Central Virginia is six COVID cases away from losing 80% of its hospital imaging capacity.
I wish I didn’t know this. I wish this weren’t true. I wish I were even exaggerating. But I’m not.
I am writing this to you in a modified form of confidence. I am married to a Field Service Engineer (FE) who works for a major healthcare corporation. Because this article will discuss things that are sensitive in nature, in order to protect my husband and his coworkers I won’t name the company. But I’m going to call it Big Meatball Corporation (BMC) so it’s obvious.
I want it to be obvious. Because that 80% could happen in as little as month. We BMC wives already know that, if it happens, there will be very little that can be done about it. The imaging capacity of much of a state’s healthcare system will, hospital by hospital, go dark and stay dark due to equipment failures until engineers from other parts of the country can be brought in. That process will take too long and will result in cascading failures among other states’ imaging capacity due to the illnesses that their engineers contract while traveling to help Virginia…or the illnesses they contract in their own states as they’re stretched to the breaking point covering their own hospitals’ issues.
What I want…why I bothered writing about this at all…is to expose this problem now so that we as a country have a hope of rectifying it someday. I already know that it’s too late to fix it right now. It can’t even be fixed in the short term. There is literally no amount of money that could do so. It couldn’t be fixed even with two straight years of physical, hands-on work performed by a magically doubled BMC workforce (which is already global and massive), even if those employees started today. We BMC wives know that, if even one COVID case happens among our husbands, it will be a matter of time until the hospitals’ imaging capacity goes dark and stays that way.
No x-rays or CT scans to diagnose COVID. No ultrasounds to guide their treatment. No MRIs to diagnose and save the lives of those who stroke or clot due to the disease. No cardiac catheter procedures to get their hearts beating again. Nothing.
I wish I could say this is just BMC’s problem, or that its competitors are faring much better. Believe me when I say, it’s not, and they’re not.
At the root of the 80% is a problem so enormous it took the entire United States generations to build it. That problem will not go away after COVID is dealt with, either for BMC or for its competitors. In fact, the problem is so bad that it will take just as many generations to fix as it did to create.
The problem is massive, complex, and not easy to explain. But I will do my best. Any infelicities or outright errors are mine and mine alone.
The problem is composed of three parts: corporate mismanagement, age, and generational disdain for skilled labor (AKA the “skills gap”).
That problem has literally left the maintenance and repair of the imaging capacity of 80% of Virginia’s hospitals on the shoulders of only six people.
Here are the numbers and the shape of the problem.
1) Corporate Mismanagement
My husband and his coworkers here in Virginia have in the past served as the manpower model for all of BMC’s imaging repair modalities across the United States. What that means is, BMC has traditionally broken its field engineer workforce into teams that handle a particular geographic area (e.g., most of the state of Virginia, with only the so-called “lost counties” at its western tip, the beaches at its east, and the NOVA area handled by other teams). Each team is further broken into modalities according to which machines each engineer is trained to repair (e.g., MRI/CT, vascular, cardiac catheter, x-ray/fluoroscopy, ultrasound, mammography, etc.). Most engineers are cross-trained to multiple modalities in order to cover for each other during service crunches, vacations, illnesses, etc. My husband, for example, has over the years been trained for x-ray, ultrasound, and bone densitometry, and is often under pressure to learn more. [Side note: There is also another entire division called Biomedics that is devoted solely to servicing the wheeled machines that everyone sees cluttering up hospital halls (like automatic blood pressure machines) and also, unfortunately, to ventilators. The Biomedics team has massive issues of its own, especially in this time of COVID, but I’m not married to a Biomedics field engineer and cannot speak with enough specificity on their issues to be useful to them. So I will stick with what I know.]
