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Tickets to Paradise in Radiology

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What are the key drivers for facilitating staff retention in radiology?

Suppose you have been tasked with creating a radiology practice from the ground up or restructuring one to breathe new life into it. In an early step, you conduct a focus group of rads to brainstorm what appeals to them in a theoretical job. One would try to ascertain what features bring satisfaction, happiness or even a sense that the job they had found was a professional paradise.

If you have been a rad (or worked with them) for long, you can probably list the yield of that brainstorming session right now. You wouldn’t need to personally agree with all of it. Different strokes for different folks. However, with a sufficient mix of participants and time invested, there might be some opinions that would make you think: “Why on Earth would you want that?” Even with those opinions, however, if those focus group participants went on to explain themselves, you would surely get their point of view.

A step away from not even understanding someone’s input would be dismissing it out of hand as unrealistic or irreconcilable with other goals. For instance, suppose your group is a big, corporate one, or in a hospital with entrenched leadership. If a prospective rad says that a realistic path to partner or other executive-level status is important to him or her, you might just assume you won’t appeal to that person and others of similar mind.

Suppose one rad in your focus group says that he or she is happiest with a broad spectrum of cases. Meanwhile, another rad feels strongly about doing only subspecialty reads and does not like it when colleagues without his or her skillset try reading from his or her case pool. You might determine that there is no way to satisfy both extremes.

Leaving these bits of rads’ wish lists on the cutting room floor may thus seem entirely reasonable, if not necessary. Nobody can be 100 percent happy, right? This is the real world, not a paradise.

I think this attitude is sometimes embraced a little too readily. It flies under the radar that each one of these “wants” is like a lottery ticket to professional satisfaction for chunks of the rad population. If you want them to be happy or have a shadow of a chance at feeling like, yes, their job is kind of paradisical, it is in your interest to collect and retain as many of those tickets as you possibly can. You want to give them, and by extension yourself, more ways to win.

As if that is not challenging enough, individual rad tickets to paradise (with apologies to Eddie Money) might vary over the course of time, sometimes fluctuating in a single day. I might want to read my subspecialty for the majority of my time but prefer to focus on simpler X-ray and ultrasound during my first hour of work when my mind is still getting in gear. I was all about becoming a partner or other leader-type for almost 20 years after exiting fellowship but have come to appreciate having zero responsibilities after my daily shift is done.

In other words, having as many tickets as you can not only satisfies a greater number of rads, but increases the proportion of time each individual rad is likely to be happy. I would much rather have a team that is happy for 80 percent of the day than one that operates at 20 percent or spends some days without any happiness at all.

It might seem that there aren’t too many ways to increase the number of tickets you hold. Here is the amount of work that needs to get done, here are the hours that need to be covered, here is the budget that can be used for compensation, and here are some immutable rules of the environment in which your team will be working.

Some places are just as restrictive as that sounds, and not fertile ground for improvement. If their status quo is good enough to attract and retain rads, maybe they don’t need to make changes. Otherwise, their people will “vote with their feet” and find greener pastures.

The few-ticket outfit might grimly chug along with a revolving door of dissatisfied rads, keeping who they can, indefinitely or might one day wake up and decide it is time for a change. The question then becomes how committed they are to turning things around or if they’re just going to rearrange deck chairs on their Titanic.

Meanwhile, other operations that place greater value on satisfying members of their team will get creative and find more ways to offer paradise tickets. One can often identify them when they talk less about rigid rules and protocols, and more about flexibility and feedback ... and that talk is followed by action.

Some of that doesn’t require reinventing the wheel. For decades, groups have offered parallel tracks to partnership versus permanent “associate” status for those who would rather earn more in the short term, have fewer responsibilities, etc. Similarly, tracked approaches exist for folks who want the security of a salary versus the upside potential of pay-per-click.

The more challenging tickets to create and offer are the ones that do not exist yet. If you talk about them, you are likely to hear lots of rads and groups saying your idea “can’t be done.” They are usually right until someone proves them wrong.

Telerad has repeatedly been an example of this. Once upon a time, it was roundly predicted to be nonviable. Then it was considered by definition to be a nights, weekends, and holidays affair. Some time later, daytime telerad went from being a zebra to a horse, and then it became possible to do daytimes without weekends. More recently, some rads expressed interest in a schedule-free approach: Let me log in when I want and read as many cases as I like. Those rads got disparaged until some groups found a way to create that ticket too.

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