For decades, hospitals were run by physicians. Doctors who held top spots in the organization management structure spent much of their time on administration rather than on delivering patient care. The thinking was that physicians were the obvious choice to oversee hospital facilities and resources. Later, as costs spiraled out of control, the notion of managed care came along and healthcare systems attempted to better manage their resources. One of the shifts that occurred was a rise in the role of the healthcare administrator. Healthcare systems realized that in many cases, physicians did not possess the skill set needed to manage a medical system. Those with administrative degrees and backgrounds did—and they were cheaper.
I’ve thought about this change of paradigm when reflecting on the fact that so many hospital systems still employ clinical engineers to manage in-house maintenance departments. This may have been a logical choice in decades past (“Wouldn’t a clinical engineer be the obvious gold-standard choice for managing a clinical engineering department?”), but from my own experience since entering the field in 1995, I think this is another outdated mismatch of skill sets and job requirements.
Technical Experience First
Some of the best biomedical equipment managers I have seen (including managers of departments that span multihospital systems) do not have a clinical engineering degree. These are managers who came up from the bench. They are technicians who demonstrated technical competence at the front-line levels and who developed the hard and soft skills to move up the ladder.
These technician-managers know what it takes to effectively run a medical equipment management program. These leaders understand the day-to-day pressures of the job, and know the system and its stakeholders. They can relate to other technicians on more than a supervisory level. More importantly, they have a sort of “street cred” with their staff—particularly if the manager was known first as a good technician.
These leaders were allowed an opportunity to rise to management positions because their technical expertise and time in the field were valued by their organization. Although they didn’t possess an engineering degree, their hard and soft skills were factored in when it came time to fill clinical engineering management positions.
Other healthcare systems, however, require the manager or director to be an engineer—biomedical, clinical, or otherwise—in order to manage and lead an in-house clinical engineering department. These managers may have the degree requirements of a clinical engineer, but too often lack real experience in the field before they find themselves helming a department of biomedical technicians.
Fresh out of school with an engineering degree, they are thrust into the position of managing a medical equipment management program and a team of experienced biomedical equipment service professionals. Even seasoned engineers may be disconnected from the technicians they manage or from the real challenges faced by their subordinates in the field.
A selection policy that is largely contingent on diplomas rather than experience is one that runs the risk of placing directors in positions who have never really done the job themselves. Such managers may lack a bottom-up understanding of what the work entails, and may even hesitate to venture out of their office into the department because they cannot relate to the technicians.
When it comes to the day-to-day operations of an in-house hospital maintenance department, the emphasis on engineering is not as relevant as it once was. This was affirmed when the Association for the Advancement of Medical Instrumentation decided to change the name of the field to healthcare technology management (HTM).
That decision indicates that the inclusion of the word “engineering” is a bit of a misnomer in this era of in-house maintenance departments. Fewer and fewer personnel, in my experience, are making the types of modifications to hospital medical equipment that once took place. Physicians are no longer asking resident clinical engineers to modify or design devices for use on their patients.
In fact, between them, the Centers for Medicare and Medicaid Services and the US Food and Drug Administration prohibit alterations to most device maintenance schedules as well as to the design of equipment itself! A previous manager of mine, a clinical engineer, used to remark that he was lucky if he used his engineering expertise 5% of the time in managing the day-to-day operations of our clinical engineering department. If that is the case, why would an organization require engineering expertise to do the job?
A Clarification
Let me take a moment to clarify: I am not suggesting that years of experience should be a substitute for a clinical engineering degree. I am suggesting that a clinical engineering degree should not substitute for years of experience. I also dare say that a clinical engineering degree may not be the ideal or appropriate gold standard for the modern-day clinical engineering (or rather, HTM) department manager.
The role of clinical engineering manager has changed substantially over the past 2 decades that I have been in the field. Whereas an engineering degree once added great value to the position, I believe that the skill set that seasoned technicians possess also adds great value. Not all technicians possess the right skill sets to move up into a management or director position, just as not all engineers possess the right skill sets to be a manager or director. Selection of the right individual for the job is still always going to be key.
The argument I am making is that hospitals should not use an engineering requirement as a barrier to technicians who seek positions of greater responsibility. And I firmly believe that the best managers are those who have done the work, excelled at the job, and gained the additional skill sets required to take the ownership of their respective maintenance program to the next level.