The engineers are dispatched from their homes by a sophisticated smart phone paging system that tells them which machine is down, how hard it’s down (e.g., working with limited capacity, completely dead, etc.), whether or not it’s covered by a service contract, what the “customer temperature” is, and how to contact the customer directly for more information about the unit. In addition to the smart phones, BMC pays for a laptop for each engineer as well as a minivan, gas, vehicle repairs, and insurance (though the taxes we families are forced to pay because of that benefit offsets quite a bit of BMC’s costs). BMC provides a fraction of the tools required for the job—the rest must be provided by the engineer himself, at tremendous cost. The parts to complete repairs are ordered online by the engineer and then shipped overnight from BMC’s manufacturers overseas (because, despite being an “American” company that receives millions of dollars in tax returns every year, BMC has offshored all of their parts manufacturing elsewhere. Even their headquarters are in China). Each engineer is expected to drive hundreds of miles just to get to the affected hospital, and gets almost no credit for time spent on the road; all management performance metrics are driven by “wrench time,” “down time,” and how long parts and calls spend in the engineer’s online queue.
The job is hugely technical, difficult, and draining. Just to qualify for the job, my husband clocked almost a decade of electronics experience as a security-cleared troubleshooter for military vehicle radios with a major international manufacturing contractor. Field service engineering has been recognized by Forbes Magazine as one of the ten most stressful jobs in the nation, comparable with police and active military. My husband’s boss told him at hiring, “If this job feels like you’re drowning, that’s normal.” It takes a minimum of a two-year degree in electronics or IT, plus years of work experience, plus months of classroom training, plus two years of riding along with an experienced FE for a new hire to even begin to be trained enough to take calls on his own. Over the last decade, even the US military (all branches) has only provided our area with a couple of people trained enough to qualify for the job.
As part of a project for our daughter’s first grade class many years ago, we did the math on the material work needs of a field engineer: in his first eight years on the job, my husband had gone through three laptops, five phones, three vans, three extra windshields, and nearly 11,000 gallons of gas, for a total of more than 280,000 miles on the road—slightly more than around-the-circumference-of-the-Earth eleven times. As of August 2020, he will have been on the job for fourteen years. So all those numbers are now likely more than doubled. You’re about to find out why his experience isn’t keeping its original scale.
When my husband started working for BMC, he was one of nearly thirty engineers in the central Virginia team.
Today there are thirteen.
BMC has laid off or forcibly retired over half of their FE workforce, all the while adding new imaging suites to their accounts. Installations of these new systems used to be handled by a third party company paid for by BMC; now many of these systems are being installed by BMC’s field engineers without extra compensation for their time, mileage, or tool loss. As with all service industries, there are “feast and famine” cycles; there have been times my husband goes an entire day without his phone ringing. But the flip side of that is his record, which is sixteen-hour days for 21 days straight with no weekends, during which even his boss (who has since been forcibly retired from the company) brought him lunch and extra work lights, in addition to spending hours on the phone pleading with his bosses, the clients, and other engineers to help us out…or at least to turn on the main power for the room my husband was working in.
When a disaster strikes, there are three groups of people on the roads, no matter what the weather or the roads themselves look like: there are first responders, utilities teams, and field service engineers for the hospitals. Because every time the power so much as hiccups, these imaging suites go down. Field engineers are supposed to carry red signs on the dashboard of their vans that say “BMC Emergency Service.” [Side note: In practice, the signs were made of such cheap plastic that they all melted in the sun and had to be chucked out.] In this time of COVID, the engineers have been issued physical and electronic letters that provide them a pass from law enforcement quarantine stops. Hospital systems view field engineers as so essential to continued daily function that many insist BMC’s engineers go through vendor credentialing identical to their own employees’ at hiring.
In short, if a doctor or nurse is going to work, so is my husband.
There are 143 hospitals in Virginia, plus dozens more imaging and radiology centers. Each facility can house multiple MRI, CT, vascular, cardiac catheter, x-ray, and ultrasound systems. Every single one of those machines represents a unique iteration of branch of physics, manufacturer, make, model, software application, IT configuration, and user (because not all hospitals use BMC exclusively, engineers have to be able to work on all the competitors’ stuff, too). The list of machines that my husband has to be prepared to troubleshoot stands at well over a thousand different pieces of equipment.
