Goals, Systems, and Self-Awarded Raises in Radiology: The Other Side of the Coin

My last few columns were aimed at radiologists whose careers resembled my own: Satisfying/successful in other regards, but not achieving the traditional “goal” of equity partnership or something similar. I presented systems that let me parallel such a path, bypassing compensation-ceilings which would have constrained me in one rad group by switching to others whose ceilings were more porous, or at least higher.

Readers who’ve achieved partnership for themselves, or expect to in the future, might not see much in those columns for their own use. Instead, I can imagine some reacting pretty negatively if their worldview is that one should patiently and obediently climb the ladder of a single workplace…remaining loyal to it even if a trapdoor gets slammed shut above the climber.

Such readers might see my attitude as unhelpful to their own systems. What if a bunch of rads adopted my approach, and groups’ non-partner employees were inspired to leave for better gigs? What if the partners started having to pay out more to recruit and retain the rads necessary to keep their operations running?

Upper-level rads able to see from other viewpoints, however, and put themselves in the shoes of their lower-tier colleagues, would be able to see that those columns hold just as much value for them as anyone else. The other side of the coin is right there, for those able/willing to turn it over.

If you’re a partner, or otherwise in group-leadership, you stand a better chance of getting and keeping rads by maintaining an awareness of what they want. Coupled with a good sense of whether you’re giving it to them…or if you’re not, and other groups are.

Reexamine the reasons why you can’t, or simply don’t want to, give all the rad-members of your team a realistic path to partnership, or something almost as-good-as. If you can make them feel like your group is their career’s “home,” they’ll be much more likely to stay for the long haul rather than if they view it as an apartment from which to trade up.

Put another way: Equity partners generally don’t leave one practice to start over elsewhere, even though some groups’ partners do substantially better for themselves than others. But non-partner rads switch jobs all the time. Part of the difference is a psychological barrier to moving when you’ve achieved equal citizenship in your group.

If that’s simply not something a group’s going to offer, and it tries to retain rads on a permanent “associate” basis, everything held back from them by the owners/partners is going to weigh against this effort. Like Grand Moff Tarkin’s fist: The tighter the grasp on comp, the more good rads will slip away between those metaphorical fingers.

Some rad groups bake that into their business-model, trying little if at all to retain good people. “Churn and burn” works on the premise that replacements can always be hired, so no need to pay your rads a penny more than you absolutely have to at the moment. Maybe they’re desperate to live where your group is, maybe they’ve got checkered backgrounds that leave them few other options, or maybe the job market just isn’t in their favor. Whatever the case, this is not the formula for leading a high-quality, cohesive team. It’s more like being a radiological slumlord.

That’s not to say that a no-partnership, permanent-employee model is doomed to mediocrity or failure. If you start a radiology group and offer daytime telerad contracts at $400/hr (and can somehow make the finances work such that you don’t go bankrupt), I’m pretty sure you’ll be able to recruit and retain a pretty darned capable team. As mentioned above, if you offer terms that are “as-good-as” partnership to a given rad, you’ve probably got him for the long haul.

Yes, the dollars matter, but all sorts of other things factor in. Work-schedule, a seat at the table where the group makes its decisions (even a nonvoting chair beats being kept out of the room entirely)...you might be surprised what some folks value. Which is why it’s so important to ask after—not just a one-and-done query, but periodically revisited.

And that’s the other side of my system’s coin, for those recruiting and wanting to retain rads: If you can’t or won’t give them a traditional partner-like status, be attentive to what they consider as-good-as when they’re in the four phases I previously described.

No need to rehash them all here; it’s easy enough to mentally walk through the phases and think about where in that scheme any given employee/contractor is. You can then tailor your approach to them. Do everything you can to keep them in phases 1 and 2, most importantly maintaining open lines of communication. Misunderstandings, disappointments, and resentments between the group and its rads should all be nipped in the bud; if things get to phase 3 (let alone 4!) they get increasingly difficult to fix.

Retaining good people should never be about giving them as little as you can get away with for as long as you can: That’s a system for too-little, too-late action…or for folks you’d just as soon push out the door rather than wait for them to walk through it themselves.