Pat Kroken, FACMPE, CRA, FRBMA
Jennifer Kroken, MBA
If you’re new to radiology practice management, you may be worried someone is about to figure out how much you don’t know, will jump out in front of you in the hallway at any moment and yell, “Imposter!” as you’re making your way through an especially bad day. It’s a challenging field, rife with regulatory complexity, changing rapidly and often unforgiving as a business environment. Radiology leadership is not a place for the insecure, yet how do you build your skills, move from feeling like you’re faking it to feeling in charge—and then make a difference in the world?
And even more, can the Boomers and the Zoomers (GenZ) cross generational divides to successfully work together? We think they can. And it isn’t limited to GenZ, but includes other “young” categories as well.
First of all, this is an actual conversation:
Pat Kroken: “I don’t want to do that because I don’t want Google to know everything about me.”
Jennifer Kroken: “Get over it. They already know.”
While the Pat/Jennifer generational divide wasn’t as great as boomer/zoomer, we approached our work with differing perspectives and together weathered dramatic changes, largely driven by new regulations and advances in technology. It resulted in a rewarding working relationship in practice management and consulting for more than 25 years. We now work for separate companies (an amicable divergence of careers) but continue to tap into each other’s areas of expertise.
Rumor, Reputation, and Reality
Let’s talk a little about rumor and reputation. Boomers are rumored to be stuck in the “we’ve always done it this way” past, are considered techno-ignorant and no doubt have a reputation for being resistant when it comes to zoomer suggestions for change. They are characterized as having the attitude of “I learned it the hard way so you need to as well.”
On the other hand, Zoomers are rumored to be impatient, unwilling to take the time to learn and “too sensitive.” Somewhere in there is reality and each person can bring something valuable to the table. While our skills and experience may be valuable individually, they can be even more powerful when combined.
Where to Start
It helps to have perspective. Radiology as a specialty was an early adopter of technology, both in terms of radiologists and the back office as well. It is unacceptable to live in the past operationally, but important to understand and respect what has gone before. The sheer volume of procedures done by even a medium-sized practice placed manual processes on a continuum between impractical and impossible. And procedure volumes have only increased since then, both in terms of the reads per physician per year as well as billed per person per year.
Evolution of Imaging Technology
We have also witnessed the evolution of imaging technology that changed forever how diagnostic decisions would be made, elevating the importance of the radiologist in the development of treatment plans. Each new modality was initially hazed by Medicare and the insurance companies. That meant we usually didn’t get paid as a new technological advance was introduced, even if it drastically improved patient care. In order to prove the value of the study to those with the industry checkbooks, a certain number of freebies were required and we had to balance that with maintaining profitability as new equipment was purchased and proven.
And as if that wasn’t sufficiently challenging, there was always regulatory activity with new rules seemingly developed without anyone from radiology being at the table. Reimbursement cuts became an almost annual occurrence, resulting in ongoing pressure to do more with less.
The point is that senior managers have consistently dealt with sometimes overwhelming levels of change, year after year, so they are not averse to new ways of doing things. At the same time, not every new idea is a functionally sound idea.
Practical Context: Know the Process
Let’s look at this in a more familiar context. Our techno-adept zoomer manager identifies a process area that seems it could greatly benefit from automation. The boomer billing manager states the group implemented that very automation a few years ago and it took nearly a year to correct the resulting chaos. Is this a stodgy person resisting new ideas? Maybe not, so find out what happened and how that impacted the practice.
One of the first rules when suggesting change is “know the process.” That means really know it. Ideally, it will be a process you utilize in your own work (rather than oversee from another position) but you might also be able to have someone who does it on a regular basis explain the nuances to you. It also means you need to know the process in context— what happens in steps immediately before and after, as well as where it fits in the entire workflow. Do we have some stupid processes? Yes, and frequently they are the result of regulations or insurance company medical policies or maybe because we are interfacing with a legacy computer system or…
To the zoomer who wants to make a difference, sometimes the first step is pausing to listen and learn. (The most successful senior managers have done this and still do). One of the most valuable things to know is that the front-line staff may be the resource you need in order to recommend significant process change. They can also help you bullet-proof what seems like a good idea—so when you present to upper management, you have worked through the landmines. If you’re worried you’ll expose your lack of knowledge to staff members you may be supervising, it may help to know they already know the boundaries of your knowledge and experience. They are more likely to be impressed you asked for their help and demonstrate a willingness to learn.
The gap between work generations is not as wide as one might suspect. If you engage in conversation with them, the Boomers will readily acknowledge they were in over their heads many times during their careers. They just didn’t know it was a “syndrome.” Or necessarily that they were imposters, although they did hope nobody scratched the surface to find out just how much they didn’t know.
