer Center pledged to support my research program.

In addition to the positives of the new position, there were potential negatives and risks. I was reluctant to re-establish my reputation with patients and referring providers in a new environment. I would have to prove myself with a new Department Chair whose expertise was outside of my field. This Institution had a history of high turnover within this division. The decision became more complicated when they decided to co-recruit my husband, who is also an academic physician. The offer we received now presented an opportunity for professional growth for us both. We negotiated, weighed our options, and ultimately accepted. For me, this meant becoming the director of a surgical service.

Upon my arrival, many pieces of my recruitment package were missing. Construction had not yet started for clinic space that was supposed to have been built before my arrival. Some of my colleagues and many of the support staff assigned to work with me had less commitment to quality patient care than I was comfortable with. I quickly understood why previous practices within the Institution had failed.

Many of the glaring deficiencies were related to my surgical practice. The operating room equipment that had been promised had not yet been ordered. No one had informed the OR staff that a new Division Director had been recruited and I was left to introduce myself without context. The "surgery scheduler" who was assigned to my service didn't actually speak to patients. She took pieces of paper written by the house staff and put the information into the computer. I tried to meet with her and set up a time for her to come by my office. She was a no-show at the first meeting; ignored the second meeting; and I ended up walking to her workspace to introduce myself. Looking back, I should have packed up and left after the first month. But we had left old jobs and sold and bought a home in a new city. I opted to make the most of this situation and got to work.

One of the biggest obstacles in front of me was the lack of OR staff dedicated to my service. Being part of a goal-oriented group dedicated to a task was one of the things that had attracted me to surgery in medical school. Teamwork remained a large part of why I enjoyed being a surgeon. But in my new Institution, a different circulator and scrub tech showed up for each case. In or out of my block time, there were few familiar faces. Because I'm a gynecologic oncologist, the staff that rotated with me was most often gynecology staff who had little familiarity with cancer surgery. Oncology specific equipment—the Bookwalter, hemoclips, Singley forceps—were unfamiliar. Waiting for instruments became routine. The pace of my OR and the complexity of the cases was unfamiliar to this staff. Frozen sections, bowel resections, bleeding often resulted in panic. Not having staff that returned from one day to another made developing rapport much less constructing a team seem impossible.

I spoke with the nurse in charge of my OR service line; then the nursing lead for the OR. I sat down with physicians who had influence within the operating room. I waited for someone to act on my request for dedicated staff, which I framed to them (and believed) to be a patient safety issue.

An OR technician began assisting regularly in my room. She liked working with me, and I was relieved to have found consistent and competent assistance. Within a few weeks, however, I started to understand why she was available for the...