If income is the object, there is never enough

November 1, 2004

"Dr. Dick, I was wondering if you could donate time at my church's free clinic?"

"Sorry, but I already have too many volunteer commitments."

"Pardon me, but exactly what volunteer work would keep you from helping?"

"If you must know, this Saturday I will be picking up litter."

"Wait a second. I had to redo the schedule so that you could go to a polo match Saturday."

"Yes, our team's agreement with the county is that we clean up our litter after the tournament."

"How civic-minded. What other commitments do you have?"

"Last month, I gave up a whole week of my time to lend my support to local government."

"You just served on a jury!"

"I wanted to do my civic duty."

"Hah! The only reason you didn't slither your way out of it was because you were assigned to the barium pits that week."

"I donate time every month to a clinic in the city."

"What clinic?"

"If you must know, it is the Dahmer Clinic."

"That's an infertility clinic. My wife and I used that clinic because of my, you know, low counts. The only people who donate there are . . . oh, my God!"

As Dr. Bob awaits the results of what he thinks are his son's DNA tests, let's hear about the less terrifying experiences in Kenya of Dr. Tim Warren, director of body imaging at the University of Washington.

"When I was in private practice, our group had a shared philosophy that quality time off was just as important as income. For every 10 years of service, each partner was entitled to a three-month sabbatical at half-pay," Warren said. "It was the most incredible experience of my life. It changed me in surprising and unexpected ways."

Warren combined his three months with two months of vacation to volunteer as a teacher at the University of Nairobi.

Unfortunately, too many groups use income as the sole measure of success. Imagine if you were not feeling up to par, and you went to your doctor to find out what was wrong. How would you respond if, instead of actually examining you or getting any lab tests, your physician just asked you how much money you make each year, how much you have in your bank account, how much your car and house are worth, and how much you spent on your last vacation and then, after hearing those numbers, pronounced you perfectly fine? You would think this doctor was a quack. Yet many groups judge the health of their practice based only on income and not the mental well-being of their partners and families.

I interact frequently with radiologists throughout the U.S., and I constantly hear about the pressure groups are under to make their practices more profitable. This is a perfectly appropriate goal and one I fully support, but not at the expense of the overall health of a group. The pressure to meet the numbers often results in cutting corners to squeeze in just one more patient or using billing contortions that are so creative they can leave radiologists with a sense of having violated their own standards.

I was stunned recently when a radiologist told me that he needed to find a better paying job because his wife and kids couldn't exist on anything less than $450,000 a year. These people have truly lost their perspective. Financial success can enhance our lives, but unbound materialism can be a toxic and destructive force. Warren recounts his experience in Kenya.

"It was a revelation how happy you could be with so little," he said. "We had a tiny apartment with no source of entertainment, and yet my wife and I were so much happier there. We were able to reconnect and revitalize our marriage. I learned to appreciate my wife even more."

For the past 20 years, researchers have asked people throughout the world to rank their lives on a scale of 1 to 7, with 1 being totally dissatisfied and 7 being totally satisfied. Americans on the Forbes 400 list, the richest individuals in the world, rank their lives an average 5.8.

I have asked this same question of several radiologists, and the responses were all less than 5, with one being 3.5. This is in dramatic contrast to the nomadic cattle-herding Masai of Kenya, who ranked their lives a 5.8, as did the Inuit of northern Greenland. These comparisons become even more stark when measured against Calcutta's slum dwellers, who ranked their lives of grinding poverty a 4.6. The point is not so much that some radiologists are dissatisfied with their lives but that money cannot buy happiness even for the world's wealthiest. The world's poorest people don't consider themselves that bad off, because they have a more balanced perspective of their lives, compared with some doctors for whom luxuries have become necessities.

Longitudinal studies of individuals who self-identify as "happy" demonstrate that they go on to earn higher incomes compared with those who do not. They also eventually score higher on measures of initiative and productivity. Therefore, it may make more sense if a group wants to increase its income to focus on making sure that its partners are happy and expect the income to follow of its own accord. But what makes people happy?

Professors Ed Diener of the University of Illinois and Martin E.P. Seligman of the University of Pennsylvania have shown in their analysis of 150 studies of wealth and happiness that happiness is a product less of wealth and more of personal relationships, satisfying work, community involvement, and a sense that life has meaning. For Warren, volunteering fulfilled all those goals.

A study by the American Medical Association in 1994 found that two-thirds of practicing physicians provide free or reduced-cost care averaging 12% of their time. The study also demonstrated that physician volunteerism had increased between 1990 and 1994. The advent of the Internet makes it even easier to find opportunities for volunteering. Diversion magazine has an excellent list at www.diversionmag.com. Health Volunteers Overseas and International Medical Volunteers Association also have helpful Web sites. Warren learned about his opportunity from a seminar at the RSNA meeting. If you don't want to go abroad, two-thirds of local medical societies act as clearinghouses for volunteer opportunities. Many religious organizations also have lists of opportunities. For those worried about malpractice issues, 43 states have laws shielding volunteer physicians from some degree of liability.

The benefits of nurturing a group philosophy that focuses on the well-being of the individual physicians should take into consideration volunteerism, which can have the added advantage of increasing productivity, satisfaction, and financial success. Under these circumstances, learning that you are raising the mutant spawn of Dr. Dick may prove less psychologically shattering.

Dr. Trefelner is a radiologist and cofounder of NightShift Radiology. He invites comments by e-mail at ericxray@pacbell.net or fax at 650/728-5099. He also answers questions posed by readers in the "Ask Eric" column on diagnosticimaging.com.