Your Ethical Equity Score

lady justice statue in medical office, ethical equity

Your Ethical Equity Score

By: Pat Kroken, FACMPE, CRA, FRBMA
Originally Published in Nov/Dec 2020 RBMA Bulletin

How healthy is your ethical equity?

At this point in your career, how healthy is your ethical equity?  You work through your days with lists of commitments and promises but also creating a certain amount of wreckage, intentional or not. 

Based on the execution of your intentions and tasks, you build your professional credibility with a bank of “ethical equity.”  Each time you follow though on a commitment or necessary task, doing what you said you would do (and doing it correctly) you make a small equity deposit in your account.  Each time you fail to do so, you have a withdrawal.  Either way, it does not go unnoticed in terms of your reputation and ethical “overdrafts” can be costly.

We all make mistakes

We all make mistakes and at some point, there will be a biggie.  If there is a sufficient accumulation of ethical equity in terms of past behavior, you may survive an otherwise career-fatal incident, perhaps bruised and battered but with a second chance to prove your worth.  If not, your career can take a rapid turn for the worse. 

While on a consulting engagement (many years ago), the client and I discussed a mutual acquaintance and he said, “There are two groups of people in radiology—those who have been screwed over by DLS and those who have not yet met DLS.”  Valuable point made and it has stuck with me for a couple of decades.  You will at some point interact with ethically bankrupt folks, and while they can even appear successful on the surface, they do pay a reputational price and are eventually tarnished (even if they somehow stay in business).  Take note of how they fail to deliver on promises and how you feel about those incidents.  Your employers and colleagues are also keeping score.    

Building ethical equity

Where does the journey begin?  Certainly when you accept your first job in healthcare, if not before.  You begin developing credibility by gaining trust—and you gain trust by consistently delivering results.  And they don’t have to be “trophy” results at this stage.  You return a phone call when you promised you would.  You follow up on a physician-requested project.  You check the math before presenting a report to physician leadership and then you check it again.

Know your limitations

Know your own limitations and don’t over-promise.  For example, I do not have strong number retention and therefore, do not trust my “off the top of the head” numbers.  Therefore, I don’t wing it (even on demand).  One of the main reasons is that radiologists typically have outstanding number retention and if I give them the wrong estimate, they will remember it forever and remind me of what I said at some uncomfortable point in the future.  How do I know that?  There was once a debit in my equity deposit for guessing on command.  There have been other debits for sure, but not again for that reason. 

Don’t over-promise

What happens when you aren’t going to make a deadline as promised?  The week looked wide open but quickly went to hell.  You promised a report on Friday and on Wednesday, it’s clear that won’t happen.  Rather than miss the deadline and fess up after the fact with what is only interpreted as excuses, advise the person requesting the project right away—but let them know when you should be able to deliver (and be certain with that commitment).  You might ruin a weekend but it won’t be your reputation and you could still get lucky and deliver before the revised date.  No harm, no foul and usually not a debit unless this is a habitual pattern.

When you say, “I’ll take care of that,” make it happen.  You may be delegating the task but assume responsibility and accountability.  One of the mistakes I’ve seen in rookie managers is they know that “I’ll take care of that” part but then drop the ball until you remind them days, weeks or months later of their commitment.  And at that point they seem confused, ask you to repeat what you were seeking and fumble through a series of ungratifying excuses.  Debit?  Yes, and you probably won’t trust them again until that behavior changes.  A corollary to making a commitment is the “WRITE IT DOWN” rule!  It may seem like you’ll naturally remember a request later when you need to work on it but as life gets increasingly complicated, that won’t happen.  Trust me on that one. 

Ask for clarification

Then remember how annoying it is to have to remind someone to do their work.  Don’t put your physicians or senior managers in that position with you and your work.  There are times when your cryptic notes are insufficient and you don’t remember all the details of what you’re supposed to do.  Stop, contact the person who made the request and ask them to clarify. That beats working for hours or weeks only to deliver the wrong information, or woefully inadequate information, especially if the person delegating needs it for an important meeting.  While it can be embarrassing to admit you don’t remember everything, it sometimes reveals the person delegating didn’t do that clearly and they would rather know that now than when you deliver a detailed report that doesn’t address the issue. 

Your role as a leader

You do not have to have a title to be a leader in your organization, but if you are in a leadership position you most likely report to the group’s Executive Committee or Board of Directors.  In that capacity, you tend to focus on their requests and idiosyncrasies and are viewed by others as an extension of those leaders—their right-hand person.  Overall, that’s a good place to be but eventually the physician leadership will change and ethical equity with the entire group will never be more valuable.

What does this mean?  It means not treating new physicians in the group as “pledges” worthy of your attention only when they become shareholders.  Granted it can be a difficult balancing act when you’re rationing out valuable energy and intellect for all of the incoming demands, but it’s also the right thing to do.  Few radiology groups dedicate resources to physician onboarding, orientation and retention so the administrator can fill that gap by establishing communication, providing background information about the practice and sites of service and educating about billing processes and key indicators.  It doesn’t have to take an extensive amount of time all at once and such knowledge is usually more meaningful in small bites anyway.  The important thing is to become a trusted resource early in the game.

The rewards of ethical equity

Radiology is a small community, although we’re distributed across the entire country.  And we help each other, we move around…and we talk.  Your competitor today could be your boss next year.  If you interacted professionally as competitors, that can work out just fine.  If your trail is one of competence and ethical consistency, your colleagues will recommend you when opportunities arise and help you deal with problems on the days when it all seems to go wrong.  If your life looks more like the “behind the elephants” part of the parade with unfulfilled promises, shoddy work and a reputation for undercutting others, that word will also travel and at some point, the doors to opportunity will no longer be opened. 

What you do every day matters.  The ethical deposits may be small but they accumulate, are recognized by others and help you sleep better at night.      

Patricia Kroken, FACMPE, CRA, FRBMA,
has an extensive background in radiology practice management and directs education and corporate communications for MSN Healthcare Solutions

She worked as a consultant for radiology practices, billing companies, software developers, and hospital radiology departments for 20 years before joining MSN.

She is a regular contributor to the RBMA Bulletin and a frequent speaker on topics related to radiology practice management. 
Pat can be reached at
or 505-856-6128