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Golf-Like Titration of Goal-Setting for Navigating Career Courses in Radiology


Adjusting one’s goals to varying conditions along the way may facilitate optimal satisfaction and enjoyment of the journey.

I have mentioned in a few blogs that agility and manual dexterity are not strong points for me. While there are some sports-like games I enjoy, I am just not very good at them. My exercise regimen consists of simple things that I cannot possibly screw up, namely running distances and lifting heavy things as opposed to accurately throwing or catching them.

There are varying depths to my ineptitude, however, and I have found that I embarrass myself less with some things than others. From high school through residency, I found myself gravitating towards golf and not just because folks expect a doctor to partake in the game.

I could rattle off a few reasons why, but one crystallized in my mind not all that long ago. A lot of other games, darts for instance, are focused on getting things as right as you can in one shot. True, you can theoretically get a “hole in one” on the golf course, but for the most part, it is about getting as close as you can and subsequently zeroing in on your target.

That meshes nicely with a philosophy I have shared in this blog that I originally learned from Scott Adams (writer, podcaster, cartoonist): systems are superior to goals. If you just have the goal of getting your golf ball in the cup (or to lodge your dart in the bullseye), you might regard most of your shots as frustrating failures. However, if you’ve got a golfing system — good technique, decent gear, etc. — everything you do moves toward the places you want to be. Many more steps along the way are satisfying. You can “enjoy the journey.”

This thought has been on my mind in recent months as I have settled into my current teleradiology gig. I have written before about how rads can’t really know what their capabilities will be in a given situation until they have been there for a while. I can recall how many cases I read per hour, let’s say, in a previous job, but I can only hope the logistics of a new work environment will help me meet or exceed those previous heights rather than hinder me from reaching them.

Once upon a time, I thought telerad would be more homogeneous in this regard. When I left my last on-site position, I did away with variables like contrast injections, fluoro cases, personally going into sono suites, etc. I looked forward to just reading cases in tele. The only limiting factor would be me.

I then gained wisdom about all of the remaining things that still weren’t under my control: limitations of hardware/software employed by various telerad outfits; case mix; cherry-picking (by on-site clients who were choosing what to send to my worklist, or other telerads); demandingness of telerad clients/referrers or the telerad QA system; etc.

Thus, in the course of working for three telerad entities since 2011, I saw that I could read as many as X cases — or RVUs if you want to count that way —per hour in one operation. Applying the same amount of effort at my end, I could face a ceiling of 50 percent of X in another setting.

Whenever contemplating a move to a new gig (or wondering if it is worth staying put, such as if a current employer promises to upgrade its system), there is a key question: How might my capabilities fare in the prospective new situation? What can I reliably promise a new employer or myself if it’s a “pay per click” situation and I want an idea of how much more (or less) I stand to earn in it?

The question at the employer’s end isn’t just a matter of whether I am worth hiring. The prospective employer also has to plan how much work, and of what variety, it is going to supply me. Too much and the employer will need someone to pick up my slack. Too little and the employer is not making the most of its investment in me and potentially disappointing me if I was looking forward to productivity-based comp.

Getting it right on the nose — a darting bullseye — is a virtual impossibility. Sure, it would be nice if I hit the ground running in a new telerad gig, having precisely the case volume I could sustainably handle for each of the 45 hours I choose to work in a given week, but you would pretty much need to have a wizard behind the scenes to make that happen. I don’t think anybody who reasonably thought things through would expect it.

In the golfing analogy, you would make as accurate a guesstimate as you can (initial drive from the tee), see how it flies, and adjust workload afterward (using irons to get to the green and then putting for a finishing touch). Unless you have got the sort of operation where there is sufficient capacity to handle excess cases the new radiologist doesn’t get to, it’s probably best to err on the side of not giving him or her quite enough at first.

In my current gig, this is precisely how things tumbled. As one of the leaders put it, they “titrated” my volume upward every now and then and checked in with me after a suitable interval if I did not reach out to them first. It took a few months (clients don’t just conjure cases out of thin air), but I am now getting enough cases to keep me busy for as much of the day as I like, which is pretty close to 100 percent. I don’t enjoy sitting idle and I think most others prefer a more relaxed pace so their “happy place” would probably have been achieved sooner than mine.

The suboptimal “darting” approach, in my estimation, comes from rads who have insufficient real-world experience or unrealistic expectations of their prospective employers. It also comes, however, from certain employers that can’t, or choose not to, “titrate” things in the name of zeroing in on everyone’s desired goals.

I have seen that at both ends of the spectrum: There are small outfits with one or two helmsmen that have a million things to manage, and thus in the habit of not revisiting previous decisions unless forced to do so. Alternatively, there are huge entities, bogged down by bureaucracy where things get buried in committee. Yes, folks might talk about titration, but it has a way of never quite happening on a meaningful timetable.

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