Wisdom Teachers

Epi' newbie: Be sure job comes with resources

CEOs may not be aware of demands of changing field

William Schaffner

William Schaffner, MD
As a new generation of health care epidemiologists comes into the work force, these physicians may find that hospital administrators have a troubling lack of awareness about the resources required to run an infection prevention program in today's increasingly regulatory environment. Thus, in a lesson that applies to infection preventionists as well, the job interview must be in part a "negotiation" unless you want to be ceremoniously appointed the executive vice president of Unfunded Mandates.

"There is the old adage, 'you don't feed the fish after you've got them in the boat,'" says William Schaffner, MD, chairman of the department of preventive medicine at Vanderbilt University Medical Center in Nashville, TN. "The time of negotiation becomes the most critical event as you look forward to your life as a hospital epidemiologist. You have to be willing to say 'no,' because if you are [going to take the job regardless,] all power goes to the other side."

Sage advice from a seasoned professional, as Schaffner was sleuthing around as an EIS officer for the Centers for Disease Control and Prevention when many of today's epidemiologists were in short pants. He now occasionally mentors young infectious disease fellows heading out for their first health care epidemiology job, reiterating the aforementioned caution.

"The hospital administration may have a profound underappreciation of the amount of time that will be required to do a first-rate job as a hospital epidemiologist and chair of an infection control committee," he says.

The demands for data and compliance on all fronts make program resources a critical bargaining chip. "Administrators and these senior leaders may have a notion of what hospital epidemiology was like 10 or 15 years ago," Schaffner says. "Today, with the interest of a variety of regulatory agencies, the public and increasing requests — even demands — for data by units within your institution, you have to spend much more time gathering and displaying the data and educating people."

The great divide

Though those in infection prevention may feel this climate change is old news by now, there still is a persistent divide between job requirements and hospital program resources. "There is a large gap between demand and resources — there is no doubt," he says. Schaffner is getting reports back that administrators may present their prospective epidemiologist with job duties that read long on a list but vague in specifics. "Go into this very specifically and make sure that the expectations are stated explicitly, and that they confirm that the resources you are going to have — including your salary — are necessary to get the job done," he advises

Thus, in a sense, the hiring process becomes a point of education as well as negotiation, as candidates must emphasize that they need the tools to meet the job's current demands. That includes a top-flight team of infection preventionists.

"These are people who would supervise the IPs so you want to make sure that you have a sufficient number and that you can see to their professional development and evolution," Schaffner says. "You should immediately make it clear that you want someone who — if they are not certified — will become certified."

Another disturbing trend that has come up in some interviews is that administration may not see clinical work in the wards as part of the strict definition of a hospital epidemiologist, Schaffner notes. On the contrary, "it is absolutely essential that you be on the wards, seeing patients, consulting," he stresses. "That's where you can see what's happening, talk to the nurses and your colleagues in surgical and medical specialties. They see you out there as one of them."