Erik K. Paulson
2023-24 ARRS President
In radiology, whether you work in a large or small private practice, remotely by yourself, an academic department in a medical center, or part of a mega radiology practice, there has been a palpable shortage of radiologists. This shortage is fueled by a trend toward exclusive subspecialization with declining numbers of radiologists who can handle general work, ever-increasing expectations for service to our patients, referring doctors, hospitals, and health care systems. We have been stretched thinner. There is a desire by radiologists to have more flexible work hours or, simply stated, to work less hours overall compared to years past. There is a concern about what role artificial intelligence and machine learning will play; will we be displaced? Reimbursement has been decreasing relative to inflation and compared with other specialties. As a result of these realities and others, there is clear evidence of burnout among radiologists, similar to health care workers in other specialties. On top of that, sometimes, we find that the leaders in our organizations may be distant, or too corporate, or suffer from “toxic positivity,” which may be worse than “toxic negativity.”
There has been a steady headwind for years, but it now feels like a gale force wind. And a lot of this feels out of our control. So, goodness, how do we manage all of this? Hold on, let’s take a breath. One strategy that we can embrace and control is to develop a culture of teams within our workplaces. In fact, I have titled this series “The Teamwork Imperative” because we must establish teamwork as a core value within the radiology workforce. I believe that if we foster a culture of teams, we can mitigate and shield ourselves from some of these headwinds.
Let me be clear. Here, when I say teams, I am specifically not referring to the “macro teams” that many of us find ourselves in. For example, at Duke Health, it is said that the 30,000-plus employees are my “teammates.” That very well may be true. But no, I am referring to your local and focal team. I am referring to the individuals that you rely on daily or weekly to deliver your work product. It’s the folks you huddle with. And the teams develop where you huddle. If you are in training, I am referring to your team of co-residents, your chief residents, maybe your program director or program coordinator who you lean on. If you are in a private practice, I am referring to those that you share physical space with, or perhaps switch call with, or the individuals you show difficult cases to, or the referring docs you have developed close relationships with, and who rely on you to deliver care. In an academic environment like mine, it might be the members of your subspecialty division. If done well, the division pulls together as a team to deliver care, service, teaching, and research.
Those divisions that have a culture of team are far more effective than those who are unable to act as a team. If you are lucky enough to have these local and focal teams (and these often form and evolve organically), many challenges at work open up and become more manageable and attainable. The clouds begin to lift. Specifically, your deliverables, whatever they may be, are far more easily and effectively achieved if you have your team and approach your work from the perspective of that team.
Work becomes more efficient and fulfilling and, frankly, more fun. The work becomes more manageable, with more aspects under your control. You become more engaged. And that then becomes an antidote to burnout. Teams, therefore, contribute to retention.
Coaches discuss this all the time. I’ll borrow here from Mike Krzyzewski, the legendary Duke University men’s basketball coach. “Coach K” famously talked about the five keys to an effective team, likening them to the fingers on a hand. Each finger is individual and can stand alone, but when the five fingers of communication, trust, responsibility, caring, and productivity come together into a fist, the fist proves to be much stronger than the sum of the individual fingers.
Communication
Yes, of course, communication is about sharing news back and forth, accurately and honestly, but more importantly, communication is to be able to probe, to be able to respectfully question, and to be able to expect honest answers from your teammates. Sometimes, the questions aren’t easy, and the answers may not be easy either. To foster an effective team requires the ability and the safety of pointing out the opportunities—those ones are easy. More importantly, it is to have safety in pointing out deficiencies—those are more difficult. It is critical for teammates to be able to receive and internalize the information coming from within the group, whether it is a kudo, an observation, or a deficiency or a criticism.
You have to talk to each other. Actually talk. And in a world of remote work and texting, we don’t talk enough. Maybe the talking occurs in a partner meeting, defined clinical case conference, resident meeting, or division or department meeting. Maybe it is your team taking a coffee break or going for a midday walk to achieve “step” goals. Hopefully, the team dynamics are such that one can tap a teammate on the shoulder and engage in an effective and safe conversation.