We all do have our “fake it” moments. Ours involved working to appear calm in all dealings with physicians. The phrase, “Let me check into that and get back to you” usually buys some time to get the answer right and eventually, there will be fewer questions you can’t answer. The acting calm part? That’s one of the more important management skills you can develop, not only to minimize panic and overreaction, but you’ll find it can be interpreted as having a handle on the situation. If you are wound up emotionally, it is easy for a heightened sense of alarm to transfer to the entire group and not many good things come from those situations.
If you feel like an imposter, zoomer, you’re in good company! It’s all part of tackling the ambiguous world in which we live and honing your skills. Just make sure to hone those skills as you work and grow.
There is the “fake it ‘til you make it” theory of management and to a degree, that works. You just need to know what to fake and it isn’t essential industry knowledge. That’s something you really need to learn and it will take a while. Fortunately, the faculty for this information works all around you and much will be learned as you observe others. You may not want to ask a basic question in a shareholder meeting but make a note of that query and ask someone the following day. Since most of radiology management is learned on the job, you’ll find people are usually willing to share their knowledge.
A recurring theme Boomers hear from Zoomers is that they want “meaningful” work. While this may trigger the “get over it” reflex in some of the more hardened professionals, it’s worth examining the source of this request and for Zoomers, understand what might look like limitations.
It may be difficult at first to find meaning in medical billing or even running an imaging center. In the latter case, the manager can keep their eyes on the patient experience and find it easier to attach meaning to their job but ensuring smoothly run, compassionate processes and responsive patient interactions. On the other hand, some tasks seem far removed from the patient and may at first seem unfulfilling if they measured based from the patient care standpoint.
Whether Boomer or Zoomer the argument can be made that the employee brings meaning to their job. Every job involves mundane tasks that seem unimportant, trivial and even meaningless—even if you were part of the team building the first rocket to Mars. In radiology management, you are often working in the background, running the physician practice efficiently so the radiologists theoretically worry about nothing other than their jobs—which is supporting excellent patient care and providing responsive customer service to the hospital. Any job can be viewed through the lens of servant leadership (good) if you are making life better for someone else. You may feel a sense of satisfaction from completing a project you couldn’t have done six months ago. Or from getting a sincere “thank you” when you helped another manager or your boss. Or winning a battle with an insurance company that resulted in the payment of previously denied claims.
These little rewards are usually incremental and our goal is to keep generating them because the small victories form the foundation for job satisfaction. There are seldom large, consequential achievements but they can and do occur. If you love the work you do and are compensated well for it, consider yourself having hit the jackpot—but even those jobs will have their days. Or months.
We’ll say it: the generations annoy each other—but they always have!
From Zoomer to Boomer: you could stand to be more patient and give us feedback.
From Boomer to Zoomer: we’re evolving as fast as we can.
Everyone can be reassured knowing we’ve all felt like imposters in our jobs. Anyone age 40 or above can probably remember the meeting they were sitting in when they realized…in horror…that they were the adult in the room. But Zoomers, take advantage of the vast amounts of knowledge that could disappear as Boomers retire…and that’s happening quickly. The Boomers universally express concern about how to effectively transfer baseline knowledge and skills to the next generation of leaders, so they can build on it and be successful. There is so much foundational knowledge, along with a willingness to share it, that our main generational task is to focus on how we can effectively make that happen.
Patricia (Pat) Kroken
FACMPE, CRA, FRBMA
Prior to joining MSN Healthcare Solutions as Director of Education and Corporate Communications, Pat Kroken had nearly 30 years of experience in radiology management as both a practice manager and consultant to radiology groups, billing companies, software vendors and hospital radiology departments.
Pat has had more than 200 articles published, is a regular contributor to the Radiology Business Management Association (RBMA) Bulletin and a frequent speaker on practice management topics. She served two terms as President of the RBMA, is Editorial Advisor for the national RBMA publication, The Bulletin, and represented the “business side of radiology” as RBMA Liaison to the Radiological Society of North America (RSNA) Associated Sciences Consortium for 7 years.
Jenniferis a consultant for ImagineSoftware and has worked in the industry for 30 years. Her experience includes revenue cycle consulting, operations management, billing, compliance and physician licensing and credentialing.
Jennifer serves as the RBMA liaison on the Radiological Society of North America (RSNA) Associated Sciences Consortium and is a former RBMA Board member. She has authored over 30 articles for several national publications and was on the editorial team for the RBMA HIPAA workbook.
She enjoys jiu jitsu, powerlifting, is a former assistant high school powerlifting coach, a national-level powerlifting referee and enjoys reading and blogging about nothing.