Growing Pains

I'm waiting for it to all fall apart.  I know it's going to happen some day.  

When I was an internal medicine resident, drifting through the many subspecialty departments, I was struck by how many were hopelessly mired in political intrigue, infighting and general dysfunction.  Even departments that seemed outwardly to be highly effective were often broiling just below the surface. When I got into rheumatology, I discovered that the group of mellow, type-B clinicians and researchers that I had learned to love, transformed during departmental meetings into rabid hair-pulling maniacs.  Well almost.  In fact, after masochistically joining said department we managed over the next five years to completely destroy it, with the  final result that I and several others left the hospital, the city, or even the province. Landing in a community hospital with a single other rheumatologist proved to be the salve.  Sure it was hectic and there were some serious problems with patient care, but the political side of things were a snap.  "I'm going away this weekend, can you take call?"

 "Okay"

Call schedule complete.

Looking around, however, I saw that not all was well in non-academia.  Many departments were involved in constant inter and intra-departmental battles, not unlike the ugliness of the university setting.

So now the big question.  Why does it all go wrong.  Our own department is now growing quickly and soon we will become at least partially academic. I need to know what the critical factors are that make all departments go wonky in the long term.  A diagnosis now may lead me to some preventative administration.  I have several theories:

Academia:  In academic hospitals there is a toxic mix of clinicians and researchers.  Clinicians gripe about carrying the load and researchers moan about pay inequity.  Researchers compete amongst themselves for status, and believe that clinicians should have none. 

Leadership selection: In a university setting department head selection is particularly warped.  It almost always falls to the most successful grant earner over time, whether or not he/she has any administrative talents or interpersonal skills.  In the community hospital the department head is often chosen by who loses the vote.  An unpaid job with no attached prestige does not have people scrambling for the post. In both settings, there is a built-in self-destruct mechanism.

Critical mass.  It is possible that shear numbers are the root cause.  Insignificant hassles amongst a few colleagues are multiplied many fold with new members, to a point where the system becomes a quagmire despite the best intentions of the individuals.

One bad apple.  With increased numbers comes the likelihood of admitting that one malignant character that kills off the whole department. I've seen it happen and it's odd because you would think that a solid group could fend off one or two poisonous persons. It isn't always so.

Our own department may well be a classic study.  I wonder whether I should apply for a grant.  We've increased our staff and will likely to continue to do so.  We have begun a hesitant dance with the local university and will become progressively more academic.  We are also looking to bring on a research oriented rheumatologist in the near future.  So far no implosion, but can it last.  Experience tells me otherwise.

Comments

[Annette]

Maybe you should submit this post to Grand Rounds. I am sure it would elicit a lot of comment that would be fascinating. It is being hosted by purepedantry which is jamesyoung"at"gmail.com. Just a thought.

[3+speckled]

That's nice of you to suggest. I have never really considered this in the past. My personal blogosphere has remained somewhat confined to date. I may just give it a try.