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How I Have Planned for the Unknowable in My Radiology Career
While a variety of factors can influence key decisions such as career moves, conservative projections of absolutes can help reduce the risk of unwelcome surprises.
I had a nasty little surprise waiting for me in my first week of classes as a college student. It turned out that registering for a course did not actually guarantee a spot in it, and I wound up needing a replacement. Some anxiety-filled days later, I landed in an advanced-level philosophy class (“Metaphysics”) inhabited by both other undergrads and grad students.
Despite being woefully out of my depth, I managed to stay afloat and have long since considered it to be one of the most interesting bits of my education. It wasn’t all brilliant, of course. Some of it was the sort of naval-gazing stuff that makes philosophy an easy target for mockery.
One aspect was the concept of “free will,” and whether we actually have it. I thought it was obvious that we did, and a silly thing to quibble about. Nevertheless, over many subsequent years, I have seen more than a few smart folks argue against the concept of our actually having any control over what we do. When people I respect hold opinions I don’t get, I delve deeper.
In the process, I have moved my own needle a bit. I still believe that we have conscious control over our actions, but it takes a lot of effort and energy. Most of the time, we act on varying levels of “autopilot,” doing things by rote or routine. If, for instance, I consciously thought through each moment of brewing my morning coffee or brushing my teeth, it would be nowhere near as efficient, and I might actually screw something up by overthinking it.
There are times when we are more mentally engaged but there is still not a whole lot of free will going on, because there is a clear-cut course of action which will bring us the results we want. Looking at an X-ray with a fracture, I could exercise free will to report it out as normal ... but that wouldn’t get anybody what they wanted except maybe a hungry medical malpractice lawyer.
I have my greatest sense of exercising free will when pondering two or more courses of action, and none is a clear winner. With regard to the subject of this week’s blog, it is often a matter of my not having all of the data to inform me what the “best” choice is and not expecting that data to turn up before I have to make my move.
The best examples that come to mind, in recent years, have been when considering whether it’s time to change jobs, or which job to choose, and trying to weigh them in terms of compensation. That’s easier when dealing with conventional salaries: Here’s what rad group A will pay per year, and here is what B offers. If I want to get fancier, I can divide those numbers by how much it breaks down per hour, but it is still pretty straightforward.
Things get murkier when dealing with “pay per click,” or hybrid “base plus productivity” models. I have written a couple of blogs about how, since no two working situations are quite the same, I really can’t know what my productivity will be in my next job by thinking about what it has been in my current gig or any time in my past. I can recall that I did X cases or RVUs per hour in one job, but a fraction of X in another which had a worse case mix, hardware/software rig, or otherwise suboptimal infrastructure.
The thought has occurred to me to try a relative rather than absolute approach. I have a rough sense of what my percentile ranking was in each of my past gigs. If I did better than, say, 75 percent of other rads who were subject to the same vagaries of infrastructure that I was, it stands to reason that I will be somewhere near 75 percent in other environments. I can ask a prospective new employer what the 75th percentile in their ranks would look like, or a spread from 70 to 80 percent if I want to allow for some fluctuation.
In planning for an unknowable future, however, my brain doesn’t allow me to make a quick, rough projection and leave it at that. Until the future arrives and its concrete details are revealed, I keep returning to the mental exercise of trying to predict it. That would probably be annoying or nerve-racking for a lot of folks, but I have come to appreciate it since each iteration increases the chances that I will catch something I overlooked, see things from another perspective, etc. “Measure twice, cut once” makes for a nice expression, but twice is far too cursory for me.
I go ahead and try to crunch numbers, knowing that accuracy is a pipe dream and that the best I am going to do is a rough approximation. All I can hope is that the future’s reality isn’t too much of a surprise aberration from what I anticipated, but I can make efforts so whatever surprises I get are pleasant ones.
To that end, I constantly adjust my guesstimates in unfavorable directions. If I have previously seen that I can read 10-12 RVU per hour, I won’t let myself calculate with anything better than 10. If I have historically taken no more than four weeks of vacation in a year (promise to self: I will do more!), I calculate with eight or even 10.
Then, when calculating things, I always round down. Ten RVUs per hour in a nine-hour day comes out to 450 in a week, but let’s make that 400 instead to account for lunch and whatever else might interrupt me. This also helps because my repeated mental rehashings often happen when I don’t have a calculator, PC, cellphone, etc. handy. Mental math is a lot easier with numbers like 400 instead of 450, or God forbid 425.
Ultimately, my projections should come out solidly below what my prospective actuality will be. If they are anywhere near a danger zone (“Gosh, my current job might be better than this new one”), it is a warning sign that I might be contemplating a bad move.
All by itself, it won’t make a conclusive decision for me. It is just a chunk of evidence I will consider in the process of exercising my free will (or, some would say, indulging my fantasy of having any).
