Entitlement

We as interventionalists are becoming entitled. Sometimes, we really think we deserve to do every interventional procedure there is. Have we lost our innovative skills and our fight and our ability to create new procedures? Do we offer the best service available to do the procedures?

Most people act “entitled” in some period of their lives. I know I do sometimes, particularly when I'm flying long distances and I want to be upgraded to first class. I know it's a bad thing to expect it, but I have flown so much that sometimes that I get free upgrades, and when I don't, I sometimes feel that I have been wronged. I look at people in business class and I say, I deserve to be upgraded. It's foolish but it happens.

Sports, of course, are full of entitled people. The Boston Red Sox, a local baseball team, are dealing with this right now. Their number 1 pitcher, and, perhaps the best pitcher in all of baseball, is a prima donna, a diva, and is full of “entitlement.” In the long run, I don't think it helps him or the team. He wanted to leave the team to return to his native Dominican Republic before the scheduled all-star break; he was asked to perform in a ceremony in the Dominican Republic and he left his team to do just that. He didn't pose for the team picture. Sports are full of these prima donnas and entitled people, as is life.

There's nothing worse than having one of your best “athletes” or best “radiologist” acting entitled when it comes to working on the schedule, doing low-level jobs such as reading a KUB, or generally acting out. It's easy to deal with the marginal person who acts entitled or who doesn't follow team play. I have done it several times in my division and find it much easier for me to become upset and be rational with the “less talented people.” The problems I have occur when the superstar acts entitled.

How does this relate to general interventionalists and the situation now going on in radiology? Sometimes I think that as interventionalists we sit around and say, “We should be doing this procedure. Why aren't we doing this procedure? Why is a cardiologist doing this procedure? Why is a nephrologist doing this procedure? Why is a gastroenterologist doing this procedure?” We can't legislate that we perform all of the interventional procedures. All the CAQs and added certification and approved fellowships in the world will not make any difference if we act entitled and don't offer the service that is necessary out there.

I have always felt that it's up to the leadership of the interventional group to understand these issues and to provide the services in order to combat some of the competition that we have. I'm not naïve enough to believe that we are going to take back cardiac imaging or even some of the cardiovascular procedures that we have obviously lost to both cardiologists and vascular surgeons. Nor am I naïve enough to think that it's simply a matter of bad actors in interventional radiology or uninterested interventional radiologists as the reason we have lost these procedures. Clearly it comes down to more than that.

There is obviously a tremendous crisis going on in interventional radiology. We are being hit bilaterally, if you will. First, there is competition for our services. Second, many if not most radiologists see lucrative jobs out there that pertain to imaging which offer an easier lifestyle, easier hours. Young physicians aren't going into general surgery for the same reasons. The hours may be too long, the coverage too great; I'm not sure that we will ever solve these particular problems.

I do believe, however, that the worst thing we can do as interventional radiologists is act “entitled.” We have to seek newer procedures that other people aren't performing. I have harped on this before. But I'm a big believer that many nonvascular interventional procedures are under performed by interventional radiologists and not taught well in most interventional radiology fellowships. Draining pleural effusions, while seemingly boring, involves commitment, service, patient care, and follow-up, and leads to bigger and better things. Many radiologists, particularly interventional radiologists, shun this particular procedure because it is beneath them or it is not difficult enough for them; they only want to perform biliary drainages and complicated vascular procedures. This is the thought process of an entitled individual. This is the kind of thought process that I believe hurts us as radiologists.

The sports world, as I said, is full of this kind of individual. They may be superstars for their local soccer or baseball team; they may be the faces their fans want to see. But sometimes in the long run this actually hurts the team. It is up to the leadership of interventional radiology to show the general interventional radiologist the importance of not being entitled. It is up to the leadership to pursue these rather mundane procedures and try to create areas that will help us recover some of the interventional radiology that we have lost. Don't get me wrong. I don't believe entitlement has caused us every single problem we have in radiology. However, I believe that sometimes we have an entitled approach. No one wanted to do cardiac radiology when it was drudgery, but now all of a sudden it's become an elite thing to do and we are trying to scramble back into it. Frankly, I think it's lost and I don't think we will get it back.

It is up to us to fight the battle in interventional radiology and I believe it has to be fought at all levels: service, commitment, low-level procedures, new procedures. Be there, have the right attitude, and fight for your territory. Don't be an elitist and an entitled individual who thinks it should just come to you as you sit in your office waiting.

Entitlement: don't succumb to it.