Is There a Place for Island Time Amid the Productivity Demands of Radiology?

I just vacationed in Barbados. It was a little overdue. I had gone there for a long weekend during med school on a shoestring budget and loved the glimpse I had gotten. Twenty-seven or 28 years has been more of a wait than I intended to return and see the place properly, but better late than never.

Borrowing from Thomas Wolfe, you can't go back on the same vacation again. Places can change quite a bit in that stretch of time, and the island was no exception. It is a lot more built up, and some of what med school me loved about the place is now harder to find.

Still, things remain familiar, and aren't exclusive to that particular bit of the Caribbean. Being an East Coast guy, I have done a fair amount of island hopping there. The region provides an easy go-to getaway when I am craving a respite from winter.

A commonality, which I enjoy as part of the experience, is "island time." If you aren't familiar with the term and ask someone about it, the response can vary greatly because not everyone is a fan. Even the Wiki definition calls the phrase "sometimes derogatory." More than a few years back, on my first trip to Aruba, a local explained "We have two speeds here: Slow and damn slow."

Good! That's what I want in a vacation. Unless I'm trying to see and do a gazillion things in a small amount of time, I like to leave stressful rushing about for when I am at home. I have known people for whom vacations, even weekends, are a matter of "Hustle and hurry up so we can relax!" That has never made any sense to me.

With that mindset, some people never quite seem to shift gears to the part where they enjoy themselves. They get aggravated about what's taking a waiter so long to come by while they're sitting at a table overlooking a lovely beach. They fume about why a taxi is taking forever to arrive, or why their hotel's people aren't on task. Even if they aren't being "ugly Americans" by expressing their displeasure to everyone around them, they are inclined to give a running commentary to whomever they are traveling with. An old travel mate once asked a bickering couple in our group: "Did you come here to vacation or complain?"

Even for folks like me who love a bit of island time, there are plenty of circumstances where it is unwelcome. For instance, long-term readers know that I have spent more than a little of my radiological career working with productivity incentives. That has included pure per-click models as well as RVU-based bonus schemes. Put me in an environment like that, where more work earns me a heftier paycheck, and I will hustle like you wouldn't believe. Heck, I would do the same even if it meant I got to leave earlier at the end of the day.

(Editor’s note: For related content, see “Speedy Reads and Slower Deliberations: Key Factors that Impact the Pacing of Radiology Interpretation” and “Big Radfish in Small RVU Ponds: You Have No Idea What You Are Capable Of.”)

That doesn't work out so well when there are factors preventing would-be hustlers from doing what they know they could. If you take a rad who is capable of 12+ RVU per hour and hamstring him or her with a worklist or system that reduces the RVUs to seven per hour, he or she is not going to be happy. This is especially the case if you hired the rad with a productivity bonus that kicks in at eight. Island time goes right out the window when one's livelihood is at stake; I have seen taxi drivers in the islands get just as vexed in traffic as a New Yorker would.

Time and money are common manifestations of this issue, but the bigger picture is how well (or poorly) one adapts to one's environment, or, ideally, sizes up that environment before entering it. A 100 percent island-time style rad who pokes along at three to four cases per hour should know that a demanding per-click job probably won't be the right place for him or her. Put another way, one should ideally "read the room” in advance from the outside.

Another potential mismatch between rads and their workplaces is work quality. A rad who takes pride in his or her precision and has strong feelings about how studies should be done and reported is not going to mesh well with a group that doesn't live up to his or her standards. If the rad feels like an unreasonable number of chest CTs are marred by respiratory motion or too much MR is being done without fat suppression, it is going to grate on the rad every time he or she opens up such studies.

The rad also might find it unacceptable that referrers are allowed to get away without providing proper clinical histories. Another source of frustration might be constantly finding what the rad considers to be careless errors in previous comparison studies read by his or her teammates. That can work in the other direction too. A laid-back rad can fail to live up to the standards of his or her group.

Such conflicting philosophies and styles are ideally identified before anyone has signed a contract to be bound to one another. Otherwise, the options are learning to peacefully coexist or parting ways. Staying put and constantly clashing against one another won't be good for anyone involved.

Generally, I have found it is easier to gravitate toward island time than away from it, and I keep that in mind when thinking about how a person (or group) might change. That probably has something to do with systems naturally trending toward entropy. You have to put more energy into them to move in the other direction.

This isn't just an issue for cogs in the machine. Folks in charge should remain mindful of what sort of environment they want to create and whether they are successfully doing so. If you have your own rad group and have no intention of operating on island time, you had best avoid hiring a bunch of island time-minded people.

On the other hand, if you honestly appraise your outfit and realize that, like it or not, it's often working on island time, you have to decide whether you're going to put in the necessary work to change that approach. Choosing to live with it is fine but you will probably want to avoid hiring anybody who is not on that wavelength. They might struggle in an attempt to bring things up to their standards, but don't expect them to singlehandedly fix your island time system.