Gnat or Giant?

October 16, 2015

Pick your poison in radiology practice size.

I’ve noticed that, when physicians are in a complaining mood (cue the peanut gallery: “When aren’t they?”), most of their comments can be separated into two categories: 1) Things they don’t like about the health care system, and 2) Things they don’t like about their particular situations/jobs within it.

Except for those with friends in high places (or deep enough pockets to buy some when it matters), no. one is pretty much beyond our ability to do anything about. Assuming one isn’t just complaining for love/hate of the game, might as well focus on no. two.

I’ve also noticed that an awful lot of the latter category consists of issues reducible to the relative size of the entity for which the complaining doc is working, whether as an employee, independent contractor, partner, sole proprietor, you name it. The complaints seem to boil down to the entity being too big, or too small. A cumbersome, awkward, lumbering giant, or an ineffectual gnat.

This is, of course, much more of a spectrum than a dichotomy; however, a doc grousing about his hospital being a bureaucratic maze is unlikely to suddenly sing a different tune if it’s pointed out to him that his hospital is actually a rather small one, and there are multihospital groups that dwarf his own place by an order of magnitude.

Complaints aside, there are strengths as well as weaknesses to being a giant, and for that matter a gnat. Advantages to being a giant come to mind more intuitively; after all, is not the goal of starting a business venture to thrive and expand? To enjoy efficiencies of scale, greater resilience in the face of adversity, and to overmatch or even take over competitors?[[{"type":"media","view_mode":"media_crop","fid":"42431","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_8381795607351","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4590","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: 170px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©","typeof":"foaf:Image"}}]]

Meanwhile, anybody who’s been part of a giant operation can tell you common weaknesses: One hand doesn’t know what the other is doing. Decisions languish in committees and subcommittees, and are made slowly or not at all. Even people in positions of authority can be unclear on who’s responsible for what. E-mails and voicemails are forgotten or outright ignored…because so many other things fall through the cracks, nobody gets taken to task for fumbling a ball.

The gnat life has few to none of these issues, because there are only a handful of people involved, as compared with the human hive to be found in a typical giant. You don’t send an e-mail to some faceless individual and wonder when (or if) you’ll get a reply; anybody you need, you likely see in person on a routine basis.

Gnat decisions get made by individuals, sometimes on the spot, rather than languishing in subcommittees for weeks to months. While a giant would still be shifting its massive bulk and trying to get out of its own way when attempting a change in strategy, the gnat will have turned on a dime and proceeded in its new course of action.

An individual deciding between work with a gnat or a giant, therefore, has the chance to pick his own poison. Someone comfortable playing multiple roles in an enterprise, with a decent chance to have his voice heard and potentially share in upside growth of the place, might seek out a gnat (or found his own). Hopefully understanding that gnats are more vulnerable to being swatted out of existence.

Contrarily, someone seeking greater stability and more of a well-defined niche within it (think cog in a machine) might gravitate towards the nearest giant. Especially if that someone is not bothered by bureaucracy, even knows how to work it to his advantage. And also knows how to play politics, if climbing the hierarchical ladder is his interest.

It behooves the folks in charge of the gnats and giants to remain cognizant of the vehicles they are piloting, not only playing to their strengths but watching out for their weaknesses. A sole proprietor of a private practice gnat might not be able to outbid a 20-doc group for a contract covering the local community hospital. Similarly, the CEO of a hospital megagroup might decide that sooner or later an unanswered e-mail or voice message might have serious consequences…and institute a new initiative to squelch this maladaptive practice.