みなさんこんにちは。
今回は、「医師ってホントに中間管理職だよなぁ」とつくづく思うことがあったので考察してみました！
でも、対岸の火事ではないですよ？
ホラ、気づけばアナタも中間管理職。。。（世にも奇妙な物語風に。）
記事のサムネイルはあの人をイメージしました！（over 30ならわかるでしょ！）
中間管理職って何？
まずは中間管理職の定義から。
手っ取り早く調べたものとして、
中間管理職とは、管理職の中でも、自身より更に上位の管理職の指揮下に配属されている管理職の事を言う。・・・（中途略）・・・部長は一般的な組織系統の場合、役員の指揮下にある場合が多く、役員は管理職ではないので、部長は中間管理職ではない。しかし、課長は更に上位の管理職である部長に、係長も更に上位の管理職である課長の指揮下に配属されているので、中間管理職となる。（Wikipediaより抜粋）
直接現場や部下を管理する責任者。一般の会社の課長・係長クラス。（weblio辞書より抜粋）
つまり、中間管理職に必要な要件として、
- 自身が上司であること（「管理職」である必要があるか、「管理を行っている」だけでいいのかは定義次第で変化する）
- 自身の上司も管理職であること
ということのようです。
なんだか、あえて定義を確認する必要もなかったですかね。
でも、ちょっとずつ見えてきましたね。
僕の意見ですよ！
頂点と下っ端以外、みんな中間管理職
中間管理職の苦悩
さて、そんな視点でみていくと、誰もが中間管理職なのではないでしょうか？
仕事上も勿論そう。
家でも親がいて、自分がいて、子供がいて。
兄弟だって親と下の兄弟に挟まれて。
そう、世の中人とかかわりを持つ限り、「管理」とまではいえないまでも、多かれ少なかれ「上下関係」の中に組みこまれてしまうんです。
仕事においては殊更「上と下の板挟みになる」ことがストレスフルだから中間管理職って言葉が特別についたんでしょうね。
医師における「中間管理職」
さて、医師に置き換えてみましょう。
入職時、私たちはいわゆる研修医です。
その時にはすべての職種の最も下に置かれます。
簡素化するために、医師に多くかかわるものとして病院内に「医師」と「看護師」だけがいるものとします。
そうすると、↓のような構図です。
何においても一番下っ端です。
そうすると、大変やりやすいのです。
全てYes , sirですみますからね。
しかし、そんな期間はすぐに終わります。
3年目～いわゆるレジデントという、若手医師
6年目くらい～ 助教とか医員とか行ってまだ若手ですが、目下の医師がつきます。
10年くらいになれば、それはすでに中堅医師です。知らぬ間に中間管理職みたいになっています。
つまり、↓こんな感じ
立派に、上にも下にも人がいる状態になっていますね。祝、板挟みポジション。
「中間管理職論」における医師の特殊性
こんな声が聞こえてきそうですね。
そういう部分もありますが、やっぱり特別な中間管理職だと思います。
- 最も目下の人間が、すでに国家資格保持者
- かかわっている人間が多種多様で色んなピラミッドの中でのポジショニングがある
- 人の生死にかかわるため、上や下との折衝に妥協が許されない
- そもそも、望んで「管理」をしたかったわけではない
これが、その理由です。
医師は多職種の中にいるため、医師の中での上下もあります。また、医師同士だけでなく、看護師を相手にしたり、多職種をうまく使いこなす必要があります。医局において、病棟において、外来において、検査室や手術室において、近隣の医療機関とのお付き合いにおいて・・・色々なピラミッドが存在する複雑さを持っています。
その中には全然使い物にならない目下の医師もいるわけですが、それでも彼らは国家資格ホルダーです。現実彼らを使いこなさないと患者の命を守れません。「やる気がないならもう来なくていいよ」と言いたいのを我慢し、懇切丁寧に指導し、その実力で守れる範囲の患者の命を守っていただくのが現実です。相手がベテラン看護師であっても、自分がそこそこ中堅になれば、こちらが「使う側」になってしまうのです。
ちなみに、誤解があってはいけないのですが、
