No Finishing Line

In my various discussions with radiologists, tele- and otherwise, I’ve enjoyed a broad sampling of others’ perspectives. Docs like myself, in the thick of their careers; folks fresh out of training, still in it, or indeed not yet done with med school; and those in retirement, or nearly so.

Probably not too surprising, the younger crowd is more frequently represented. Older, seasoned folks tend to have more of the answers, or at least think they do, whereas newer faces know they have lots to learn, and often less of an ego to get in the way of reaching out for others’ wisdom.

I thus take particular notice when I receive inquiries from rads who’ve “made it” in the field: Achieved partnership, for instance, or hierarchical ranking (Medical Director, CMO, Chair, section-head, etc.). What could they possibly have to gain from a chat with little ol’ me? They’ve crossed the finishing-line and should be living happily ever after.

As my contacts with such individuals have accrued, I’ve come to see that last bit is fiction: There is no finishing line, unless you want to get morbid with the notion that, eventually, we’re all “finished.” Unlike in childhood fairy-tales, there is no happily ever after. If you’re alive and have your wits about you, there’s no point at which you size up everything you have and all that you’ve done and say, “This is it. I have nothing more to achieve.”

We’re not programmed that way, and evolutionarily speaking that’s probably a good thing. However secure and comfortable we might get, as satisfied with ourselves as we might be, once that becomes our status quo we find new things to reach for; things to do to maintain what we have, or we reassess our lot and decide it needs improvement.

So, while many rads strive to find jobs that will turn into partnerships or other positions worthy of “the rest of my career,” it turns out that others who’ve scored such things find life after the finish line isn’t a quantum leap beyond what it was beforehand.

Sometimes, it’s an entirely subjective matter. For instance, one of the partner-level rads I know, within the past couple of years, realized that he (and his wife) didn’t want to continue living where his rad group was. The job itself hadn’t changed; if he could magically relocate it to the more rural area they preferred, he’d happily maintain his role.

Moving, to them, was worth taking the hit to his income and professional clout by finding a job local to their new digs, or via telerad. (Since he and his group had a good relationship, I suggested he float the notion to his current partners that they keep him on as a remote telerad employee or contractor, but that wasn’t in the cards.)

Circumstances on the other side of the finish line can also change, even if the individual who’s “made it” does not. A “partner” in my second post-training job found his professional life gradually deteriorating over a course of years, for instance. Maybe it was that reimbursements were steadily declining and the group’s overhead was always on the rise, but from what I could see it was mostly that his “partnership” wasn’t a real one in most folks’ sense of the word (hence my usage of quotation-marks), and the group’s true owner was steadily chiseling away at his piece of the pie.

The last I heard, he’d never actually made a change for himself; however much his deal diminished, it seemed better or at least safer to him than anything he was likely to get elsewhere. Which always struck me as a sort of Limbo; you achieve your “happily ever after,” find out that it’s not so happy, but accept being stuck with it. I referenced this situation as being “treed” in a blog nearly 4 years ago; you’ve climbed a tree to a decent height, but can’t go any higher without first going back down to the forest floor—at least temporarily losing your progress—and starting up a different trunk.

Another such individual recently reached out to me from a rad group where he was not only a partner, but one of the inner circle of leadership…talking about maybe switching to a telerad gig. Crazy? Maybe to some who’d view his position as being on the other side of a pretty impressive finish line, but from his perspective, he’d seen his group change in ways not for the better, and threatening to get sufficiently worse as to prompt serious consideration of bailing out.

I freely admit to having, once upon a time, swallowed the partnership/title-bait, hook, line, and sinker. It’s what a lot of young docs are taught to pursue, just as they’d been told childhood fictions routinely ending with “happily ever after”; how could they not believe it all? It’s a powerful enough story that I might be snowed even now by a prospective employer who spun a good yarn about making me a CMO or the like.

Nowadays, I’m a little better equipped to think a few steps further down the line. Okay, so someone’s talking about partnership, or a Medical Director position. What does that really entail? How can I know what that will look like a week, a month, or a year after I get the post—if indeed it comes to pass?

One thing is to think of and ask the relevant questions, rather than just hearing words like “partnership” and swooning. And, if the answers are promising, get them in writing, even reviewed by your legal-eagle at the appropriate stage. That includes “future-proofing” as much as possible; not every unwelcome change in circumstances can be foreseen and/or prevented, but a lot can.

Another approach, which I’ll touch on in another column someday, is to focus not so much on the goal of partnership or titles, but the systems you’re using in your life that will bring you towards and across such finish lines, even if you don’t recognize those lines as goals until after you’ve crossed them. Some readers (especially those familiar with the author/podcaster/artist Scott Adams) will know what I’m talking about. For the rest: Stay tuned.