The Best-laid (Backup) Plans

June 19, 2015

A little adjustment can go a long way.

Last column, I began relating the tale of how, despite months of planning in advance, my move from nocturnal to daytime teleradiology work didn’t immediately pan out as intended. Specifically, the reams of X-rays that were supposed to be awaiting me were decidedly non-reamlike in number…and, as a telerad who is compensated purely according to his productivity, I was a wee bit concerned about my financial situation for the month.

I daresay the anxiety was not unfounded. I was only the third doc vRad had transitioned into their daytime X-ray initiative, and as far as I was aware, the first two had not encountered my dearth of work. Thus, there was no established precedent for me (or, I imagined, vRad’s leadership) to know what might be done to remedy the situation.

My nightmare scenario was that the answer would be nothing. vRad has, I think, over 400 rads in its ranks, and there are surely more out there looking to sign up. Especially if the teleradiology-detractors out there turned out to be right, and telerad companies regarded us docs as nothing more than interchangeable cogs in its machine, I could have been given a cursory “Sorry, that’s just how things are.”

Happily, there was instead a bit of number-crunching behind the scenes, analyzing how productive I had been during my previous nocturnal workshifts. My average productivity (when presented with a full worklist) was calculated, and applied to the idle-time I had experienced during the daytime hours.

This was, by no means, a one-way-street handout. During those idle times, I wasn’t sneaking away from my workstation to go lounge in the sun on my patio, or taking naps. Rather, I was sitting, fully attentive at my RIS, ready to grab any studies the moment they appeared. Both because I wanted to demonstrate my work ethic, and because, as I mentioned in my last column, I had come to really dislike being less than 100% productive.

Which, as it turned out, worked well for vRad. I had offered to move back to nights until more daytime work was available for me, but it seemed there was a facility or two that sent daytime cases that might otherwise not get read quickly in my absence. These cases, therefore, could enjoy a quick turnaround time due to my eagerness to grab them.[[{"type":"media","view_mode":"media_crop","fid":"38705","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_1416003729005","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3875","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"Eric Postal, MD","typeof":"foaf:Image"}}]]

Ultimately, temporarily adjusting my hours was part of the solution. vRad staff and I had noticed that my worklist began to show more signs of life in the later afternoon and evening hours, and we experimented with having me onshift from, say, 1 PM-11 PM rather than 9 AM-7 PM. This resulted in maybe half of my idle-time being eliminated, as there was pretty much always stuff for me to read as evening arrived. Effect: vRad would subsidize me less, and I would feel less anxiety about not earning my keep as much as I had when I’d been on nights. Meanwhile, they would be furiously working behind the scenes to get me licensed and credentialed such that more facilities sending daytime X-rays would be available to populate my worklist.

A more cynical mind might ask: Why would vRad go through these efforts for little ol’ me? Surely, it couldn’t be just because they were swell folks looking to dispense goodwill and fair play. (For what it’s worth, I might be Pollyannish, but I do believe this was a significant factor.) I wasn’t in on the discussions of the situation behind the scenes, but here are some reasons why I imagine it was in vRad’s best interest not to leave me hanging out to dry:

The daytime X-ray initiative remained an important part of their strategy, and while I was not the first rad to volunteer for it, I am far from the last. It would serve their purposes not at all to have rads getting punished for stepping up to the task.

Not to toot my own horn, but I’m a bit more productive than the average radiological bear. Even to someone considering radiologists as interchangeable cogs in their machine, if I stand to be even 10% of a better return on investment than a random replacement, and resources have already been spent to get me licensed and credentialed for my current post…it might make sense to put in a bit of extra effort to keep me in the fold while more work is gathered for me to do.

Morale-not just mine and that of the other daytime X-ray program participants, but that of other docs in vRad’s ranks. Word travels fast in our radiological sphere, and a rad who sees that his current gig is liable to do right by him if circumstances go awry is less likely to have his head turned when another job offer comes along. Other rads seeking work might also be that much more attracted to an outfit with such a reputation.

These, and the other behind-the-scenes reasons I have probably failed to consider or mention, are far from brilliant innovations in management and human resources, and certainly not unique to teleradiology or indeed health care. Yet it’s been something of a breath of fresh air for me in this field where it seems we have grown accustomed to receiving the barest minimum of decent treatment (or, often, the maximum tolerable abuse).

Someone in the upper ranks at vRad-I forget who-once made a remark about favoring strategies where “We all win together,” as opposed to the group getting ahead at the individual’s expense or vice versa. I daresay it’s a philosophy more radiology groups would do well to emulate.