Time for a Change
Clinical engineering departments that offer biomedical equipment technicians little opportunity for upward mobility or barriers to departmental management positions result in some of the most talented and creative people in their own systems finding themselves bumping their heads on a promotion ceiling, feeling stifled, and looking outside their own healthcare system for further upward mobility.
Perhaps it is time for healthcare systems that emphasize engineering degrees over experience to rethink their selection policies so that they do not miss out on a rich opportunity for leadership: the seasoned technician.
Valdez Bravo is a former biomedical engineering supervisor, current graduate student, and frequent contributor to 24×7. For more information, contact editorial director John Bethune at [email protected].
Yes, I agree with the author of this article whole-heartedly. I too tried on three occasions to apply for the directors position at a VA MED CEN, only to be told I am not qualified because I have no engineering degree. I am a Biomedical Tech with 28 years experience. I have managed maintenance shops of 22 techs down to only six techs. I have even developed a maintenance program for a client that had no maintenance program at all for their medical equipment. I have a BS in Business Management. Yet I could not get the position, and was even told by one HR I was highly qualified.
As a former CE who wrote about this topic years ago in a column for BIT and continue to argue with other CEs about it to this day, I basically agree with the author but believe he and the field in general continue to take a myopic view towards the need for engineering in healthcare. I most recently brought up the issue during the BIT Editorial Board’s meeting at the AAMI Annual Meeting this past July, where I spent a few minutes describing why I no longer choose to call myself a clinical engineer.
There is great need for the skills engineers can bring to health care that has been going largely unmet. A handful of organizations understand that and hire engineers to address the needs. But those organizations are few and far between.
I have described those needs and matching skills elsewhere and will not list them now. I have also said that engineers could choose to compete for clinical engineering leadership positions, including in maintenance management, should they choose to acquire the necessary leadership and management skills. After all, graduates of our nation’s service academies are placed in positions of leadership without climbing through the ranks from the ground level.
But then, our national defense services don’t train officers only to make front-line decisions. Their perspective is far broader in scope and focuses not just on the here and now but also downstream in time. The author alludes to the recent adoption of healthcare technology management as the name of our shared profession. I didn’t accept it then, and I don’t accept it now. Or at least I don’t accept it being applied to me. I know I’m not alone, but others can speak for themselves.
Speaking for me, I’d be perfectly happy to see clinical engineering understand, identify, and position itself as professionally distinct from medical technology maintenance. The fields intersect just as do facilities engineering and maintenance, but they diverge as well. If you accept that and are willing to consider that it is where they diverge that they each bring added value, then you can begin to appreciate they may need distinct management and functional structures.
From my perspective, healthcare desperately needs what both professions have to offer. But I will be 60 next month, and it’s up to younger others to identify and adopt a vision for the next three decades. I will end with this: Had the person interviewing me in early 1979 told me that the scope of clinical engineering was limited to maintenance, I would not have built a career here and would not be writing this now. Be honest about your vision, and reflect on it critically.
Did I fail to mention that the topic under discussion at the BIT Editorial Board meeting when I again raised my concern was the graying of the field?
I too believe that the author of this article is on point. I have 35 years in the field and came up through the ranks. I’ve served in multi-facility healthcare systems with multiple shops and over 25 technicians. I’ve developed CMMS systems that were used within facilities both in Clinical Engineering and Facilities departments. For one group I developed an Asset Recovery Management system, which managed redistribution of assets throughout a multi-facility system or managed the disposal of assets no longer required. I’ve managed multiple vendors that utilized our own system departments as their own service arm – at a benefit for the healthcare system. Yet, interestingly enough, when I decided to relocate to the SE US, was turned down for several opportunities due to simply not having a degree.
While I agree that an engineering degree is not required to effectively manage an HTM department, there are some things to consider in this discussion.
Too often HTM professionals stop their formal education at the Associates level. As we seek to escalate the profession and perhaps more importantly, the perception of the profession, four year and advanced degrees become desirable. While working with a community college to assess the curriculum, it was made clear to me that there simply aren’t enough hours available in a two year program to cover the broad range of knowledge required of today’s HTM professional.
Despite my belief that the skills taught in a traditional engineering program are not necessary as we do very little circuit design, we do need advanced analytical skills to perform some of the systems level trouble shooting and yes design, that some senior technicians and engineers perform.
