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Talk About the Elephant in the Room Before it Tramples Your Radiology Group


While the status of incentives, such as yearly bonuses or partnership track aspirations, can be a tricky conversation, ignoring it can be the tipping point for a radiologist’s exit to another practice.

I recently chatted with someone who was about to take on a new leadership position. Part of my two cents was a subject I have touched on in these blogs: a sometimes cyclical pattern of morale experienced as one goes from taking on a new job to ultimately moving on from it.

It might be hard to pin down at the time, but if job satisfaction is trending downward, one can usually think back and identify a tipping point. Perhaps work had been a positive thing or at least stable, if not looking to get better with time, and somehow that changed.

Wait until after that has already happened, and you have got a much bigger task to course correct than if you had avoided that fulcrum entirely.

There is one good thing about holding a few different jobs since fellowship. I have experienced this process more than a couple of times. I have also seen how other rads around me have dealt with the same circumstances. When you see other folks react the same way you do, it goes a long way toward self-validation. If they react even more strongly, you can come away feeling that you were extra patient and reasonable.

Each time I left a position, it was always my choice. I have fortunately never had to deal with being canned. My departure was more or less for the same reason. I had reasonable expectations that did not get met, whether they were partnership tracks that went nowhere, bonus or profit-sharing plans that never came to fruition, a lack of upward hierarchical growth, etc.

These weren’t private little pipe dreams I kept to myself. If they were not actually written out in contracts, they had been discussed as realistic incentives. Perform well today, and you will get X tomorrow. Meet goals this year, and you will be in line for bigger and better things next year.

Almost invariably, my fulcrum was when I noticed that these “better things to come” stopped getting discussed by anybody who might have the power to grant them. As an employee, I was usually reluctant to bring up the subject lest I look like more mercenary than team player, or needy rather than confident.

These incentives became elephants in the room. Nobody forgot about them and, as time went on, they became harder and harder to ignore. This was especially the case if there were deadlines involved. My hiring anniversary date should ultimately be when partnership got granted. The end of the fiscal year would be when we finally learned the size of our bonuses. If the deadline arrived and nothing was given or even said, was I just supposed to slink away with my tail between my legs, or humbly beg for an audience with my hat in my hands? Where’s the professional respect?

If you’re the one who doesn’t have the information in that kind of situation, you start drawing conclusions for yourself or with other employees who are also wondering about the situation. It’s hard to think of any positive reasons why all talk of incentives has dried up. People generally like to share good news, especially if it will boost morale and performance on the team. On the other hand, if they keep their mouths shut, it looks like they have something to hide.

The longer I had those elephants in the room, the more they would wear on me. I would increasingly resent the folks who knew what was going on behind the scenes and intentionally kept me in the dark about it. Did they think I had somehow forgotten about the incentives they had once promised? That would be even more insulting.

Perhaps they even resented me in return. Here they had bad news or maybe they had no news at all, waiting on other developments to know where they stood. However, they knew I expected them to say something. Every time they had to deal with me, they would be in the uncomfortable room with the elephants. Maybe they even started avoiding me and came to blame me for their living in fear of a subordinate.

The advice I gave to that newly minted leader was to avoid letting those elephants into the room in the first place. Resist the urge to withhold information, even if you know it is going to be poorly received. If you don’t even have the information, make it your business to get it. The truth will come out sooner or later. Waiting another six months will lead to the same unhappy reception. The negative sentiment your silence generates in the meantime will be like interest compounding on a debt.

Even worse, suppose the bad news comes out from some source other than you. Now you have permanently lost the ability be the leader who stood up and distributed the info your people needed (and deserved). As far as they know, you never planned to face the music. Maybe you even intended to try pulling the wool over their eyes.

There is an easy solution for this. Get into the habit of giving routine updates. Maybe it comes in the form of brief weekly emails if you don’t already have meetings for other things where you can tack this onto the agenda. If you already have meetings for your partners, that is great. Now do this for the employees who aren’t allowed in that room. If anybody’s working for you who might care about what’s coming down the pike, not making it your business to keep them informed is a lost opportunity.

Your update doesn’t always have to be the Gettysburg Address. You can just give a few bullet points. Let it be an itemization of “What I did as your leader this week.” You can toot your own horn at the same time you’re coming clean about things that are not going so well. If you’re telling your team in July that a lost contract will mean December’s bonuses are going to take a hit, it might sting a little less if you simultaneously point out that contract was responsible for 20 percent of the weekend coverage responsibilities.

Finally, what if you personally don’t have the updates your people want or expect? For example, perhaps you are middle management and answers will only come from the higher-ups. Invite them to speak (or write) or give you a message to relay. If they are reluctant to do so, gently point out that you could use their help keeping elephants out of your shared room.

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