Week 1: Plastic Surgery Center of Hampton Roads

During my first week at the Plastic Surgery Center of Hampton Roads, I noticed many things about the leader-follower dynamics in the practice. Medical teams are typically centered around a hierarchy with the physicians at the top. In this practice, there are four plastic surgeons, all males. Because cosmetic plastic surgery is typically not covered by insurance, there is a lot of money involved in each case. In most cases, this creates a lot of competition between surgeons for patients, explaining why most plastic surgery practices consist of only one physician. However, in this practice, if a patient has no specific request for a doctor there is a rotation of which doctor is placed with that patient. This helps to minimize bias and competition between the doctors. In addition, the culture in the office is only slightly competitive, but mostly friendly. Each doctor holds equal power in the office. The physicians get along and joke with each other often. As far as the hierarchy between other medical personnel, a typical medical hierarchy exists. The surgeon is first in charge, followed by the anesthesiologist. Under that is the nurse assistant and scrub tech. While I have, in the past, been in operating rooms where the surgeon has a short temper, all of the surgeons in this practice are patient and friendly with their medical team. While the medical team set up the operating room for the surgeon, they are self directed. If a team member has questions or concerns, often the anesthesiologist will answer the questions. Once the surgeon enters the room, the medical team becomes directed by the surgeon. The medical staff, having worked with the surgeon many times are often able to predict which instrument the surgeon will need next or what assistance he will need. This requires the surgeon to trust his team and vice versa. In addition to trusting the team, the surgeon specifically has to trust the anesthesiologist to ensure that the patient is deep enough asleep that they will not feel the procedure being done. In this situation, the surgeon/leader is very influential over his team, because of the power of his status.