Satisfaction in Radiology: A Fractal Phenomenon

I have written in this blog about how my career has steadily improved in pretty much every way. One way is the amount of time off available to me. Since I am a 1099 telerad who gets paid per click, I can take as much vacay as I like as long as I give advance notice. The limiting factor is that less work equals a smaller paycheck, so I have plenty of incentive not to go wild.

Once upon a time, for instance when I was salaried in an outpatient imaging center, I was much more constrained. Even then, I had more of an allowance for time off than I needed. In some of my gigs, I have been able to take less time off in exchange for more pro rata cash. I would generally space the time I did take off around the calendar year.

It wasn’t a perfectly even distribution, such as a week off every two months. Sometimes the interval would be shorter since I liked to cram more into the winter for warm, beachy escapes.

I became aware of a peculiarity. No matter how long it had been since my last break, it seemed that my patience with various imperfections of my job would run out just before my next getaway. That included when I worked the entire summer since I live precisely where I want to be for that season. I would be on a relatively even keel for three solid months, but ready to blow days before taking a trip in autumn. Meanwhile, if I scarpered in January and again in March, I might only make it three weeks before getting on my last nerve.

Not that I have made a scientific study of it, but a decent amount of anecdotal evidence tells me that other folks experience the same thing. I suspect higher-stress, harder to get lines of work like radiology are more predisposed to it. If I were in an easily gotten job that did not pay well, I might not stick around to endure any major dissatisfactions. It wouldn’t really be worthwhile, and my chances of finding another comparable or better gig would be strong.

As my career and overall life circumstances have gotten better, I have come to the conclusion that the variation in tolerance for work-related nonsense was just one manifestation of a larger phenomenon. Satisfaction, or lack thereof, scales to one’s circumstances. It’s a psychological fractal.

If you are unclear what fractals are, you are not alone. A glance online shows plenty of people arguing over it, many far better versed in mathematics/geometry than the average Joe (even Joe Radiologist). The definition I chose to accept was a pattern that repeats itself in the same way as you zoom in or out on it. The crystalline structure of a snowflake is a common example.

Regarding (dis)satisfaction, I have perceived that many folks will find themselves vexed or pleased with about the same frequency no matter how their circumstances change. That might not be understandable from the outside. A middle-class person might not get how a fabulously wealthy one could be anything but deliriously happy with his lor her lot, but if you ask the rich person, he or she would be able to give you a list of things he or she wished were otherwise. Whether or not the middle-class person would consider those to be “real” problems is another matter.

Docs like radiologists have a rarer perspective. Unless we happen to be born into particularly good circumstances, our eventual lives as attendings are a giant leap upward from where we got started. Even those born with a silver spoon in mouth have to go through residency, where income divided by number of hours worked, at least when I was in training, can dive below minimum wage. (A web-based AI estimate I just grabbed said $15.62.)

Off the top of my head, my major concerns during residency were: physical health (how to fit an exercise regimen and sufficient sleep into a schedule, which was heavily taxed by demands of the hospital); professional success (finding yet other bits of time for things like reading/studying); and financial viability (making ends meet on house staff salary). Last but not least was quality of life (finding opportunities to meet up with friends, date, or God forbid, just sit and watch TV).

Residency and fellowship done, those particular sources of potential dissatisfaction — for instance, “I’m shorting myself on sleep every night and feeling crummy by the end of each week” — faded into the background but other things took their place. I still didn’t have perfect attendance at my gym but I might feel as dissatisfied by missing a couple of days in a week as I would have if I missed most of a month during my IR rotation years earlier.

My self-estimation of professional success shifted from “Am I studying enough and not looking like a fool when my attendings ask me things?” to “Is my performance giving the rad group any excuses not to make me partner at the end of my track?,” although if you have read this blog long enough, you know that didn’t work out, and I might as well have not bothered.

Nowadays, I would know better than to complain to anybody because dissatisfactions in my current (best-of-career thus far) gig are objectively miniscule. Subjectively, however, when PACS rarely goes down, voice recognition screws up the same way for the gazillionth time, or referring clinicians behave like northern ends of southbound horses, I can still feel that the ups and downs of my satisfaction occur in roughly the same frequency and intensity as they once did. Like fractals, they scaled with my circumstances.

This phenom works in both directions by the way. If, heaven forbid, I should lose the ability to practice radiology (if AI takes over completely for instance), it would be a harsh adjustment, but I know I would adapt to whatever new level at which I landed. My (dis)satisfactions would scale back down with me.

I know this because of what happened when my less-than rigorous work ethic as an Ivy League student jeopardized my entry to med schools, and I ultimately took a spot at a bottom-rung (but legit) joint. Yes, there was a sense that I had transgressed and been cast out of academic paradise, but I found sources of satisfaction even then. That included losing the 30 excess pounds I had taken on in the university food halls and getting into the best shape of my life.

In the lengthy path from med school hopeful to attending radiologist, there is plenty of opportunity to think, “One I get past this, everything will be wonderful.” It is good to have motivations, but I would suggest an awareness that there is no true “happily ever after.” One just levels up and moves on to the next plane of challenges.