Leadership in Radiology: A Closer Look at the Other Side of the Coin

There was no ambiguity about it. You had to pursue, achieve, and demonstrate leadership. At least, that's what the guidance used to be for med school hopefuls. Really, it was the case even if you just wanted to get into a competitive college for your undergrad degree.

So high schoolers tried to become team captains, presidents of social clubs, managers at their summer jobs, etc. I did the same and continued to do so in college. For good measure, I presided over my fraternity for a year (although I probably would have had a better GPA if I had chosen otherwise).

There is a funny thing about grooming leadership. There wind up being way more docs trying to climb the medical hierarchy than the hierarchy actually has positions to accommodate this lesdership drive.

I have found that leadership drive to be most abundant among the younger docs. I was no exception. Fresh out of fellowship, there was no doubt in my mind that I wanted to achieve partnership somewhere, if not run my own group. If I had been more of an academician, I would probably be aiming for things like section head or chair.

It therefore baffled me when I encountered more seasoned rads who expressed an aversion to such things. One, in particular, had run his own group and ultimately sold it. He was thus just an employee alongside me. The desirability of leadership, in my mind, was such a given that I almost considered it a defect if others did not feel the same way.

Still, he made some good points: It was nice to be able to finish his work for the day and leave without any lingering issues. You lose that freedom when your responsibilities run deeper. "Man with many keys has many worries" as the old expression goes. He had seen the leadership side of the coin and subsequently flipped it.

I was still very much in sight of the former. Being young and ambitious, it made all the sense in the world to me that one should work hard, prove oneself capable and deserving of higher levels of responsibility, and achieve then. Plus, I expected that it would be more intellectually gratifying to move on to higher order things in the radiological world than just racking up RVUs for the next few decades.

(Editor's note: For related content, see "Evaluating Your Effectiveness as a Radiology Adminstrator" and "RBMA: 7 Leadership Tips to Improve Your Practice.")

Folks who have read this blog for the longer haul know, in that particular job, the promise of partnership turned out to be a sham. Moving into telerad afterward, I knew that there would be far fewer hierarchical opportunities; that's just the nature of the beast.

Still, when opportunities knocked, I was ready to answer the door. I wound up holding a couple of titles in my first telerad gig. When I moved on from that job, it was to another outfit that said promising things about making me a telerad section head.

Actually being in such posts (or witnessing others who have) impacts one's perspective. One rarely achieves the level of authority that was envisioned. If you're in telerad, that's pretty much a given since folks willing/able to be on site invariably trump you. Even if not, though, "there's always a bigger fish," as a wise Jedi said. That also holds true for rad group top dogs: You still answer to a lot of people, not the least of which are government regulators and insurance companies.

That leader/not-leader coin might also be likened to a billboard alongside the highway of one's career. When you are younger and less experienced, as you drive up to the thing, all you see is the "be a leader" side. At some point, passing it, you start to see the "don't bother" aspect, and the further on you go, the less you remember the front of the thing.

Interviewing for jobs, I referenced that phenomenon (not quite putting it in those terms). I described how, thus far, I had hoped to be more than just a film reader, and knew I would bring a lot to the table in that regard. However, I acknowledged that I had been in the field for a couple of decades. The more time moved on without my getting a shot at higher-order stuff, the likelier it would become that I would just want a good paycheck and no hassles.

In other words, I was still looking for opportunities but not quite as hungrily. And I might not have that appetite at all in another few years.

I think the field would probably do better if that trend didn't happen. You want your leaders to be the experienced ones, the folks who have seen more and learned from it. But you don't want to wait so long that whatever leadership ambition they once had withers on the vine.

Maybe if you're looking to be groundbreaking and revolutionary, like a venture capital (VC)-funded AI radiology startup, a hot-blooded young'un is a better flavor. He or she will have fresh perspectives and novel ideas not constrained by too much "real world" wisdom. However, this does not describe most of our field.