医師は確かに医療業界の職種上は最上位に存在する存在であって、その指示というものはトップダウンです。よって相手がどんなに年齢が上の職員であっても医師の指示（採血、点滴、画像検査など）は議論はあれど、基本的には指示に従うものです。
でも、その「職種上のヒエラルキー」と日常生活における上下関係は別物です。（時々それを勘違いしてしまう輩もいますが。）年齢が上なら人生の先輩です。その礼儀は忘れてはいけません。そしてその礼儀を普段持っていれば、職種上指示を出した時には気持ちよく従ってくれるのです。
また、取り扱っているのが人の生死ということもあるかもしれません。
上へ上申、または下から上申の際には、お互い妥協を許さずに議論をしなければなりません。そこで紛糾したらまたその上にお伺いをたてなければなりません。
そして最後、コレ最も大事なのですが、学年が上がった医師は漏れなく「プレイイングマネージャー」をしなければならないのです。
診療は今まで通り（当然若手の比ではありません）、そこに加えて管理・教育を仰せつかるわけです。看護師さんなどは、基本的には師長さんになれば患者に接する側からは離れた役職内容に専念しますが、医師の場合は一人の臨床医としての役割を担いながら、そこに管理の業務が発生します。
これがストレスの理由になるわけです。
自分の使える時間の中に診療以外のことが入ってしまうと診療に使える時間が減少してしまいます。
元々、時間的に無駄を一切削除してようやく時間と質を担保していた診療時間を、時間というところで減らされてしまうんです。患者に寄り添いたい医師としては、やるせない思いになるのも当然です。しかも診療時間に遠慮なく電話がかかってしまいます。
これが私たちのモチベーションを下げる理由になります。
中間管理職のプレッシャーにどう立ち向かうか
中間管理職というものからは解放されない前提で、では私たちはどのように昇華したらいいのでしょうか？
はっきりいって、万能な結論はございません。
でも、提案ならできます。下記です。
- 下に業務を振り分ける
- 素直に上司に思いを伝える
- 業務の質を下げる
- 職場を変える
このような悩みが起きる人については、大半が完璧主義である人が多いと思います。
「自分がやってあげないと」という使命感をもち、それが患者にとっても安心感につながっています。
職務上も、「中間管理職とはかくあるべき」と思って、それに必須とされる責任・コミュニケーション・危機管理・マネジメントなどあらゆることを完璧にしなければ、という思いがはたらいてしまいます。
でも立ち止まってみましょう。
あなたがやらないと仕事が回らないですか？
あなたが（すべてのことを）自分一人でやらないと患者が死にますか？
あなたじゃないとできないことは何ですか？
そこに立ち返ったときに、優先度の低いことは外していきましょう。
患者さんに、「ココの部分は人に頼みます」と言いましょう。
他の医師に、「ココの部分は任せます」と言いましょう。
きっと、患者の予後は変わりません。
任された方は、期待にこたえたい一心で頑張ってくれます。成長してくれます。
回り巡って、あなたのキャパが上がるんです。
勿論、絶対に自分が関わりたいことは、関わればいいのです。
大事なところ、「だけ」。
どうしても自分が最初から最後までという事であれば、業務の質を落として対処するしかないですね。
ベストではないかもしれませんが、いったん仕事をこなせるキャパは広がります。
またすぐ限界がきますが・・・
まとめ
医師とは切っても切れない中間管理職の世界を解説しました。
やはり職場の上司とのご縁は大切で、「この人の下で働きたい」と思う人なら、一生ついていけばいいと思います。
でも、一生選んだ上司の下で働くわけではありません。
その場合には、下に目を向けて、自分についてきたい、と思うような仲間を集めましょう。
いや、能動的な行為ではないかもしれません。
まじめにコツコツと、背中で見せていけば、きっと、アナタを慕って仲間が集まってきます。そんな仲間なら、あなたの大事な仕事を、おすそ分けできるのではないでしょうか？
望むところだ、中間管理職！
どうせやるなら楽しみましょう！
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