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Reaching For and Relinquishing the Reins of Leadership in Radiology


While leadership offers a variety of benefits for ambitious ladder climbers in radiology, does it lose its luster as goals shift later in one’s career?

Years ago, I wrote in this blog about a cellphone game that had begun gobbling up my spare time. I started playing not long after the game’s launch and became one of the players on the cutting edge as the game grew.

Part of that growth was the institution of teams or “Guilds” within the games. Up to 50 players could work together to pursue communal loot or compete against other guilds. I had no way of knowing whether any given guild started by someone else might prove to be a good one so I decided to start my own.

That was not my only reason. There are a bunch of motivations for seeking leadership. While I am sure individuals’ priorities vary, I suspect most are driven by the commonality of having control over one’s own fate, or at least a hand on the steering wheel. Other reasons may include being able to ensure things are done properly, increasing the stability of one’s situation, and/or getting a “slice of the pie” or other rewards beyond that received by the grunts.

Radiology is no exception. For a long time, it was sort of a built-in expectation that a successful career meant becoming some sort of partner or departmental head. Even if it wasn’t, as I have mentioned before, the typical path to medicine includes plenty of selectivity for “leadership.” Even if being in charge of stuff is the last thing you want to do, you are repeatedly told that you had better be president of this student group or that before filling out a med school application.

I did not dodge that bullet at all. I came into residency with a nice laundry list of previous leadership roles, did a chief res year, and emerged with intent to find a rad group with a hierarchical ladder I could climb.

If you have read this blog for the long haul, you know I lived in entirely the wrong area for that. Lots of people wanted to live there, the rad groups knew it, and they easily got away with offering substandard jobs that had no upward mobility because if you didn’t take it, someone else would. When I took a “partnership track” job, I expected it to be a sham, but the other details were good enough to take in spite of that. If partnership actually happened, that would be gravy.

Of course, it didn’t, and instead of taking other local dead-end jobs, I jumped into the teleradiology pool. I still had a certain drive to grasp the reins of leadership before all was said and done. I had several decades of career ahead of me after all.

My first telerad gig was in a corporate entity of several hundred rads, however, and if even a small fraction of them were similarly ambitious, I would be competing with a much larger pool. Just from a probability perspective, my chances were much slimmer.

It also didn’t take long for me to see that even the top-dog rad was not much better than a mid-level manager, answering to a horde of corporate types as well as the VC entities that owned the place. That eroded the promise of autonomy and self-determination, which had motivated me to seek leadership in the first place. Other motivations got nibbled at as well. For instance, I discovered that, hour for hour, a hardworking, per-click telerad could surpass the stipends given to section heads. I dabbled in a couple of lower-level posts, but they were clearly going nowhere.

When I moved on to a smaller group (dozens of rads instead of hundreds), they were building up a tele-service to support their on-site operations. Of course, they mostly needed me to read cases for them, but they also wanted me to serve as a point man for this new tele-initiative. I had done seven years of telerad and knew a thing or two about the field, observing how the corporate tele entity had done things as well as how the corporation’s client facilities had conducted themselves.

For a while, it went nicely. They actually wanted my input and were impressed with how much I had to give. It seemed that not everyone in the group was on board with the idea, unfortunately, and I ultimately got “ghosted” in my role as tele-lieutenant. That was a compound loss since part of the role was supposed to be helping them develop a tele-version of their partnership track. Once again, some semblance of partnership failed to materialize for me.

I had gotten a pinky finger on the reins of leadership, but nothing ever resembling a firm grasp. Those flirtations had nevertheless shown me that even a more conclusive success wouldn’t necessarily satisfy those leadership motivations I mentioned above. If anything, the odds were against it and my interest had begun to wane. To be fair, I also find that repeatedly trying for something, and failing to achieve it, makes me less inclined to keep trying.

Meanwhile, after playing that cellphone game for about seven years, I have come to a point where managing 49 teammates has run its course. It can be rather like herding cats so there is a limited ability to actually control things. There is no added loot for the extra work, and whatever effort it entails has long since become part of the background noise rather than being intellectually engaging. I am about to hand over the reins to a younger, hungrier guy, and move to a more competitive team where I can just do my part and reap greater rewards.

That is not all that different from what I have done in the last few years of my radiology career. Having gradually set aside the drive for leadership, I have focused more on optimizing things for myself: working precisely the hours I want with the sort of case mix I prefer at rates superior to what I have seen elsewhere.

If someone came out of the woodwork and asked me to take a leadership post now, I can’t say I wouldn’t be moved (out of flattery or, perhaps, if they offered a staggering comp package), but it would be an uphill battle for them. Recalling last week’s blog, this might just be my current stage of “psychoradiological development.” A rad (or cellphone game guild leader) reaches a point where he or she doesn’t feel a need to run things and either ceases seeking the reins of leadership or, having held them, passes them on to someone else.

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