Times 80% of 143 hospitals, plus dozens of imaging centers and doctors’ offices. Times easily five pieces of equipment at each site. That adds up to over 600,000 unique potential calls just to BMC, and just in Virginia. That doesn’t even address the myriad unique causes of those calls. [Side note: By the way, multiply that 600,000 by $350 per hour per engineer, which is what BMC’s billing starts at. Multiply that amount by fifty states, and you can see why BMC’s annual profits register in the billions of dollars even in a bad year. But it’s considered a “failing” company anyway.]
So, to recap: just for BMC in the state of Virginia, those 600,000 potential calls are riding on only thirteen guys.
At any given time, two of those thirteen guys are on installations of even more brand new BMC equipment. Another couple guys are generally out sick (because of age-related issues, more on that below). Another couple guys are generally on vacation (because, you know, these guys deserve one occasionally). Which means, at any given time, there are only six guys covering most of the state of Virginia. And that’s not the lowest it’s been. There have been multiple weeks over the last few years that my husband has been one of only three people covering the entirety of central Virginia.
There used to be thirty of these guys, and even then it often wasn’t enough.
Where are the billions in profits going? BMC certainly isn’t hiring more engineers. In fact, over the last fourteen years of my husband’s job, field engineers have been laid off on average every other year. All the while, every single engineer layoff announcement has been accompanied by the “good news” of the hiring of more sales people and upper management.
Yet even as BMC is selling more systems than ever and their competitors are dying out one by one, BMC’s stock is in the toilet, they’re laying off engineers again, and their engineer hiring remains frozen in a pandemic.
Need another example of serious mismanagement? I’ve got a bunch off the top of my head, but this one’s a doozy: BMC’s parts manufacturing was moved to China years ago, because it was somehow “cheaper” to build the parts there and ship them overnight via FedEx over entire oceans than it was to store the parts here in the US. The tolerances on most x-ray parts have to be incredibly tight—there’s a reason the phrase “close enough for government work” used to be a compliment. After all, BMC’s parts have to meet the FDA’s guidelines for health and safety for use with radiological and other hazardous materials. [Side note: Yes, field engineers wear radiation dosimeter badges to work.] However, ever since the move to China, most field engineers have gotten into the habit of ordering two, three, or even four of the same part at one time for a single repair because the parts so often arrive DOA, only partially functional, or just plain wrong. In what world can this possibly be safer? Or cost effective?
How about a silly example of mismanagement? BMC rolls out new laptops to their field engineers without checking to see if the field engineers can actually use them. Big hint: You can’t use a modern laptop to communicate with an x-ray machine so old that it still uses film. The damn thing doesn’t even have a USB port, let alone WiFi capability. At one point, BMC tried to roll out iPads to do the job. How precisely is an iPad supposed to talk with a machine so old it uses serial ports or (I kid you not) 5-1/4″ floppy drives? [Side note: The field engineers have a nickname for one of the major local hospitals: “the working museum.” That hospital’s machines are, on average, almost as old as the field engineers themselves.] Even today, running a skeleton crew, BMC has over 1,300 field engineers. Every one of them needs a laptop to do his job. Each time this screw-up happens, hundreds of thousands, and possibly millions, of dollars go down the drain in software patches and peripheral buys…all because some genius couldn’t be bothered to talk to the people whose wrench-turning gets him his paycheck.
I wish I could say corporate mismanagement on this scale is uncommon. It isn’t. It is the rule, not the exception, in American healthcare. We don’t have the “finest healthcare in the world.” We have a pastiche of outrageous overbilling held together by fewer and fewer actual working people, while upper management golden-parachutes out of the mess they’ve created. Politicians love to demonize the idea of government-run health care as shoddy and overpriced. BMC wives know that our system is absolutely no better. Don’t believe me? Ask the families of patients who were killed when parts of BMC imaging equipment fell on them during an exam…and then ask them how much their deceased loved ones were charged for the privilege.
The youngest of the engineers in the Virginia team turns 49 this year. The average age of this team skews close to 60. Every single one of these engineers already has at least one major health issue (think epilepsy, PKD, stroke or heart attack survivor, or an Agatston score north of 600). Every single one of these engineers is already at 20% risk of major complications from COVID that would require hospitalization. Every single one of the engineers works on portable x-ray machines and ultrasound units so freshly broken from COVID overuse that they’re literally still dripping bleach when the engineers get them. [Side note: The bleach is burning out components and cables faster than China can make them, by the way. Especially when every other cable arrives with pins already broken out of its plugs.]
