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Suffrage Movements in Radiology Groups


Do you have a true voice in the direction of the radiology practice or are you more likely to be voting with your feet?

If you have read this blog much, you know that half of my fitness regimen is distance running. I spend a bit over an hour per outing, during which I have plenty of time to think without interruption by cellphone alerts or other distractions.

That thinking is helped in some ways and hindered in others. For instance, if I come up with something unknown, five minutes into my run, I can’t just hop onto a “Google machine” (as one of my residency mates liked to say) for a quick answer. Like it or not, I have got a solid hour ahead of me to ponder that unknown and try to figure it out for myself.

For whatever reason, voting was a morsel of thought during one of my sessions this past week, and I got stuck on the word “suffrage.” It sounds like it refers to suffering. How did it come to mean the right to vote?

As the miles went by, I concocted a notion that perhaps the idea was that a citizen who is going to suffer whatever conditions are brought about by the management of one’s country or municipality, one deserves a share in its decision making. Without competing ideas, and steadily losing mental cohesion as I expended my energies, it seemed more and more reasonable.

Of course, after I got home and Googled, I saw that my made-up etymology was totally wrong. This was far from the first time and will not be the last.

I have had occasion to think about my own suffrage over the years. Of course, there is the political aspect of deciding who to vote far (and sometimes wondering if it really matters). This also comes up in other arenas, and I find my interest is inversely proportional to the number of other voters.

For example, if I, along with a gazillion other mutual-fund shareholders, get a proxy ballot to vote for the fund’s managing board, I am liable to toss it right in the trash. However, if I am with friends and we are deciding where to go for dinner, I might not only offer my opinion, but argue for it.

It is no big surprise that one gets a lot more emotionally invested in voting when money, or one’s professional livelihood, is on the line. Radiology groups understandably place a lot of importance on who gets to have a say in their affairs. Having worked in a few radiology groups, I have seen it handled and fought over in a few different ways.

I have written about how my last on-site rad job offered a sham partnership to keep me in the ranks. One of the fake things about it was that the “shares” they proposed to give me were a newly created type that specifically did not carry the right to vote within the practice.

It was an unnecessary slight. The only partner other than the owner/founder had a minority share, and even though he technically had the right to vote, he would never have the ability to overrule the senior guy. They could easily have given me something similar. I was young and idealistic enough that it might have appeased me. Being denied a voice outright, however, was one of several reasons why I did not stick around.

Almost a decade later, I landed in a larger group (a few dozen rads) in which partnership was a real thing. Part of why I had joined was the group’s expressed interest in having me help develop a telerad partner track with the group, something with a palatable on-site/off-site differential. That initiative crashed and burned. I suspect a contingent of the group’s rads had never bought into the concept in the first place.

Still, while we were going through the motions, one wrinkle presented itself: Should the telerad version of a partner be allowed to vote? Some folks, such as my younger self, would have considered it a silly, even insulting question. Of course, someone should have suffrage if you are going to claim that he or she is a partner! What kind of partnership is it if the telerad partner doesn’t even get a hand on the group’s steering wheel?

Having been around the block a few times, I found myself looking at it differently. There were maybe half a dozen telerads in the group at that point, a very small minority. Even if we reliably voted as a bloc, the on-site guys would easily outvote us. If they decided to selectively cut pay or increase hours for the off-site folks, we wouldn’t be able to do anything about it. What exactl would voting get us?

I instead suggested that maybe we didn’t need the right to vote and that, if giving it up appeased some of the on-site rads so they allowed other aspects of partnership to happen, maybe it was for the best. What I did consider important was that we be allowed to attend meetings where things might be voted on and express ourselves. If I can speak about why I would have voted this way or that, and I can convince the actual voters to see things my way, that should be good enough.

As it happened, they balked at even letting telerad “partners” attend meetings, which showed me their true level of interest in the initiative. On I went to my next gig, a move which was another type of voting (with my feet).

There are, of course, ways to “vote with your feet” other than completely bailing on a situation. Giving verbal warning is one approach: “If you enact policy X, it will hurt/alienate the telerads in ways 1, 2, and 3.” Alternately, if policy X goes through anyway, such as by slashing rads’ ability to earn bonuses through productivity, one can cast one’s “vote” through action such as relaxing a little more at the workstation and reading fewer cases. Why beat yourself up pursuing an incentive that has been taken away?

Under such circumstances, action in lieu of voting can get the job done. If leaders/voters see productivity drop after cutting incentives, it sends a message: Here are the consequences of the actions you took without our input. If you course correct, we will do the same.

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