At the Still Point of the Turning World
Residency is over, NOW what? (While I'm waiting for the answer, I'll get some spinning done....)

Saturday, August 16, 2003


It's a difficult year to be Chief. The economic downturn has caught up with the county hospital system, removing historical sources of financial support for our hospital and revealing a projected $20 million in debt over the next two years. As a result, we've had to merge clinic spaces, reduce specialty services, and lay off some beloved members of the hospital staff. Political tensions, always present but brought to a boil by economic stressors, have resulted in the departure of two well-liked attending physicians and severely limited the teaching role of a third. Furthermore, the cafeteria--which was never gourmet but could always be relied upon to provide comfort food, with a splash of local Mexican flair--is now closed in the evenings and on weekends, a small inconvenience that has had an incalculable impact upon staff morale.

What's a Chief to do? Instead of facing a few minor administrative annoyances, I find myself struggling to address fundamental issues of survival: providing food for the residents, and helping to organize advocacy on behalf of the hospital. To further both of these crucial ends, I am pleased to introduce--

1. The Catering Corps: Staffed by two second-year residents and a third-year (yours truly), this team shares responsibility for stocking the call room fridge with Trader Joe's frozen entrees (mostly vegetarian, to appeal to the masses), soft drinks, bottled water, juice, yogurt, bread, milk and cereal. The residency provides us with a small stipend to fund the Corps, but it's up to us to be serious budget shoppers--you have to stretch a buck to feed 23 residents.

2. The Advocacy Committee: Staffed by two second-year residents who are organizing the rest of us to participate in political canvassing, letter-writing, phone banking etc. etc. on behalf of a half-cent tax initiative to benefit the county hospital. This initiative is Measure Q, and has the dubious distinction of sharing an election day with the California govenor's recall election. Those of us who spend most of our waking hours at the hospital think Measure Q is by far the more important issue on the ballot. In an interesting political wrinkle, we are not permitted to campaign actively for Q while on hospital grounds, because the hospital itself was partially built with electoral bond money, and therefore cannot be the site of further political campaigns. Therefore, the Advocacy Committee is reduced to being very sly, referring to Q as "The Measure that Dare Not Speak Its Name," or "The Measure Formerly Known as Q."

I am learning that it is vitally important for a Chief to delegate responsibility among the rest of the residents. This is a personal struggle for me, because I have a loud, obnoxious Inner Control Freak co-existing with the (comparatively) placid Outer Normal Self people see in me every day. In the first few weeks of my office, the ICF was completely in control, doing everything herself, which compelled the other residents to ask, "Is there anything we can do to help?" Then the ONS realized that the ICF was taking up all available knitting/spinning time with administrative scutwork, and resumed control. Every day is a battle between ICF and ONS, with much tongue-biting needed to maintain the balance. But even ICF must admit that the new delegation of responsibilities has been a boost for resident morale. Residents who take an active role in the stewardship of their residency see themselves as forces of change, not merely passive victims off these most grueling three years of their medical training.

In the next segment, the Chief's most important responsibilities: promoting education, and boosting morale. Stay tuned.