If the reality of these engineers’ age and health doesn’t alarm you enough, here’s another fact of the job: Despite being dispatched directly from their houses to their work sites, the engineers frequently have to have contact with each other as they hand off parts and tools, share critical information, cross-train each other on the job, and provide the second set of hands that heaving upwards of 150 pounds of million-dollar-equipment over your head to screw it into the ceiling sometimes requires. The engineers are all masked all the time, but they all have to ration their N95 use. Most just use homemade cloth on a daily basis.
Yes, your instincts are telling you what every BMC wife already knows: Just one case of COVID among the engineers would take them all out.
And remember, to replace even one of these guys would take a minimum of two years, even if a qualified person were to be hired today. Remember how I mentioned that even the US military (all branches) has only provided this area with two engineers over the last decade? That’s not just because of BMC’s idiotic hiring freeze. That’s because the job is just. That. Specialized. BMC can’t even train up one of its Biomedics guys on the fly to do the job. They tried. The initiative failed. Biomedics is a plug-and-play repair job, whereas the training for a field engineer starts with different branches of physics, continues with IT networking, and only then gets into which end of a socket wrench goes clickity-click. (Oh, and, you know, the Biomedics guys are already a little busy with ventilators right now anyway. But I digress.)
I’d love to say Virginia is an outlier in terms of its engineers’ age and health. But it’s not. It is a function of the experience and training required to do the job. Only those engineers who started with BMC in the 1980s were younger than thirty years old when they started…and every one of them freely admits that, were they hiring on today with the training and experience they had in the 1980s, they couldn’t do the job at all. Some of that is the advent of computers and the internet. But a lot of it is the age and experience and maturity required to handle a job that has gotten exponentially tougher since it was created.
While we’re talking about age, we have to consider not just the age of the people already doing the job, but the aging of the theoretical workforce-in-training. Even if you hired forty people today, you’d only have at most four people qualified and free to do ride-along training in this area. So the other new hires would inevitably get let go or shunted to other modalities. (Technically you’d have thirteen engineers who could give training, but given how BMC runs their engineers, you’d only ever in reality have access to four. Ride-along training slows response time too much, and too many contracts have been written that require “less than two hours until response,” 24/7. So four would be training while working, three would be just working, and the other six would be taken up by installations and, you know, life.) Which means that, in two straight years of busting butt by three engineers free to work as fast as possible plus four engineers training all day while working, you’d have…four new engineers. In two more years, you’d still have only four new people, because the first crop of newbies wouldn’t really be doing more than holding their own. In two more years, you might have the first eight newbies ready and able to provide ride-along training, so you might have 21 engineers total. In two more years, you might have 29. And in two more years after that—in 2030, a total of ten years from today—if you hired and trained the maximum number of people possible, you might have a total number of field engineers that exceeds what BMC considered necessary to do the job…in 2006.
To get the proper number of field engineers trained up just to meet 2006’s demand, you’d need to train engineers continuously until 2030.
You’d still be decades behind the need.
And half the team who did the training would be retiring or flaming out of the job because they’d be nearing 70 years old.
And these numbers assume that nobody dies, nobody leaves, and nobody gets hurt in the next decade.
“But wait!” I said to myself. “Surely BMC can just rehire all the laid off field engineers.”
I asked my husband about that. And he laughed. He passed the idea along to his engineer friends. (Because when you work this hard this long with this few people, you become friends. You do game night at each other’s houses. You go to each other’s weddings. You visit each other in the hospital and bring food when they get injured. Because they do get injured. They all do.) And they all laughed at the rehiring idea, too.
None of them knows a single ex-engineer who would come back to work for BMC.
