Medical office design matters

Fresh out of residency and having just turned 29 years old, I started my first job as a general pediatrician in Sioux Falls, South Dakota. One of the first official tasks of my new position involved picking out brand new office furniture for my private windowed office which was housed along the perimeter of the multi-specialty clinic I had joined. I went with a blond L-shaped desk and shelf unit and later framed my diplomas to match. I was given a set of pens with my name engraved on the wooden holder. And I was directly involved in the hiring process of my own clinic nurse.

Fast forward 15 years, and I am now a pediatric hospitalist at a tertiary care hospital. I have enjoyed this career path and have been at my current institution for nine years. I was a hospitalist in Phoenix for three years before starting my current job and had been a general pediatrician for three years before that.

So, I guess you could say that I am solidly mid-career. I am among five hospitalists in my group who have 10 or more years of experience. We enjoy the intellectual challenge and diversity of our job and take pride in our excellent clinical and teaching skills.

We do not, however, take pride in our current office situation. After inhabiting several group offices (each housing up to six providers) adjacent to the patient care units for many years, we have recently been relocated to the “east office.” This area is also home to employee health, utilization management and the hospital’s dog, Sven. Located on lower level 3, an elevator ride of at least seven floors and a short walk through the parking garage are required to travel from patient care to office space. These offices each house two physicians (so far). They are windowless, and many have water stains on the ceilings. The suspended flooring squeaks and creaks whenever someone walks down one of the narrow maze-like hallways. Being able to use these offices while on service requires conscious planning and careful thought to create a workflow that maximizes efficiency and availability.

I refuse to interview candidates for our residency program in the affectionately nicknamed “shed,” so I am always scrambling for a table at the hospital’s coffee bar or in the lobby during interview season. It is not uncommon to make several trips back and forth from “the annex” to the wards throughout the day. Some of us have become resigned to working on laptops from the shared sign out office in order to avoid the constant back and forth.

Although the logistical inconvenience is bothersome, the psychological consequence of being relegated to the “shed” is more damaging. It does not escape our notice as shed dwellers that the newly hired subspecialists (often former residents who have been trained, in large part, by us) are placed in private offices with sturdy furniture and windows. They are able to move between seeing patients and working in their offices without bringing their winter coats, phone chargers, and laptops.

Pediatric hospital medicine is not glamorous. We don’t cure the cancers or repair the malformed hearts that we often diagnosis. We may find the problems, but the solutions often lie in the hands of proceduralists or subspecialists. Far more often, we are adjusting bowel regimens, weaning oxygen or pleading with parents to feed their malnourished babies.

And that’s OK. We are not asking to be paid like surgeons or featured in the glossy publications sent out by the marketing department. But please grant us the dignity of a space in which to complete our discharge summaries and argue with insurance company directors while being close enough to respond to patient codes and resident questions.

Although there is something to be said for the proximity to Sven.

Lisa Sieczkowski is a pediatrician. 

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