The Four-Year-Itch

March 13, 2015
Eric Postal, MD
Eric Postal, MD

Why do we do everything in fours?

At some point during my education, it occurred to me that there seems to be an academic fascination with four-year intervals. High school, college, med…unless one is doing some sort of accelerated program (or the opposite; call a 5-6 year bachelor degree “delayed” or maybe “relaxed” if you want to be kind), there is a progression from freshman to senior, at which point one is theoretically prepared to go on. Even if only to become a freshman once again in another institution.

Residencies vary their terms amongst the specialties, but radiology perpetuated the four-year routine, at least when I did it. Even one of my post-fellowship jobs claimed to offer a four-year partnership track, although I’m not sure that qualifies when four years drags into five, and even during those extra months the promised finishing-line evaporates like the morning dew.

It doesn’t have to be a rigidly-defined four-year affair for this to happen, but after a few cycles of starting at the bottom and progressing through the ranks to some sort of graduation day; one gets accustomed to passing through certain phases along the way.

At the very beginning, the environment (or at least one’s role within it, if one has gone from med school rotations to residency in the same hospital) is full of new things. There might be enthusiasm and excitement at the novelty of it all. Anxiety and stress over new responsibilities, or simply getting a handle on what one’s burden will be.

Months down the line, the dust settles. Eyes less bright and tail less bushy, the no-longer-quite-newbie has meshed with the routine of the place and has some idea of how things are supposed to progress during the remainder of his tenure there. Occasional novelties still turn up, and might be greeted as was the endless newness above, but they might also be viewed as unwelcome disruptions of what had been learned to be the normal routine of things.

More time passes, and experience is gained, hopefully followed by proportional confidence. Things that had previously seemed full of ready-to-absorb wisdom are just part of the daily grind, and familiarity might breed contempt. Meanwhile, other facets, perhaps previously too complex or advanced to comprehend, come into mental reach. A typical workday, once seeming fit to burst at the seams, now seems entirely doable, and even contains slack where pet projects or pure goofing off are possible.[[{"type":"media","view_mode":"media_crop","fid":"33026","attributes":{"alt":"4-year-itch","class":"media-image media-image-right","id":"media_crop_4588079243678","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3479","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":"height: 110px; width: 100px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

“Senioritis” tends to settle in towards the end of the stint. The soon-to-be-graduate has outgrown his position, or at least feels like he has, and might feel like he’s marking time until the official last day. He might have tried to make things more interesting or challenging for himself by expanding his role in the facility, or pushing for what he perceives to be improvements in the place…and perhaps gotten frustrated when his efforts gained no traction. Eagerness to move on might be tinged with the expectation that future work environments will be more receptive to such efforts…or sufficiently closer to perfection that no such effort will be needed.

Even the most academic of individuals eventually emerges from such four-year cycles and begins longer term work somewhere, even if punctuated by occasional contract renewals. Maybe the previous rounds of freshman-to-senior established a pattern, or maybe people just adapt to their circumstances with growing acclimatization or boredom…at some point, to borrow from a Jack Nicholson flick, lack of a date for graduation or other moving upwards raises the question as to whether this is as good as it gets.

I’m only just approaching the four-year mark in my stint as a teleradiologist, so maybe it’s too soon to make such determinations, but I don’t see myself adhering to the usual later stages of the four-year cycle. Reasons why are touched upon in some of my previous columns about tele (I can revisit them if anyone requests), but the upshot would be that, unlike my pre-telerad gigs, I haven’t encountered a ceiling. No partners protecting their turf by hoarding their favorite study types or their bottom line by freezing/cutting my salary; my case mix is whatever hospitals send, and if I want a bigger paycheck I can pursue it with greater efficiency (still increasing even this long after I started!), and/or more working hours.

Perhaps other non-telerad work environments out there have found ways to accomplish the same thing; I can only go by the often-maladaptive practices I have experienced and heard about from colleagues. Were I at the helm of my own rad group, I know I would never let someone I wanted to retain get to a point of stagnation in terms of intellectual engagement or career-advancement. Granting partnership (true equity and a role in decision making, not a paper-thin sham title as offered by some less-than-savory groups) is a classic mechanism for this, but far from the only possible.