Communication needs to be practiced. That is why I think standing, regular, in-person meetings, even if the agenda is light, are very important. The opportunity to come together regularly promotes the importance and expectation of communication. And it is habit forming. You get better at it.
Trust
Trust means telling the truth, and telling it sooner rather than later; knowing that within a team, that can be hard. It can be hard because so many of us struggle with confrontation and conflict and try to avoid them. But consider it this way, from the perspective of the iconic University of Tennessee women’s basketball coach, Pat Summitt. She said, “The absolute heart of loyalty is to value those people who tell you the truth, not just those people who tell you what you want to hear. In fact, you should value them the most, because they have paid you the compliment of leveling with you, assuming you can handle it.”
Honest and fair difficult conversations almost always produce results. If you can get through the first thirty seconds of a difficult conversation, often the clouds lift and a very productive conversation follows. For me, I need to write down the key first few sentences for that opening thirty seconds and the rest flows. If difficult conversations don’t produce results, you have learned something.
Collective Responsibility
A coach might say, “We win together, we lose together, there is no “blame game.” In the workplace of radiology, the collective responsibility is the pulling together to deliver on our various missions. Everyone does not play the same role. One partner may be a fast and efficient reader, that’s great. Her partner is slower because he spends a lot more time consulting and discussing with referring docs. Both these individuals are important to the team. Or in an academic environment, one may be more focused and skilled clinically, another may be more focused on teaching. In a team where there is collective responsibility, they complement one another and each can be proud of each other’s successes. Indeed, the light of their success shines on the other teammates, on the entire team.
Caring
This is also about humanity and human connections and colleagueship. Caring in a team reflects time spent with each other and sharing aspects of ourselves, in this case the women of Duke Radiology. The caring strengthens the interconnective web between team members, in this case at our annual Fall Gathering. It makes the team softer in a positive way, and more personable, yet, at the same time stronger.
Here is where I worry about remote work. I get it. The pandemic has shown that we can do radiology effectively, even remotely. People like it and expect it. And we have learned that we can teach remotely. Sort of. But it seems far more difficult to foster a genuine, caring environment when work is dispersed in many geographic locales and individuals work essentially independently, free of meaningful, direct interactions with other teammates, other humans. To me the same applies to Zoom meetings. All the nuanced talk and greetings pre- and post-meeting are lost. The body language is lost. The sense of community is lost, or at least different. And I think the effectiveness of the meeting suffers. Indeed, on a Zoom meeting, you can’t even have real eye contact. I worry that with remote work, the culture of our teams maybe eroded. We do need to incorporate the best aspects of some remote work, but incorporate it in a fashion that fosters caring.
Pride/Productivity
Coach K says, “Everything we do has our own personal signature on it…and if we all sign off on everything we do, then we have a chance to be great.”
And your teammates all do have the chance to add their personal touch and signature. Collectively then, we have the opportunity to harness the best of what we can be, and to be great, even with all that is facing us and challenging us in our current and future work environments. “And it is going to be hard; we all wait in life for things to get easier…when we are well staffed, when I pass the Boards, when I make partner, when the kids are older, when the pandemic is over … it will never get easier. What happens is, you handle hard better.” As pointed out by Kara Lawson, Duke women’s basketball coach.
Each of these domains, communication, trust, collective responsibility, caring, and pride; the five individual fingers are important. But when the five fingers are formed into a fist, a true team, the collective strength is much greater than the sum of the individual parts. When these five areas can be applied to our teams in radiology, we can become more effective and efficient. As individuals alone, we are relatively weak. Together as a team, we are stronger. And this is something within our control.
To me, there is an imperative to create, sustain, and grow teams in our workplace.
Colleagues, I personally invite you to join us for ARRS 2024, either in Boston or online. This exceptional event brings together top radiologists from around the world to share new knowledge shaping our field.
Our Annual Meeting is renowned for its cutting-edge education, providing clinical information you can put into practice right away. We are excited to share the latest advancements in radiology, along with comprehensive review lectures to stay sharp on core topics.
Whether you attend in person and immerse yourself in the vibrant atmosphere of Boston, or choose our convenient online option, ARRS 2024 promises to be a remarkable experience. Your participation and engagement will help us connect, learn, and advance radiology together.
