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The Not-So-Holy Grail of Equality


Are all radiologists equal?

Some time back, in discussing terms of engagement with one radiology group or another, I was stonewalled with a blanket statement about all rads in the group being given equal terms. I forget the exact phrasing, but it was something to the effect of “no special deals.” Meaning, in that context, that I would be wasting my time if I tried negotiating better terms for myself.

Forgetting for the moment how such a “my way or the highway” stance might come across to a prospective colleague, the concept of everyone being equal seems anything but obnoxious. We like the sound of equality. It’s fair. Even a toddler could tell you, perhaps not in so many words, that it’s an injustice of the highest order when a playmate gets an extra cookie or a sibling is permitted to have a slightly later bedtime.

The harsh reality is that circumstances, and the people which inhabit them, are never actually equal, notwithstanding such noble sentiments as expressed in the Declaration of Independence. However much one might feel that it would be nice if all were created equal, it doesn’t pan out that way, and it doesn’t take medical school education in genetics or behavioral science to recognize this.

Notwithstanding individuals’ innumerable differences in skillsets, aptitudes, and work ethic, it remains an understandable thing for a would-be employer to hype equality, and not just for the purpose of squelching attempts by new hires (or current staff when it’s time to renegotiate)to get slightly better terms. It simplifies things greatly to have one size that fits all. There’s never a need to dig through files to rediscover which employee got this perk or that accommodation that others didn’t. And one need not worry about X coming by with angry demands when he finds out that Y has been getting better treatment…

…and if you believe that last one, you should know that this column is being digitally penned on April 1. Yes, the contracts might be identical with exception of signatures and dates, but inequality, real or perceived, will seep into the situation one way or another. Perhaps X works in a busier site than Y, and gets more interruptions to his workflow, hence lower measurable RVUs at the end of the day. Or Y gets a disproportionate share of the mammo because X isn’t credentialed (having been hired for his MSK expertise).

Or inequality gets more intentionally introduced. Management might have had every intention of adhering to the “no special deals” rule, but the day comes that it is necessary to get some extra hours covered. Pure equality would dictate that the hours should be divided evenly amongst all hands, which would surely create some grumbling. Instead, a happier alternative might unfold: The extra needs are announced in conjunction with bonus compensation; self-select to do more work, and you get paid more (or extra time off down the pike).[[{"type":"media","view_mode":"media_crop","fid":"33812","attributes":{"alt":"Unequal","class":"media-image media-image-right","id":"media_crop_7964270269445","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3578","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: 200px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©Blue Planet Earth/Shutterstock.com","typeof":"foaf:Image"}}]]

Inequality, however, begets more inequality. Now, grousing might commence over who gets first pick at the extra hours. Some, perhaps more senior and less eager to work extra, might gripe that the bonus money being paid out to others is diminishing the seniors’ share of the profits, and the incentive should be reduced…or eliminated, as those junior to them should be doing the extra hours as their part of “building the practice.” Meanwhile, the more one tries to utilize top-down tinkering to appease this party or that, the further things migrate from a simple “everyone gets equal treatment, no exceptions” environment.

There is also the matter of letting the inequality genie out of the bottle. Whatever prompted the powers that be to move away from a “no special deals” position. Once terms have gotten individualized, it’s a lot harder to revert to an all-are-equal stance without being regarded as anything from unrealistic to hypocritical. Which isn’t to say it’s impossible; again, folks tend to have a strong belief in the justice of equality, and might just buy into the notion that, yes, things got lopsided but we’re going to simplify things and keep them fair from now on. That is, until circumstances arise to disrupt the veneer of equality once more.

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