How to interview: medical social work edition

May 25, 2023 12:05 PM

I am in the process of interviewing for a job as a heart transplant social worker and am invited to a virtual "meet and greet" with the surgeons tomorrow. I've been advised that I should convey my understanding of the hospital hierarchy in those conversations and would appreciate any insight on that topic—or anything else that comes to mind!

My hospital experience thus far is limited to inpatient psych, where—though I was a part of the interdisciplinary treatment team that met with patients daily—I was clinically-focused and thus somewhat isolated from the medical concerns that many of our patients faced. I'm interested in any advice about medical social workers' place in the hospital hierarchy, how to interact with MDs of different "rank"/responsibility, or honestly anything else anyone might care to share. Especially interested in any transplant-related thoughts!

posted by pgoat to Work & Money (9 answers total)

This sounds like a really great question for r/medicine on reddit. I read it bc I read a lot of professional reddits (that I am not a part of) about which I'm curious. It has its issues (mostly about PAs and NPs), but it's very active and I think it would respond very positively to your question.
posted by atomicstone at 12:10 PM on May 25

I sent you a pm, I've got professional contacts.
posted by AlexiaSky at 12:52 PM on May 25

Answering from the perspective of an MD who just wrapped up an interdisciplinary transplant meeting Zoom. That seems like very strange advice to give unless it was a coded way of telling you to suck up to the surgeons... which... you probably should (if you want the job).

It's the 21st century and there has thankfully been a movement toward a much more flat hierarchy and more multidisciplinary work in medicine, but as an internist who works alongside surgeons, they still tend to be treated with much more deference by just about everyone in the hospital as compared to other physicians or other members of the health care team. If someone told you that it's important to show that you "understand the hierarchy" I can't imagine they meant anything besides that the surgeons want to be treated like they are at the top.
posted by telegraph at 12:56 PM on May 25 [18 favorites]

Just a thought from a residency dropout. Telegraph is 100% right, but there’s a flip side—without a MSW, no one gets discharged and LEAVES THE HOSPITAL. So you’ve got some power, too, believe me.
posted by 8603 at 1:43 PM on May 25 [1 favorite]

I should convey my understanding of the hospital hierarchy

I've been a nurse for 17 years, the last five of which I've spent sterile-elbow-to-sterile-elbow with surgeons in a big, urban Level I trauma center operating room. The only way I can interpret the advice you were given is that you should expect to defer to the surgeons in all ways and never fail to make them feel like the most important people in the room.

It's a huge red flag that the culture of the hospital is outdated at best and I would think twice about taking this job.
posted by jesourie at 2:38 PM on May 25 [8 favorites]

Having had six surgeries in the last six or so months, my experience has been that yes, the surgeons feel that they are the top of the heap. Because they can do things that other doctors cannot do as well. Interesting that one of my surgeons said that surgeons are not usually great doctors.

But they have vital skills. Skills that bring in the big bucks.

I am grateful for all of my surgeons, as they have saved my life on now a couple of occasions. But the nurses I've had, they have been the ones that do all the heavy lifting/nasty, boring work.
posted by Windopaene at 4:55 PM on May 25 [1 favorite]

Does the person who gave you this advice actually work for this hospital?
posted by lapis at 7:52 PM on May 25

To add to 8603's comment, "without a MSW, no one gets discharged and LEAVES THE HOSPITAL. So you’ve got some power, too, believe me," patients on a transplant list can also live or die by your evaluation of their appropriateness for the procedure.

I worked as a psychologist on a solid organ transplant team, and soooooo many patients get denied a transplant because of psychosocial issues that are uncovered by the social workers. In most cases the MDs on the transplant team were super grateful for this information because it increased the likelihood that an incredibly valuable resource (i.e., an available organ) would go to a suitable candidate who has the resources and abilities to adequately recover and care for their new organ (and improve their transplant center's favorable outcomes data, which usually leads to more money and cache for the center and hospital).

Happy to chat more via memail if I can be of service.
posted by massa intermedia at 9:42 AM on May 26

My info is a couple of decades out of date, but in case it still applies and could be helpful... I've had occasion to interview some cardiac surgeons for work. I was told that cardiac surgeons, and particularly the kind of cardiac surgeon who does transplants, can be such assets to a hospital that a wing might be built to lure the one you want to hire. I was also told that they're often at the tippy-top of the hospital hierarchy... EXCEPT for a top neurosurgeon, and that that almost-but-not-quite god status can foster a particularly haughty brand of egotism. One who I'd arranged to interview sat at the conference table pointedly holding that day's newspaper in front of his face while I tried to ask him questions. (A few questions in, he apparently realized I was more competent than he expected, and put the paper down. I was later told that was quite a coup.) So, I agree with others above who think that advice is likely telling you to be prepared to suck up to haughty surgeons.
posted by daisyace at 11:19 AM on May 26