It has also been my experience that promoting the most technically proficient HTM professional in a given department or organization has some potential negative consequences. Frequently the skills required of a leader: charisma, business acumen, leadership skills, and presentation skills, are not strong suits for the highly skilled technician. As a result when promoting such an individual several things may happen.
• Technical base of the department is diminished as the once productive technician is now focused on managerial duties.
• The highly motivated and skilled technician is now in an unfamiliar and perhaps uncomfortable role. His job satisfaction diminishes.
• The department suffers from a lack of strong leadership. The entire department suffers from diminished job satisfaction.
AAMI’s Future Forum III addressed this very discussion at length with “boisterous” discussion on both sides of the argument. Career paths were recommended and are being developed along with recommended educational tracks. While some organizations require an engineering degree, I believe that this is not the norm (VA being the exception).
As I work with my staff on career paths my recommendation is this: Pursue a related technical four year degree followed by an MBA. Like it or not, our industry is dollar driven. To successfully rise beyond department manager in the HTM department of the future, expect to posses both technical and business/leadership skills.
I can Say Right On! A good manager is the guy who does a great job moving the wood to the saw mill and keeping the blades sharp and spinning. The wood is the customer and their technological barriers to taking care of our patients. Biomeds are the teeth on the saw blade.
A manager who was once a tooth on the blade has a much better idea of what it takes to support biomeds well. Managing and supporting are two sides of the coin that buys a happy customer. Talent and experience and a track record of success with customers is the more important than a degree any day.
Imagine saying this: I am sorry John, Paul, George and Ringo, none of you have a degree from Berkeley, so we can’t hire your band for the Hospital Christmas party. Or, We’re sorry Mr Gates, but you’re a college drop out, we cant use your OS in our computers…
Degree inflation and the education industry are not doing anyone any favors except the college loan industry. IMHO we should all take a few steps back.
I myself was quite disappointed a few years back after having started and successfully run a CE dept for a 125 bed community hospital for almost a decade. I was told by the board, without some sort of degree I was not qualified to take the CCE exam. I knew after living and working the job for almost a decade, using the study guide and taking the review course, I could have passed the exam with flying colors. Why was it so important to have a degree to join the club?
I think we go to a full merit based system: if you can do it, prove it and pass the exam, then you get it…
What are your thoughts???
Uggh, I could only hope some of my previous managers, especially one in particular, would read this. We have BMET III, seniors, leads, etc, with MBA and CBET, CRES, and other certs (IT, Networking), devoting their life to this career field, but many managers I have encountered see this as trouble. They feel threatened by our ability to communicate with administration, understand business trends, and have ideas outside of just being the break-fix guy they are trying to keep locked in the shop.
I understand one may only have few years left until retirement, or maybe you’re in over your head because you choose not to go to school or rely on weak experience only to struggle with keeping pace with this ever changing world. Why can’t we work together to accomplish a common goal or at least solicit those with credentials listed above for ideas (go ahead and make them your own, it’s for all of our good anyway).
I know, I sound bitter here but lets face it, I read articles like this and realize it may only be wishful thinking or someone’s pursuit for a perfect world rather than reality. I would dedicate the rest of my career to an organization that was on board with ideas such as these, but I have yet to find anything but power hungry management that is biding their time until retirement. Maybe one day we can compile a list of employers who are looking to grow their technicians into leadership and build a stronger organization for others to model after. Wouldn’t that make a great article.
A clinical engineer or biomedical equipment technician must be able to demonstrate competency in the field. A degree is one way to do this. Since this is an technical field, a technical degree seems to be a preferred way. While managing the members of the department is a very large part of the HTM job, dealing with medical, nursing, and technical staff throughout the institution requires their confidence that you know your field. Experience may provide this for existing areas, but education, preferably technical, provides the background and confidence for a HTM to develop new programs. It also allows the HTM the confidence to trust his or her staff enough to acknowledge their superior competencies so that the depatrment can progress into new area.
Regards,
Tom O’Dea
I was a Navy BMET starting in 1980. I attended one school some of you would recognize as ‘The Short Course’. By 1985 I had become a CBET. Ironically I was working for a community college teaching a practicum in Clinical Engineering in the mid 1980’s when I decided I needed the AS degree. The same school paying me to teach claimed my experience was not credit worthy.
Through a program which is no longer is available, I used my military transcripts and CLEP tests to get an Associate’s Degree in 1992. I then became a department Director in 1993.
