By Rick Schrenker

Once again, there is gnashing of teeth over HTM programs closing. It is nothing new. And, once again, the same solution is trotted out: We have to raise awareness among high school and college students. In “Economics 101” terms, this amounts to creating additional supply. Indeed, I do hear that it takes time to fill positions. But is inadequate supply of skilled staff the full story? What about the nature of demand?

Rick Schrenker

From 1981-1985, I taught the BMET program at Howard Community College in Columbia, Md. The first year, I taught the weekly lab session; the three thereafter, I taught twice-weekly lectures. That meant the students were in class three evenings a week, and they had day classes as well. Clearly they were motivated. The class size was typically nine to 12 students.

I don’t know what student aspirations are now, but back then Howard marketed the program by saying the field was poised for growth. In particular, it marketed the idea that hospitals were just starting programs and would have openings at the supervisory level for people to create in-house programs.

By the time I started teaching, I already knew alumni who had indeed started up programs in the region. And some of my students lamented that those who had come before them were already blocking their opportunities to advance. Indeed, one of my old Maryland colleagues who had started the program in a county hospital just retired from the same position he created over three decades ago.

I’ve never been interested in running a department, but plenty of my colleagues have had that as their goal. And while I don’t follow trends nationally, I do know a little bit about what goes on in Massachusetts and Maryland from grapevine connections. I still get the sense that opportunities are few and far between. Every so often, someone in 24×7 laments our inability to get a spot in the C-suite, and prods readers to push for that. But why does that nut rarely, if ever, get cracked? What does it imply about the perception of the field by those who determine where to throw their salary budgets—i.e., create demand?

I remember sitting in an AAMI plenary session around 1990. Two or three of clinical engineering’s thought leaders were up on stage with one or two hospital administrators. One of the administrators noted needing help with understanding IT, particularly because of the big numbers on the budgets they were starting to see. The CE leaders pointed them to their IT staff—essentially saying, “That’s not what we do.” That was partly the right answer, but a hospital administrator had just given them a door to walk through, and the CE leaders replied, “Not my job.”

I walked out of that session dumbfounded. I asked two former colleagues who attended the session with me: “Did we really ignore a request for help with complex, medical-related technology? Did we really not hear it for what it was?”

Perhaps the most frustrating arguments I’ve found myself in over the years have been over the question of professional scope. The above is the most discussed aspect thereof—aka: “What is CE’s role in health care IT?” But consider the National Academy of Engineering/Institute of Medicine report from 2005 titled, “Building a Better Delivery System—A New Engineering/Health Care Partnership.” Not once does it mention clinical engineering. The focus was on applications of systems engineering, an area where I saw opportunities well before 2005.

I worked that angle for years, jumping outside the box to become active in the International Council on Systems Engineering (INCOSE) and some of its health care-related efforts. I encouraged folks from AAMI and INCOSE to work together, and wrote and presented on systems engineering. As far as I can tell, only a few CEs have jumped out of their comfort zones and into that new box. Imagine the demand that an expansion of scope could offer! And I really get animated when pushback on ideas like this includes diluting the value clinical engineering adds.

Years ago, others hammered me for reporting how my colleagues and I established an in-house PC service program. But that work exposed me to device-connectivity issues that ultimately led to my later work on medical device interoperability—which, in turn, led me to systems engineering. And that’s only my walk along the road less traveled; there must be others.

Should people interested in pursuing such efforts have to leave the field? Health care knows it’s stuck in quicksand of its own making and needs problem-solving skills unlike the ones that got them stuck in the first place. If that’s not an enormous opportunity for the analytically minded, I don’t know what is.

Why clinical engineering chooses to blind itself to opportunities like these is beyond me. Instead, after all these years, nothing draws a CE/BMET crowd like a George Mills presentation on the latest Joint Commission nuances. That’s not a knock on George, but just an observation about the field at large that makes my head want to explode, year after year.

I could discuss codependency issues between CE and hospital administration or Einstein’s definition of insanity. But I no longer get the same rush out of being a curmudgeon. It’s like criticizing politicians: At this point, why bother?

Rick Schrenker is a systems engineering manager for Massachusetts General Hospital and senior biomedical engineer for the MGH MD PnP Program. For more information, contact chief editor Keri Forsythe-Stephens at