To be sure, there are competitors’ engineers who would kill to be hired on with BMC. You know why? They’re treated even worse. We’ve met field engineers whose standard week is north of one hundred hours (and that was before COVID). And while those engineers are all still relatively young people (late 40s to early 50s), shuffling them from another company to BMC does nothing to solve the long term problem. After all, those other companies will now need engineers even worse. Only bringing back already-trained folk would provide a “quick” solution. Problem is, not a single ex-engineer (for BMC or any of its competitors) would come back to this job now unless they were incredibly desperate, because the fact is, they’re almost all in their 60s. They had time to do the job, be laid off from the job, and find new jobs in the intervening years. Unless they were starving, they wouldn’t voluntarily leave their IT desk jobs (which they’re eminently over-qualified for) to go back to heaving around 150+ pounds of hazardous materials with one hand while screwing it all into the ceiling with the other hand. They wouldn’t voluntarily go back to crawling around on hospital floors until the knees of their pants were permanently stained white with the dried powder left over from barium enemas. They wouldn’t go back to spending every after-work shower swearing at the dozens of stinging cuts up and down both forearms, and wondering if any of those cuts had some incurable virus active in them. And they definitely wouldn’t go back to doing all that crap while being paid less than the average high school principal and barely more than the average teacher.
3) Generational disdain for skilled labor (AKA the “skills gap”)
Remember that kindergarten project I mentioned? It was called “Career on Wheels.” Every kindergarten teacher at the school invited their students’ parents who used a company vehicle of some kind to bring that vehicle to a giant “show and tell” in the school’s bus loop. The idea was for the parent to prepare a little talk about what they did and how they used that vehicle for their jobs. All that math I mentioned about all the laptops and thousands of gallons of gas and number of trips around the world was exactly the kind of “wow” factor that can get kindergarteners’ interest. So we put together some fun posters with lots of pictures cut from magazines to communicate about my husband’s day and taped them to the van’s sliding doors. He plugged in his converter, set an oscilloscope to show a basic sine wave pattern on its screen, and laid out all of his 100+ pounds of specialty tool kits and a few of the safe (and more readily identifiable) dead electrical parts on the pavement around the van. It made one hell of a fan of steel and plastic and rip-stop nylon and optical-grade acrylic and wiring. I mean, stuff was everywhere, in an arc yards wide. It flatly didn’t look possible that it all fit in that one minivan.
[Side note: Even he later admitted, “You know, it’s not until I saw all that laid out, with the laptop and the phone and the posters and all my tools, that I realized it’s…you know…kind of a lot.” He smiled sheepishly. “But then the fire truck and the police cruiser showed up, and even a Roto-Rooter truck showed up with guys climbing all over it while telling poop jokes, and well…my moment was done. You know kindergartners.”]
Class after class got wide-eyed at the array of intimidating stuff. My husband was quick to correct any kid who mentioned something about tools being “just for boys”—he took great delight in pointing out that the drill he had in his tool kit that day actually belonged to his wife, because hers was better. [Side note: My drill is still better. BTW, honey, I want it back.] He was pleased to see lots of girls suddenly get interested in the idea of using that drill and all those other big tools, too. But the moment that he came to dread as each new class came by was when every teacher asked the question, “So how much college did you do to get this job?”
Because while my husband has an absolutely unholy amount of job experience plus two associates’ degrees (one in electronics and one in IT), he has never graduated from a four year university. So when the first teacher asked that question, he answered honestly: “You don’t have to have a four year degree to do this job.” And the teacher, far from being impressed or even curious about that assertion, instead hustled her class away from my husband as if he’d said something rude. She even looked back and shook her head at him, as if to say, “Don’t give them any bad ideas!”
Before anybody reading this thinks I’m about to millennial-bash: I’m not…unless that millennial is one of those teachers.
Every. Single. Teacher. Asked the college question and got huffy about the answer. They didn’t want to hear that on-the-job training and a couple of AA’s were better suited than college to handle such an impressive amount of equipment. Even BMC itself no longer accepts field engineer applicants with less than a four year degree. Yet any field engineer will tell you that, unless it’s in electrical engineering, a four year degree is about as helpful as a bicycle is for a fish. Not even a physics degree will be any more useful than an AA in electronics or IT.
The entire United States has gotten so wrapped up in the illusion of “the cushy desk job and the four year degree” that no one—not even teachers or employers—will admit it’s a lie. It’s a lie that is driving the private debt load of American citizens into the stratosphere, and it’s murdering the trades.