My formal education was very limited, but I continued to move through this career as a site manager or director. More recently I tried my hand at online classes and completed five upper level classes for a Certificate in Healthcare Management. If I could honestly say what I learned from that experience, it would be that most colleges believe you cannot learn outside of academia. I was warned that I should not be attempting these level of classes as my CLEP exam did not meet the English requirement. After my second class was completed with an A, the dean waived the requirement.
I completed the classes with a 4.0. I spent over six thousand dollars out of pocket.
I would feel much better about that if I could point to one new idea or concept presented in all that effort. Is formal education more valuable than experience? I think that if you were to look carefully at hospitals and third parties, the department manager and site managers are experienced techs without engineering degrees. It may be an economic factor which places these people in these positions, but degrees cost more.
If I had the chance to finish a degree, I would. If my choices at 17 had been more open, I would have taken college over boot camp. But based on my limited academic experience, I don’t believe the schools are teaching what technology managers need.
I have been in this field now for 40 years, starting out in the military where you had one wild card to use through the basic and the advanced course, and if you didn’t make it, you became a cook or a forward observer in the artillery. It taught me that if you are going to talk the talk, you better be able to walk the walk. I believe education is important in the development of all people. For some, it’s hands-on technical theory and training, and for others it’s principles of operations and theoretical applications.
In my career I had to climb the ranks, go to where opportunities presented themselves, and I worked diligently to grow through experience and application of skills. I used my GI Bill to help me attain a certain level of education and it has helped me to achieve where I have needed to be. I don’t have an MBA or an MSEE and my Phd (post hole digger) is in the tool shed. I commend the people that have committed themselves to furthering their education and I praise all the people that have worked in this field to maintain their technical proficiencies while taking care of equipment that sustains life or diagnoses illnesses.
I believe that personality, people skills, and experience are the critical tools for success in this field. Yes, we are healthcare professionals, but we are still maintenance personnel who are assigned to diagnose and fix the broken, and we have to be a jack-of-all-trades to doctors, nurses, and technologists to address their needs and assist them in the delivery of health care. We have to be confident, but humble, cooperative but rigidly compliant.
Some are born leaders and others develop to be leaders, but you have to have people skills and a commitment to succeed.
I believe that this has helped me throughout my career through all different levels of management, and if a potential employer desires formal education over seasoned experience, then they may not be totally addressing their real needs.
The second article mentioned that the extent of knowledge required of an HTM professional can’t be obtained in a 2 yr community college program. I would submit that knowledge resources aren’t limited to the college campuses. Requiring a degree is a closed minded view of sources of knowledge and abilities.
Mr. Bravo has touched on a subject that goes well beyond just Biomed Engineering but into every aspect of any profession. Doctors and nursing staff take years of training to earn their degree. The same can be said for the IT profession and certainly becoming Cisco or Microsoft credentialed are not often that easy since it does take an ability to understand the subject matter and pass the tests.
But let’s face the real reason behind all of the degrees and credentialing: if anyone applies for a job, how does the business know the person they are hiring really knows what they are doing? If a doctor applies for a position, that person must bring with them all of the documentation necessary to prove they know and understand what they say they do. No one wants a physician that failed anatomy doing surgery on them. Thus, there is a general movement in the larger world to have people become accredited, thus proving their knowledge base. (I believe there are commercials for motorcycle mechanic schools so you can become a certified motorcycle mechanic). It would be then natural to apply this reasoning to the Biomed field. Get a degree, prove you know something. Get an Engineering degree, you should know more.
On the other hand, I know of some very smart people who have degrees in various subjects that could answer any question on a test but have them to any real practical work, good luck. The other issue which has already been presented in comments is that often times a person’s starts out on one career path and often ends up in something totally different. Along the way they may take various classes or just end up learning the business on the fly and be very good at what they do. Does this mean they are incompetent because they do not have a degree? No not necessarily, it may just mean they never received any formal recognition for what they know.
In the end, I highly suspect that the Biomed field will succumb to the larger driver of employers requiring degrees and credentials because they have a piece of paper that states they passed a credentialed program. However, with any program, I hope it becomes more like a physician, in that you get your degree, then you have to put it into work in a controlled environment so you can actually see what you have learned being applied. Meanwhile, just like any other profession, there are fully qualified non-degreed people who are fully capable of performing more advanced work, and they should be allowed to flourish despite not having that official paper. Perhaps, there is still room in this profession for the school of hard knocks to be recognized more officially.