Valdez BravoFor 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engineering department?”), but from my own experience since entering the field in 1995, I think this is another outdated mismatch of skill sets and job requirements.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