Joseph R. Hageman, MD

I have a long history of being in middle management…almost 40 years in medicine. It was a conscious choice on my part, for the most part. Being in middle management in medicine is challenging and interesting. In certain parts of your job, you are in a leadership role, like being the head of inpatient pediatrics, the pediatric intensive care service, the apnea service, and having a lung injury research lab…the fun stuff. Then there is the administrative stuff, which was the only part of my job that I considered work. My favorite parts of my career are clinical care, teaching, research, and lastly, administrative responsibilities. Nowadays, I consider Quality improvement (QI) in the research category…although, I have to say, I am not the most popular person in the NICU (1). This is another middle management position. Why am I talking about middle management? Because recognition for your efforts is limited. Please don’t get me wrong, I have enjoyed everything and feel fulfilled in my career. I am enjoying my present role as well and have figured out ways to accomplish small steps in neonatal QI, help young trainees publish their first and early career papers, and help with clinical, educational and QI research projects. Being pleasantly persistent is a necessity in all of these efforts and I have received a “thank you” from my more senior colleagues and friends. You work in the background to help and continuously reevaluate your positive vs. negative balance in your professional life. For those of you who are in a middle management position, you know what am I referring to in this discussion. Work with yourself as the satisfaction balance is dynamic.

William Henry Wills was Charles Dickens’ subeditor for his journals, including Household Words and All the Year Round. Has anyone ever heard of him? He was in a middle management position. He was in charge while Dickens traveled, while he was writing some of his novels, while he went through domestic changes in his complicated life. Wills was very productive in his professional life as the “go to” editor where almost all submissions went to be reviewed. If the papers came to Dickens first, he forwarded them to Wills. He also published some articles, books and collections of poems and stories as the primary author or editor while he was Dickens’ sub-editor. We know how incredibly productive Charles Dickens was and what a brilliant author and editor he was during his professional life. From the brief biographies presented in Wikipedia, Spartacus Educational, William Henry Wills was a trusted, consistent, detail oriented, and thoughtful editor, author and friend of Dickens (2,3,4).

So, as you progress in your careers, think about how you enjoy spending your time, both professionally and personally. Sometimes you can make choices and sometimes, the choices are made for you, depending on what the needs of your group, section, department, hospital, university and community are. If you do get the chance to spend time doing things that help you and the organization and get a chance to work with a mentor, like Charles Dickens, and you are in “middle management,” it might be worth your while!

References:

1. Hageman JR. Quality improvement and safety in the Neonatal Intensive Care Unit. Accepted. http://www.aappublications.org/news/2017/05/10/Quality-Improvement-And-Safety-InThe-Neonatal-Intensive-Care-Unit-NeoReviews-5-10-17.
2. https://en.wikipedia.org/wiki/William_Henry_Wills_ (journalist)
3. https://spartacus-educational.com/PRwillsW.htm.
4. Lehmann, RC. Charles Dickens As Editor. London: Smith, Elder and Co. 1912. pp.i-xvi.