Words of Advice to My Younger Self
—and to Other Early Career Professionals

By: Patricia (Pat) Kroken, FACMPE, CRA, FRBMA
Originally Published in RBMA Bulletin January/February 2024

Congratulations!  Who knew you’d end up as a radiology practice administrator?  It wasn’t a career choice in high school, you probably didn’t previously know anyone who did this for a living and yet somehow you accepted a job you can’t explain to anyone outside of the medical field.  Even more challenging is the fact you probably can’t explain the day-to-day of what you do to the physicians you work for either.

Getting serious

It’s probably safe to say you may never have a boring day in your chosen profession.  Most of us state the profession chose us and we cite a range of situations where our lives somehow crossed an interesting opportunity.  I entered as a marketing manager and through a series of events, was offered the chance to “front the practice,” described as attending a few meetings with the hospital folks, coordinating the group’s board meetings and doing some other interesting stuff like opening the seventh MRI center in a seven-MRI center market.  That was how one of the radiologist leaders explained it to me.  And I did that.  And oversaw an in-house billing department, pulled another imaging center out of the depths of failure, coordinated new physician recruitment, handled more types of contracts than I could have guessed existed and participated in joint venture board meetings with hospital executives who had an unending list of questions. It meant learning as fast as possible.

I was prepared for the job to the degree I had experience as an Account Supervisor for an advertising agency and handled large, complex clients as well as being on the “pitch team” for new business.  The latter meant bringing in new clients and quickly producing results.  (Nobody changes ad agencies when times are good so you have about 90 days to learn their businesses and visibly make something happen).  I knew how to quickly learn a business.

So the first piece of advice for my younger version is to identify who in the organization knows what you need to know so you can fast track amassing knowledge. I was fortunate to learn from a radiologist with outpatient imaging business experience, from the front-line billing staff (the ones who actually do the work) and from diving headlong into professional associations, including the Radiology Business Management Association (RBMA). Beyond these people, my faculty included the variety of vendors supporting our profession, technologists (who also know valuable market gossip), subspecialty focused radiologists, hospital department heads and other practice managers.

The advice: listen much more than you talk, especially during those early years—and spend time in the radiologists’ reading room. Also, don’t try to fake knowledge to impress those who work for you. It’s very evident that you’re the new kid and if you’re honest about learning from those around you, they seem to respect that.

Life in the riptide

Even the experienced manager can be overwhelmed by the pace of our profession.  There are many days when it seems life is trying to happen all at once, when you’re busy every second but in the end have no idea what you did for the day.  We live in a time when it seems like the busiest, most overburdened person “wins” so you’ll be in contention for that dubious honor. 

A key to success?  Write it down!  Take notes as fast as you can because you won’t remember everything from a conversation, meeting or informal “hallway meeting.”  According to an article from the Psychology Today website, physically writing something down “activates multiple brain regions associated with optimal memory-encoding (and subsequent retrieval) more robustly than using digital services.”[1]  There is simply too much going on to remember it all, especially in terms of commitments made and essential details.

At some point the practice manager’s to-do list becomes voluminous and varied.  The problem with planning your week is that someone else is planning your time as well and their tasks randomly pop onto your list.  And it seems most of these are urgent—at least to the person requesting them, often at the worst possible time for you.  There are time-honored guidelines about prioritizing urgent tasks versus those important projects that are less time-sensitive but critical.  Logic supports the guidelines but the tyranny of reality can raise havoc with the best of intentions.

What if half the list remained undone at the end of the day or week?  In some cases I could make progress by scheduling them for a less frantic time and in other instances I worked evenings and weekends.  Yes, I’m a boomer, but not one who says, “I had to do it so you need to suck it up and do the same.”  I don’t recommend it as a lifestyle.  My physician mentor advised me there were no medals for martyrdom and he was right.  There is a time to ask for help and a time to decline or at least defer.  Saying, “I’d be happy to help you but I can’t do it right now” can at least delay the crunch.  I had a radiologist call me four times on a Friday morning and each of those calls had a project request.  I finally told him on the last one, “Dr.  Amazing, you’ve called me four times today with requests and I need you to know I can do them all, but you won’t have them right away.”  He actually laughed, said he didn’t realize he’d done that to me and that I could complete his projects when I had time.

I also learned to delegate better but frankly never mastered the ability to say, “I’m not going to do that because I’m already working too hard.”  My drive to learn, expand my skills, develop expertise and set the pace as a leader was simply stronger than my need for a workload that let me go home at 5:00 every day.  You will face those choices.    

Developing resilience

Everyone has a truly bad day (or week or month or even year).  You will too and we all have ways of coping and/or recovering.  One of the things nobody tells you is how important it is to take care of your health, both mentally and physically.  Burnout is real.  Job pressure is real and it can easily be self-induced.  If you are a perfectionist by nature, it will be difficult to learn to run with “good” rather than perfect.  Accepting “good” can extend your professional lifespan.

On the day your psyche is battered and bruised, get out of the office and begin healing yourself.  The gym is therapeutic and I fled to the squat rack as well as deadlifting heavy weights, guided by a compassionate coach who helped me refocus my energy and frustration.  Some people run for miles or head for the yoga mat.  The venue varies but the message is to find a physical outlet to help manage stress.

One of the hard parts in developing resilience is taking the time to examine and learn from battles won and lost, from successes and failures.  A trusted mentor can be invaluable at helping you see how in some instances you might have handled something differently or how you were perhaps in a no-win situation.  Self-awareness is a necessary success skill and can be developed and nurtured.  It means looking at the ugly, acknowledging personal deficiencies and modifying behavior.  It means learning from the failures and behavior of others as well. 

It also means being your own friend.  If you are in a difficult situation, how would you advise someone you really cared about if they were in the same position?  That doesn’t imply dodging responsibility but looking at yourself compassionately with the goal of getting through a tough time.  There can be a time to fight, compromise, apologize or a time to move on.  Again, what would you say to a close friend experiencing your situation?

Final words

At its most basic, managing in a radiology practice is not boring—and not easy.  However, the days add up to a challenging and rewarding career where your work can really make a difference, both for your employers and employees.  Leading in a smaller practice requires wearing a wide range of hats so you can develop expertise in a broad range of areas, each of which potentially offers a more targeted career option. 

Becoming active in an association such as the RBMA can develop a broad network of friends and colleagues and most of us agree those relationships are a key benefit for the days, weeks and years of hard work.  They not only make for warm conversations at the conferences but an provide a lifeline during difficult times.

And finally, at about the time you’re tempted to say, “I’ve got this!” radiology karma will show you just how much you don’t.  Stay vigilant, know the ground is always shifting and be sure to have some fun.

Patricia Kroken, MSN Healthcare Solutions Director of Education and Corporate Communications

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. 

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