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The Nonexistence of Perfect Balance in Radiology
In the elusive pursuit of reconciling case volume and having an appropriate number of radiologists, the proverbial windsurfer may fare better than stand-up paddleboarders and daredevil surfers at navigating the waves of the profession.
I might have mentioned once or twice that I greatly value being near the shore. At times, it feels like a physiological drive. I did my residency a few hours inland, and when I would head back for visits to my hometown near the beach, there was a sense of physical uplift as soon as I could smell, let alone see, the water. Thus, most of my vacations, and ultimately my home, have been coastal.
One sees plenty of people engaged in balance-related activity in such places, whether it is stand-up paddleboard, various types of surfing, even boating from a certain perspective. It is somewhat captivating to watch someone trying to maintain balance, which I suppose is why so many folks like watching gymnastic or skating events in the Olympics.
I think part of the attraction is an instinctive awareness that balance is never permanently achieved but is actually a constant struggle to maintain. Outside of a vacuum, there are external forces requiring compensatory adjustment, and even intrinsic disruptions (muscle tremors, respiratory motion, etc.) conspire to move one’s needle from dead center. Really, the best we can do is to stay close enough to a balance bullseye that our deviations from it are inconsequential.
That is not just a physical phenomenon nor is it confined to individual mental/emotional affairs. Try organizing a group of people into a team with mutual goals and perhaps competitors, and all sorts of new types of balancing come into play. Anybody who has been in the radiology world for long could tell you about our constant struggles to remain upright, let alone perfectly poised.
For instance, consider case volume versus the number of radiologists. Someone unfamiliar with our field might not appreciate why this should be an issue. Why not just retain enough rads so that all of the work is done on time? If you have five rads and there is always a backlog, just add a sixth or seventh rad, whatever it takes.
Get to know the field and you see things aren’t so simple. Suppose you have more work than five rads can routinely handle, but not enough for six. Can you afford to add a rad when it means that some of the team will wind up sitting idle? Will they all partake in a cut in revenue when you have to pay six people for, perhaps, five or four folks’ worth of work? Might one or more of your initial five rads get irked and leave, especially if they were paid on a pay-per-click basis?
Things don’t occur in a vacuum here either. The workload is unlikely to remain static. Maybe some days, fewer patients show up to occupy the scanners or a bunch of STATs show up to bloat the schedule. Perhaps a referrer stops sending some or all of what he or she used to, or another enters the mix and leadership recognizes that his or her prospective business is just too good to pass up.
There are as many variables as you can consider. Rads on your team come and go, sometimes not as fast (or slow) as you would hope. Technology advances to boost your capability or disappointingly fails to deliver. Referrers come up with new expectations of turnaround time, subspecialty reads, etc. Government, regulators, and insurance companies impose ever changing rules and play with numbers you have been living by. Now you have to figure out how the new lay of the land will impact your operation and adjust your balance, so you don’t fall over.
Some rads (or rad groups) take the struggle for balance as a given, and approach it as a windsurfer might. There are constant changes all around so no point in struggling to achieve perfection. Even if you do, it will be momentary, and there is no point stressing about it.
Some seem to relish the challenge and are reminiscent of daredevil surfers seeking out the gnarliest waves. A rad group near me was mildly infamous for gobbling up whatever hospital contracts they could, only worrying afterward about recruiting the additional rads they would need to live up to their commitments. Sometimes they failed to, hence the infamy, and they even went belly up once or twice as a result.
Others are more like stand-up paddleboarders, expecting and/or exclusively choosing conditions that will allow them to control as much of their situation as humanly possible. The exemplars I have seen sometimes overestimate their control, and a lot of stress, disappointment, etc. can result. Still, if they manage to stay afloat, they do seem to maintain a greater sense of stability. Their operations might not grow as rapidly as in the more tumultuous outfits mentioned above or at all but not everyone needs or wants that.
There is a sort of “meta” balancing involved for the worker bees in these organizations, the rads who have no real control or even input into the balancing efforts of the folks in charge. Going back to the nautical metaphor once more, you don’t have to be steering the ship or charting its course to suffer (or enjoy) its pitching and yawing. As a passenger, you are still trying to maintain your own balance.
For instance, consider the infamous rad group I mentioned earlier. When it had gobbled too many contracts and recruitment hadn’t caught up to the subsequent obligations, the rad group was in the habit of sending their rads all over the place from one facility to another (they didn’t have a robust tele structure to do otherwise). Rads had to frantically get work done in one location and then drive to another within each workday, sometimes three facilities or more.
A lot of rads in that situation would, and did, get stressed out and leave. Others, with a differing temperament, might have thrilled to it, and seen it as a chance to grow in their career. They might have told the bosses, “Hey, I can endure this in the name of the greater good but let us talk about some recognition for my practice building efforts. What sort of shareholder status might I be looking at in the visible future?”
