Are You Hungry, Radiologist?


Can a return to a per-click reimbursement model reignite one’s drive?

Casual acquaintances might not guess it of me, but I am kind of a sucker for most of the Rocky movies. I couldn’t tell you how many times I have seen each one of them. If someone could magically tell me the number, I would probably be embarrassed by it.

An expression that came up in a couple of the movies, one that is apparently common among boxers, was “Are you hungry?” It is surely not exclusive to that sport. Of course, anybody doing that kind of demanding physical training has to be eating a lot, but in this context, it refers to a hunger for victory, even just the competition that leads to it.

This has been on my mind a lot in the past couple of weeks. I recently switched jobs, something regular readers of this blog knew was imminent. The new gig is per-click, a model I have not lived by since the end of 2018. At that time, I wasn’t sorry to be leaving it behind. I have previously written about ways that per-click can be bad for a rad, and those writings were mostly from firsthand experience.

Subsequently, I enjoyed the reliability and security of a steady paycheck (first based on an hourly rate and then an annual salary). In both systems, there was an additional mechanism to reward productivity with bonus money, something I also appreciated.

I had seen enough instances of unrewarded productivity to know what results from typical human nature. Some people carry more than their share of the team’s burden, others less. Without consequences, there is nothing to fix that differential or even to prevent it from getting worse.

Unfortunately, the productivity/bonus apparati I experienced subsequent to 2018 were “less-than.” That is, it was theoretically possible to do better for oneself by working more but realistically, not so much.

Sometimes the case mix wouldn’t allow for it. For instance, I might get nothing but low-value ICU chest films for half of my day while CT and the like got shunted elsewhere. Sometimes, there wasn’t enough work sent to my list at all, and I would sit idle, waiting to jump on anything that turned up before someone else grabbed it.

At other times, the hardware/software infrastructure held me back. Whether or not there were cases on my list, a crashing workstation or dysfunction in the system that fed it could do a real number on me. More than occasionally, I felt like a capable racer who had been mandated to wear a weighted vest, or old, worn-out running shoes.

A particularly synergistic double whammy awaited me when I had a shift full of those ICU films and a system struggling to open and process each one. Such balkiness adds up a lot faster if you are reading a few dozen films per hour than if you got just a handful of CTs.

At first, I struggled against these obstacles. I had just come away from a per-click system for the previous seven years, and during that time, I was the only visible limit on my productivity. If I was hungry (and I was!), I could do very well for myself. Mind you, I was not one of the top speedsters in that telerad company. There is only so fast I feel like I can go before quality or my sanity suffer, and neither is dollar-negotiable to my way of thinking. Still, I was well within the upper percentiles.

I brought that hunger to my subsequent non-per-click world. It wasn’t just about reaching for bonus money (though that would have been nice), it was also about giving a good accounting of myself. Running into the obstacles mentioned above, I was frustrated but initially had the notion that I could “adapt and overcome.”

Time passed and I saw that there was only so much I could fix or improve. Appealing to superiors who might remedy what was beyond my reach, I met with no additional success. If I kept my hunger alive, I would just be banging my head against the wall so I gradually squelched it.

Slowly but surely, my attitude toward work shifted. When I had been hungry, I lunged for cases. I often signed in early for work and logged out a little late. I minimized my breaks, and usually enjoyed what I was doing. However, when that hunger was frustrated, opening cases lost much of its joy. I still logged in on time and completed my obligated shifts, but it was a drag. As Chris Rock once observed, I was working at a job, no longer a career.

Like actual dieting, it’s initially a struggle to suppress such hunger, but one gets used to it. Eventually thinking of a return to the per-click world, enough time had passed that I genuinely wondered if I could rekindle my appetite. Sans weighted vest and worn-out sneakers, would I still be able to run at my old pace? On some level, I knew there was no reason I shouldn’t be able to, but I wouldn’t really know until I was trying to do it.

The starting line was a couple of weeks ago, and of course there’s been a learning curve as well as the usual process of setting up and optimizing equipment. It took me almost a month in my first telerad gig, back in 2011, to get up to what I considered a decent pace, and I continued to improve over multiple subsequent months. I did not expect to go from 0 to 60 immediately this time either.

Whatever doubts I had developed about myself, however, were wiped away almost immediately. Cases loaded speedily, my system functioned the way it should, and there was no institutional nonsense to hinder me from reading cases as speedily as I felt capable. I hit the ground running.

It was like the past five years had not existed. In the blink of an eye, I was hungry again.

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