Case in point: I have a master’s degree in English. Yet my husband has always out-earned me, even at my best job. I went into three times the debt that my husband did in order to get my degree. It took me nearly twenty years to pay my debt off. My husband was out from under his debt and earning as well as a tradesman can in less than four years. I haven’t had a decent job since before my daughter was born, and she’s in middle school. Yet every single person who comes to our house assumes, when they see my degrees on the wall, that I’m the primary breadwinner. And those people represent multiple generations, everything from the Silent Generation right on down to the Yers. The only people who’ve been unimpressed by that piece of paper…because that’s all it is…have been Millennials working underpaid jobs in the trades, and Zoomies who have grown up watching their parents in the trades struggle with long hours and neither enough help nor enough pay.
Let’s be honest here. In fact, I’ll even quote Shakespeare to make my point: “There was never yet philosopher that could endure the toothache patiently.” There is no desk job in the world that works without electricity, water, food, or shelter. There is no desk job in the world that works happily without air conditioning or heat in extreme climates. There is no desk job in the world that works for long without healthy workers. All those things—electricity, water, food, shelter, comfort systems, and health—are supplied by skilled tradesmen and women trained in specialty programs.
In this age of COVID, everyone’s definition of what (and who) is essential is getting a hard reset.
There are six people, and only six people, keeping hundreds of imaging machines functioning in Virginia’s hospitals. All the advanced medical degrees in the world can’t tell a doctor how to guide a lumbar puncture needle without a fluoroscope to show her where the needle is in someone’s spine. All the accountants in the world can’t add up all the algorithms required to run a single MRI through someone’s brain to check for blood clots. And right now, there are only six people keeping the lion’s share of those machines running in central Virginia.
It will take more than two decades to expand that number to a reasonable cohort.
My husband and his best friend both turn 50 next year. They are the youngest field engineers on this team. The average age is close to 60.
They will not still be doing this job in two decades. They might not even be alive in two decades. Hell, given COVID, they could be gone in a month. But even if COVID were solved today, BMC and employers like them have at most ten years before so much of their existing team ages out that they will no longer be able to mount a service team of any meaningful size. And remember, BMC already considers six an acceptable number of people to service much of a midsized state.
Philosophers can’t endure a toothache, so they have to have a professional fix it for them. Philosophers also can’t turn a wrench. Neither can the MBAs making all those layoff decisions. They may be raiding the fruits of my husband’s labor, but they sure as hell can’t do his job.
Mike Rowe, the emcee of the old cable TV show Dirty Jobs, has been railing about the “skills gap” for decades. He’s addressed Congress about it. He’s even used his paycheck to found the MikeRoweWORKS Foundation, giving scholarships to kids who want to go to work in the trades. Mike Rowe, my husband, and other skilled tradesmen like him give great thanks for the young kids who are coming up through schools now because many of them are disregarding what their parents and teachers and administrators are telling them about college. They’re seeing for themselves that their parents and older siblings are weighed impossibly down with a lifetime of debt, like a living version of Dickens’s Jacob Marley. These young kids (and some of their Millennial siblings or parents) have been tuned in to what’s happening financially to the citizens of this country…and because they’re tuned in, they’re turning on to the trades and they’re dropping out of the corporate rat race. They’re even dropping out of traditionally American dreams, like getting married, having kids, or owning a home. They simply can’t afford those dreams until the paychecks of the trades catch up…
…and they’re already two decades behind.
COVID has exposed fault lines in the structure of the oldest scions of American business. It’s also exposed fault lines in the structure of American life. Regarding COVID, Congressman McCarthy recently tweeted something to the effect of, “Don’t let a public health emergency cause you to restructure the American way of life.”
My response: The American way of life is, as we speak, ceasing to exist on its own. Corporate and social mishandling are letting time (and COVID) kill it. Without a massive restructuring, to quote Stephen King’s The Dark Tower series, “The center cannot hold.” Either we restructure the American way of life now, or in ten years…or ten days…we will look just like any other failed state that can’t provide adequate healthcare for its citizens.