Saw this post on Reddit.
Confessions of a Cedars Sinai Anesthesiologist: behind the sterile curtain
As an anesthesiologist, we are commonly faced with a complex balancing act of managing multi-faceted patients, personalities and ever changing dynamics both in and outside the operating room. We face inquisitions from patients and surgeons alike to our clinical prowess and validity, often dismissed and blamed for all the ongoings in the ingrained hospital culture and structure. However nothing compares to the pressure and morale crusher as ineffective and domineering leadership from a hospital system. This you will find to some degree in any hospital, and we navigate it well providing both safety and comfort to our patients in the face of growing pressure by hospitals to do more with less, but little compares to the power hungry control-obsessed leaders at Cedars SinaiFor those inside and outside the medical field, it is easily dismissed as privileged over paid physicians lamenting over small problems; unfortunately it is a major factor in why physician suicide and depression are disproportionately high among those in our field; it is the fear of transparency, retaliation against our licensure, lack of autonomy, etc for why so many go with untreated mental health or burnout symptoms all for the sake of the healthcare machine. No machine is bigger than the juggernaut iron fist known to many as Cedars Sinai.
This money hungry, VIP catering institution would run over any employee in the pursuit of a loose dollar on the floor while clapping for the “healthcare hero”. This became ever apparent in the management of the Anesthesiology department at Cedars Sinai when they decided to renegotiate the contract of their 100+ anesthesiologists much to chagrin of all employed. This supposed academic institution which prides itself on the label is anything but an academic institution, it depends heavily on residents and fellows to operate, but does little to support actual academic integration with its faculty. It makes it difficult for faculty to have dedicated time to lecture residents, it is not staffed well enough to provide relief for its residents or faculty, and it expects all to continue to work well past end of shift to finish the litany of cases it is too poorly staffed to cope with. Meanwhile Cedars decided to cut its nose off despite its face and pursue gouging its employees of their prior benefits including CME time (They offer but almost never approve), academic development, vacation, professorship opportunities, promised bonuses (rescinded) and a 401k that doesn't even match their employed admins. In gutting these benefits a reasonable employer would host a meeting to discuss the proposed changes then attempt to justify the means to the end. But when you work for a heavily fortified castle, with its army of lawyers standing at the ready atop its concrete walls, they feel untouchable and unaccountable to those who work with and for them and dictate the terms and the resolution far in advance of any discussion.
A quick bit of history is in order: the anesthesiology department requested a meeting with their leadership (ahead of proposed changes) which comprises the interim chair of anesthesiology (actually held by a surgeon which is very irregular), two vice chairs (non practicing and ill equipped anesthesiologists for leadership), an ever powerful head of HR (Making clinical power plays and decisions with no clinical/medical background) and a growing list of admins for the department. "Leadership" received a barrage of requests to have a department meeting which they rebuked and instead of hosting a Q&A early on, discontentment grew and the department grew even more vocal. In the face of this the department finally relented. This is hyperbole of course, because juggernauts are going to juggernaut. They not only rebuked the growing discontentment in the department, but they then proposed a very small sign on bonus to the new contract (a very small percentage of the bonus they had used to recruit employees in the previous contract and did not uphold) which had a deadline two weeks ahead of any meeting they were willing to schedule. Nothing speaks transparency like demanding you sign a contract before a willingness to host a department meeting. Instead they enforced individual meetings with all while pushing back on those needing meetings to discuss the proposed changes to their compensation and then further pitted subdivisions against each other (cardiac, regional, pain, liver, OB, peds, general). They know the quickest way to achieve their dominance is to break the spirit of those who work for them, an onslaught of divide and conquer.
Lawyers at the ready, cedars views any open discussion as collective bargaining. An institution that grips power like a dictatorship and refuses to listen to any demands of its nurses or physicians while expecting the employee to soldier on with a smile on their face. So why dont people ban together and take on this behemoth of a monster? Fear. Fear of reprisal, fear of judgement, fear of loss of reputation, loss of employment, cost of the fight, fear of retaliation with assignments or call. You may say "That sounds toxic just leave"... and many have or are in the process. This has only added to the shortfall of staffing. Meanwhile "leadership" forges ahead claiming they are heavily recruiting (not true) but it is at a rate dwarfed by its attrition. Simultaneously “leadership” laments over their difficulty recruiting because of the culture they themselves manifest and then project blame onto the very same department they engineered the culture for. A culture that becomes increasingly incentivized to be self serving despite being comprised of great people with amazing skills who work very well together. In time even the strongest camels cannot carry more straw. After all the warnings from their employees and begging for solutions Cedars leadership finally relented and decided to open discussion to the many line items. Alas, the joke remains on the employed because the dictatorship is steadfast in its deliberate neglect.
Leaderships last weapon of pleasure is the built in fear to solicit a dormant obedient employee, while pretending it is benevolent, supportive and patient centric. Thus the anesthesiologist shrinks quietly back behind the curtain, taking care of the safety and comfort of their patients as the pressure under the boot of their oppressor mounts. Meanwhile, their colleagues in arms stand idly by equally fearful, providing support just short of helpful action, and the system slowly spirals toward failure; another feat they undoubtedly will cast blame on the anesthesiologist who is too powerless or too fearful to effect change for themselves or patient care. The beast then forges ahead, scattering the remains of its employees so it can raise banners of success across the city, and the soldiers soldier on, hoping for a glimmer of hope and change or at least, a changing of the guard.
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