Promises Subject to Change: The Shifting Sands on Which Radiology is Built

On radiology social media, someone asked the peanut gallery if they were receiving annual 2 to 3 percent raises to offset inflation. I had seen only one outfit with guaranteed annual bumps like that, so I was surprised when more than a couple of respondents indicated they have this.

I felt motivated to share the brief tale of my experience. When I encountered a rad group that had such a perk, it put covetous dollar signs in my eyes. I crunched numbers and concluded that it wouldn’t take many years at all for such bumps to put my income at a level comfortably above any jobs I had seen. With the length of career in front of me for compounding percentages to work their wonders, how could I say no?

In other words, it seemed too good to be true and yet, the promise was very simply stated: no ceiling, no caveats. The only way they could possibly not deliver on it would be if they were telling a blatant lie and that wouldn’t be something you would do to an employee you wanted to keep, right? Certainly not if he or she had your written promise on paper and could bring it to a hungry lawyer.

As it happened, I knew a rad who was already with a group, and he was kind enough to advise me that he had just been told his annual bump was going away. Not only that, but the place was cutting his pay. In other words, his employer was undoing a portion of the annual raises he had received in previous years. They had no complaints about him or his work. The rad group was just in a financial tight spot and said this was necessary for it to remain viable.

It was eye-opening for me. I wasn’t exactly a spring chicken and had certainly seen and heard of promises being broken before. Sometimes, it gets dressed up in the name of “it’s just business,” but that doesn’t change the sting of disappointment tinged with embarrassment that maybe, just maybe, one was a fool for believing promises in the first place.

A big piece of the eye opening was that this rad group, along with one or two others I had known to break or discard promises, didn’t come across as particularly sleazy or otherwise likely to act in bad faith. Until then, I guess I had assumed that any decent-sized business that gets off the ground has smart enough people to know what promises they can keep. If they fail to, it is intentional double-dealing or at least negligent miscalculation.

The possibility of the promise-making business entity meaning well but being unable to deliver had not really occurred to me. That might be a pitfall worthy of a mom-n-pop corner store, but not a big deal health-care enterprise.

Of course, as an individual radiologist, it is largely academic whether another party with potential to disappoint you might do so innocently or otherwise. From your perspective, you just don’t want to get the short end of any sticks.

You might have various methods of defending against that, or fallbacks for what you will do if things go sideways. For me, and I suspect more than a few others, my erstwhile blind spot had a commensurate gap in my self-defense, one that I have (hopefully) addressed.

Along with my other means of sizing up my prospective business partner for trustworthiness, reliability, etc, I have added the consideration: Assuming they want to hold up their end of the bargain, what might prevent them from doing so?

If I had applied that to the rad group offering a perpetual annual raise, I would have had my answer very quickly, one that hit home for the rad I knew who was working for the rad group in question. The rad group could run out of money or, at least, wound up with more things they wanted/needed to do (trying to hire rads like myself) than they were obligated to do (continuing to pay/raise the rads they already employed).

I wouldn’t have had to delve so deep into details. All I would have to do was consider that radiology (and health care overall) is not a world that is enjoying annual increases of financial influx. Rather, reimbursements for our work have been getting annual cuts for longer than many of us have even been in the field. If the size of the pie is dwindling, how on Earth is any particular rad group going to be able to defy that trend and give bigger slices to its people every year?

Taking a few steps back from whatever radiological situation you are working in, you might be able to identify multiple promises that stand to be broken should the unforeseen occur. A lot of them might not ever have been spelled out in word or print. Everybody involved may have made mutual assumptions that didn’t seem worthy of questioning. A certain amount of that is necessary for our systems to function at all.

For instance, it wasn’t all that long ago that we might feel zero need to spell out what aspects of radiology require an actual radiologist to do them as opposed to various types of “radiologist extenders.” Now we’re fighting turf battles as to how and when nurses or PAs might be reading MR. Someone suggesting that AI might replace rads, just a few years ago, might have gotten laughed out of the room. Now there is a lot of serious talk about it.

If we didn’t accept some of these promises, spoken or otherwise, as things we could count on, we might spend all our time in “analysis paralysis,” battling over contingencies that might never come to pass. Alternately, if nobody was willing/able to offer us assurances that we wouldn’t be summarily fired, given a 90 percent pay cut next year, etc., when Grok.Radiologist took over our worklists, we might conclude that it wasn’t worth investing any more time at our posts.