In the early days of hospital-based clinical engineering programs (usually then called “biomedical engineering departments”), there were usually several levels of positions and most departments were headed by a clinical engineer with a bachelor’s or advanced degree or someone with many years of experience. Job descriptions and minimum qualifications for department heads often included a bachelor’s degree in biomedical engineering or a preference for a master’s degree in the same field because there were more graduate programs in the field than bachelor’s level. At the same time, requirements for chief engineers in hospitals often were based upon experience only, with emphasis on hands-on experience with major building systems. Today, advertisements for positions in clinical engineering are typically for generalist biomedical engineering technicians (BMETs) or specialists in such areas as radiologyand lab-equipment maintenance and repair. There are few positions available for degreed department heads in the clinical engineering field today. Advertisements for chief engineers, on the other hand, have all but disappeared and have been replaced by position postings for “Facilities Director” or “Facilities Manager,” which usually require a minimum of a ‘bachelor’s degree and often a preference for professional registration such as Professional Engineer (PE) in mechanical or electrical engineering. PE is a licensure granted by state consumer affairs departments. It is earned through experience and testing and is intended to reflect minimum competency to practice as a consultant or designer in the specified field of engineering. It is interesting to note that there is no PE category for biomedical or clinical engineering. This fact has contributed to the desire by some to create a certification process for clinical engineering (see Chapter 133). A certification program for clinical engineers is currently administered through the ACCE Healthcare Technology Foundation (see Chapter 130). Clinical engineers (CEs) might well consider expanding their horizons to a more diverse application of their engineering and management skills. In fact, there is good reason to conclude that the best thing for hospitals and medical centers to do is to install clinical engineers as facilities directors and plant managers. This career path makes sense for many reasons but may seem controversial or even distasteful to many in the clinical engineering profession. This chapter suggests why this should not be so. First, most in the clinical engineering field know that many who work in facilities operations lack the sensitivity to, and real understanding of, the clinical environment. This is not to brand all facility managers with the same reputation. However, most clinical engineers will recognize the notion that nurses and physicians often call upon clinical engineers to assist in situations that might be the purview of the facilities department but from whom they have had poor response. An even more frequent current example is the perception of users that information technology (IT) departments really do not meet the service and support expectations of clinical professionals. This is because most of the line staff in a clinical engineering department have more education and training than the typical maintenance or plant engineer and have pursued their career because of an interest in working closely with health care providers in a clinical setting. This puts the BMET or clinical engineer on the clinical side of any activity much more than other maintenance or support departments. In fact, most clinical engineering department staff members crave exposure to the clinical environment and staff on a daily basis, while many facilities staff would just as soon wait until patients and clinical staff are gone before they enter an operating room or other patient-care area. BMET’s and clinical engineers sought out their work because they wanted to be in the hospital environment, and their careers are unique to that setting. For the most part, facilities staff might as well be working in an automobile factory, hotel, or high-rise office building. Again, this is not intended as a judgmental statement, but simply a demonstration of the fact that the clinical engineers are uniquely qualified to provide all types of engineering support to the hospital setting.