Behind the 8-Ball

October 26, 2020
Eric Postal, MD
Eric Postal, MD

When a self-imposed expectation of productivity is a driving force.

It was one of those workweeks: I spent much of each day behind the 8-ball.

That metaphor will mean different things to different rads. Heck, it has meant different things to me over the course of the four jobs I’ve held since finishing fellowship.

First was in a group of outpatient imaging centers which routinely maintained a backlog of unread cases in each location. Freshly graduated from hospitals where all the work got done each day, I could see that this was a very different mess. Attempting to get everything done here would be tilting at windmills. But, that didn’t stop me from striving to make a visible dent as I tried to prove myself to the practice.

At some point, the practice rotated me to one of its saner locations, where I was actually able to get everything done and up-to-date. This was noticed – one of the other rads was also young and hard-working, and the group responded by exclusively assigning one or the other of us to that office. It was only for half a day at a time, though, so we wouldn’t be able to quite get everything done. Still, it would be far better than their other locations, to which we’d get rotated for the other half of each day.

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Lesson learned: Getting out from behind the 8-ball would result in either you or the ball being moved squarely back in place – and, with no recognition for your efforts. The group’s offer for me to stay on with them after that year was laughably bad, so I moved on to another local group, also exclusively outpatient imaging. (The other young rad was married to the managing partner’s daughter, thus less able to extract himself.)

My second group also had a routine backlog of work, albeit far less egregious. It probably had something to do with fewer sites generating cases, and fewer rads necessary to stay on top of it all. Here, it was far more possible to get everything done every day, and while they were initially pleasantly surprised to see me empty the bin of case files, they soon came to expect it.

I didn’t mind such expectations, since I was, theoretically, in a partnership track and happy to have a chance to prove myself. It also felt nice and refreshing to be able to, once again, get all the work done each day. Even when a larger volume of cases was made available for me to draw from, I took it on. The only real sense of being “behind the 8-ball” here was when other tasks got in my way and allowed more unread cases to accumulate at certain times of day than usual, and I thought I might not actually get everything done before it was time to leave.

You might be noticing that being behind the 8-ball, for me, tends to be a self-imposed sense of productivity below what I’d like to maintain. Most of the causative factors are beyond my control, but often I’ll have a sense that I can compensate for those from my side of things. Adapt and overcome.

So, it was that I approached my third gig, in vRad, with optimism. Here was a massive business with a proven model of giving you all the work you could possibly want, and a bunch of tools to get it done efficiently. I would no longer be held back by the quirks and limited resources of my previous, comparatively tiny rad groups. Gone also, however, would be the days when all the work was done and “caught up.” Indeed, if that ever happened, it would be vRad’s failure not having anything for its pay-per-case rads to do.

It turned out there were still some things which could hold me back. When vRad’s system went down, or they simply chose to do software updates in the middle of my shift, their model didn’t have any mechanisms to compensate for the loss of productivity.

Even without such outside interference, I found that I had my own internalized 8-ball to get stuck behind. After being in the radiological world for a few years, I had developed a sense of how much work I was capable of doing—not only in a current environment, but in an ideal setting. If, in a typical day, my hourly pace was behind what I knew it could be, I’d get that “gotta make up for lost time” feeling. I’d even get that sensation when I’d had an unusual preponderance of low-value studies on my list, XR instead of MR, and my “work-unit” tally was falling behind its norm.

Coming back to the present day, I’m considerably less productive than I was at vRad. There are more than a few ways that could be changed—again, mostly beyond my control, but I adapt when and how I can. It’s no longer that every gained (or lost) case impacts my bottom line. Rather, I just want to give a good accounting of myself.

This past week, for instance, software issues were interfering with the transmission of cases to the group’s telerad system, such that I spent substantial chunks of each day with nothing available on my worklist. I could have shrugged and sat back, reassuring myself that whoever tracks productivity in my group would know the telerads were hamstrung and should not be regarded harshly if their daily numbers took a hit…

…but my 8-ball instincts wouldn’t allow for that. Instead, I watched, rather hawk-like, with each “refresh” of the RIS screen, that I might grab whatever new case had managed to trickle through the system. I knew that not all of the other telerads might be doing the same, but if even one was, darn it, I would be the faster gunslinger and click first.

There is, without question, added stress in maintaining an awareness of being behind the 8-ball, let alone carrying one around in my mind. I find that the adaptive value outweighs any excess anxiety it might bring: It gives me an extra edge as I play “catch-up,” focusing on tasks at hand and ignoring distractions.

Also, the sooner my 8-ball alarm starts going off, the earlier I can figure out what set it off and get to work fixing things. Sometimes, that includes identifying what caused the situation – and learning how to avoid or even prevent it in the future.

Follow Diagnostic Imaging Editorial Board member Dr. Eric Postal on Twitter: @EricPostal_MD