When the Best-laid Schemes Gang Agley

Eric Postal, MD

When things are not what you expected.

I mentioned, not long ago, that my role in teleradiology was changing a bit. In exchange for taking on a big chunk of often-nonemergent cases that nobody else wanted (mostly X-rays), I would be able to work during the daytime, rather than continue an intermittently-nocturnal existence.

There have been multiple paraphrases, but Helmuth von Moltke is evidently the original source of the sentiment: “No operation extends with any certainty beyond the first encounter with the main body of the enemy.” In other words, no matter how clever your plan A might be, you’re asking for trouble by not having a plan B. (C, D, and E probably aren’t bad ideas either.)

The A-plan, in my case, was that my move to daytime work would occur after several months of behind-the-scenes prep. For those not in the teleradiology or locums world, this might not be intuitive, but changing workloads is not quite as easy as it might be in a hospital department or private practice. In those circumstances, if it’s decided that you’re suddenly going to be the near-exclusive X-ray reader, pretty much all you need to do is have the XR cases shunted to you from your colleagues’ worklists (or film-bins, God forbid).

In telerad, when the cases are coming from dozens or hundreds of facilities in a bunch of different states, there’s the extra matter of getting the XR-workhorse licensed and credentialed in all of the relevant places. That takes time. There’s also a bit of error-prone forecasting in terms of how much work will be coming from each site, making sure all contracted facilities have proper coverage (both the nighttime sites the dayhawk is about to leave, and the daytime sites the rad is covering when he happens to have a day-or week-off). Plus a gazillion other factors, foreseeable and un-, give or take a zillion.

All of which means that it probably wasn’t the most improbable set of circumstances when I signed in to my first week of dayshifts…and my worklist was something of a ghost town.[[{"type":"media","view_mode":"media_crop","fid":"38473","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_9922488312904","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3819","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 200px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©Huza/Shutterstock.com","typeof":"foaf:Image"}}]]

Again, this might not be something non-teleradiologists envision as problematic. If you are getting a negotiated compensation-package for being at your post and completing the work that comes your way, a lack of work for a minute, hour, or day might seem like a good thing. You are getting paid in exchange for just sitting there while you twiddle your thumbs, check your Facebook, and phone up friends to chew the fat.

When you’re a telerad, though, or in any work environment that bases your compensation on what you produce, this is a problem. If, like me, you have gotten accustomed to always having available work on your list, spend the barest-minimum time on breaks for snacks, coffee, etc., and now find yourself doing nothing with half your worktime…you’re facing the prospect of your next paycheck being half what it had been. Anxiogenic, if you were counting on your usual income for little things like paying your mortgage. There was also the behavioral psychology element that, after about 3.5 years of working in telerad, I had come to enjoy the feeling of being as productive as I could be. Sitting idle felt like a huge waste of time.

So, trying to contain my mounting anxiety lest it become panic, I reached out to the medical leadership at vRad. As with any company, telerad, other health care, or just about any organization counting on productive employees (or independent contractors, in my case), they could have done any number of things in response. Happily, they chose to ride to my rescue…and my next column will delve into how and why.