The Slow Guy

On a radiology forum I frequent, there was recently a question about a slow rad. “Not a total tortoise,” the description went, just a substantial chunk below the median in terms of RVU productivity. Everything else about the guy was positive: popular, versatile, helpful, accurate, etc.

The question being, how such an individual asks for a raise—or avoids being first in line for comp-cuts when times get tough? His chief concern in such scenarios was that he’d be pressured to read more...which would make him “uncomfortable.” One might read that to mean he’d worry about the quality of his work suffering, but we’ll get back to that.

Online forums being what they are, responses varied in terms of their sympathy and (dis)agreement. Including the usual back-and-forth between eat-what-you-kill mentalities and those with a more “teamwork! RVUs aren’t everything” philosophy. No point in re-hashing all of that here.

Instead of that big-picture approach that often doesn’t meaningfully percolate through to the real world, I’m of a mind to drill down on what such a comparatively slow rad can do to improve his situation…and what his group can do to support him, short of just throwing him some charity.

My advice to such a rad would be to take stock of what he brings to the table aside from RVUs. Selling yourself isn’t all that different from selling anything else: if you’re trying to convince someone to pay more for you, you need to show them how you’re worth it. Yes, RVUs are the easiest widget in this regard—if you’re on the record as bringing in X amount to the group, it makes sense to talk about percentages of X. But it doesn’t help if your X is lower than others'.

Quality assurance (QA) stats, if your group has a robust enough program in that regard, is a different batch of numbers you can point at. They indirectly get at your med-mal risk. If you can make the case that you’ll cost your group less for insurance premiums and overall liability, you can reasonably ask them to pay you some of those saved costs.

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Your accuracy also gets at things less readily converted into numbers for the bargaining-table…but that doesn’t mean they’re irrelevant. Better reads from you might mean that more referrers will come to your group than elsewhere. If you’re covering hospitals and the like, your group will be in a better position to gain and hold contracts. See if you can “show your work” by naming some referrers who specifically ask for you to read their cases. Or, shades of a political campaign, make some visits to referrers you know to be in your corner. Take them to lunch, ask them if they can boost you when they communicate with your group’s leadership.

The slow rad might also look further afield from reading cases if he wants to show his worth. Take on some administrative tasks. If things need doing that don’t generate RVUs at all, it’s better for the group if the rad doing them is less of a loss to the reading room. Someone needs to do tumor board, for instance: If slow-rad does it, and fast-rad is freed up for another hour or two of producing RVUs at his greater pace, everyone wins.

Not all of these efforts need to be on the part of the slow rad, of course. It might be tempting to other members of the group to let sleeping dogs lie and let him work for as little as possible, even use his non-stellar productivity as an excuse to target him if/when cuts are happening…but that’s short-sighted. After all, remember that the group likes everything else about him and wants him to stick around with decent morale.

While the group itself can look for reasons/excuses to throw some more comp his way, including the factors mentioned above, there’s still the obvious one: the rad’s productivity. Again, he thinks he can’t read more comfortably—but has that been explored sufficiently?

Is everybody involved sure that his notion of “comfortable” is a proper benchmark to be using? Most would agree that reading to the point of discomfort would be a bad thing if it meant work quality took a hit in the process…or if the rad wound up being stressed to the point of burnout. Sort of like flooring the gas in your car so it was operating in the red—not a good full-time thing.

But what if the rad’s notion of discomfort is simply doing the speed limit, still well within his “green” but not something he’s felt motivated to do? One man’s “comfortable” is another’s “lazy.” He might have more range than he realizes…and there might be things the group can do to help him realize that. Instead of a “you need to read faster” tone, aim for “you might be more capable than you think; are there ways we can help you?”

Does he have proper confidence? Has the group given him positive feedback with any frequency, to the point that he knows that a little more speed might not actually make his work suffer? Maybe just giving him quarterly QA reports isn’t enough to do this; actually have someone sit down with him and risk embarrassing him with verbal praise.

Does he feel like he has the tools to go faster? Again, a little interview with the slow rad might be very revealing. Does he feel like he’s having to go slower because he routinely finds errors from the techs and clerical staff? Errors that he feels he’s the last line of defense to detect and correct? Maybe beefing up the quality control at their level—even letting this be an administrative task he’s in charge of—would help.

Is there some aspect of the software, even hardware that he feels might be holding him back? Has he thought of adjustments or upgrades that might reduce the number of clicks he needs to get through a typical case? Is he being required to use templates that don’t mesh well with his particular style?

Having an isolated session like this, however low pressure, might not do the trick—if he’s already worried that he’ll come under scrutiny for lack of productivity, all the gentle encouragement in the world might have him reading between the lines and perceiving the encounter as a warning.

Such anxiety might be dispelled if the sit-down is annual, even quarterly…not a one-off intervention. Make sure he knows others get similar meetings, so it’s not peculiar to him. If it’s just a routine “how’s everything going” session that everyone gets, he might be more relaxed, forthcoming, and open-minded when the subject of productivity comes up.

Follow Eric Postal, M.D., on Twitter, @EricPostal_MD.