No One Gets To See The Wizard!

No doubt you’ve heard of the “Peter Principle”; it’s been around for quite a while. Dr. Laurence J. Peter is a former professor who published a satirical book based around his theory that "In a hierarchy, every employee tends to rise to his level of incompetence," and that "In time, every post tends to be occupied by an employee who is incompetent to carry out its duties." Or, basically: We do a job well, we're promoted. We do that job well, we're promoted again. Eventually, we rise to a position that we can no longer do well -- our level of incompetence. There, we either stagnate, revert back to a lower position, or get fired.

I have met some absolutely brilliant people in the years I have been dabbling in PACS. Most of these came from academic facilities and have significantly helped the PACS “movement”. Most of the names you would recognize so at the risk of inadvertently leaving someone out I’m not naming them…but you know who they are. There have even been a few PACS laureates outside academia, (some of them work for vendors!!) While many individuals who had vendors jobs stayed with PACS, few of those stayed with the same vendor or in the same position for a long time. The field of such PACS players is rather small, and almost incestuous; the expert who worked for Company A at the time of last year’s RSNA will be front and center in Company B’s booth this year. I’m sure they all had a new position already lined up before they left the current one. Well, that’s what I would do to keep food on the table. Most did stay in the industry, continued to work on PACS, and made some pretty decent contributions as well. It was a win-win-win all around.

I have also met some people in my 28 years in private practice who appear to defy logic, gravity, and what few rules I know of in business to stay employed. They have the people skills of a brick, and product knowledge that was acquired from a brief perusal of the company website 5 minutes before the sales-call. These folks do have one positive trait: a “Can Do” attitude, answering every question with “We can do that!” (To which Engineering replies “We can do what?” How they achieve their sales quotas is beyond me. I guess they are simply lucky, but as they say, it might be better to be lucky than smart. And don’t forget about office politics, which has elevated many a mediocre employee up the Peter-Principled ladder.

I do have to say that most (not all) of the support people have been in contact with are pretty decent because they haven’t been tainted by sales and are honest to a fault. Most of them. Depends on the company to some extent. As an engineer myself in a former life, I tend to trust the technical types. (It’s ironic that I’ve had significant troubles with IT types, but that’s another story.) I have often found that the people in the back-room can fan the vapor(ware) out of the way, and find out what’s real, and what’s R.S.N.A. (Real Software Not Available).

I had the chance to chat with a few people this week who left a company without having another job in the pocket. These guys (mostly) did NOT advance to the level of their incompetence; you might say they rose to the level of the company’s incompetence (management changes, the sale of the company, reductions in force, etc.) I was shocked at how hard it is to transition from PACS to other areas in healthcare and even moving from one PACS company to another. Now I’ve been a radiologist for way too many years and with the same group for nearly all of those so I never gave much thought about job changes. We’ve hired a few guys here and there who were with other groups, and they have been among our very best rads. Sadly, in the PACS biz, things no longer seem so collegial.

My friends in the PACS world, tell me that if a VP of Sales wanted someone on his or her team he would go to HR, they would walk the person through the process and they would be in the seat within weeks. But HR has apparently become Talent Acquisition in some operations, and the rules are now a bit more convoluted. Weeks become months and there are significant impediments to migrating that just weren’t there before.

When someone submits a resume rarely if ever does a human look it over. Instead computers scan a resume looking for specific keywords. If you don’t have the keywords they are looking for, well, that’s the end of the line. The computer sends the electronic equivalent of “The Bug Letter” and says sayonara forever more. “No one gets to see the Wizard!”

You say “Tom-MAY-Toe” and I say “To-MAH-toe”. Similarly, there are a number of synonyms for PACS. It is also called an Electronic Imaging System (EIS), Enterprise Imaging System (a different EIS), Information Management Systems (IMS), Image Management System (a different IMS), Healthcare Information Management System (HIMS), Medical Imaging System(MIS) , Digital Imaging System (DIS) Imaging Informatics (II) and a host of other similar terms. (I have been known to call it POS, which needs no elaboration.) If a company calls their PACS and EIS, for example, and you don’t have EIS anywhere in your resume. then a canned rejection letter is in your future. Nothing else seems to matter but the computers. Things in the business were once on a more personal level, and not a matter of stroking transistors properly. Must follow process and procedures, don’t you know? I’m glad I only have to sell myself as a volunteer these days.

I’ve spoken about Artificial Intelligence in radiology, and I have some mixed feelings about where we are going with it. I view it as a potential assistant, not a replacement. I wouldn’t want an AI to be picking my partners, though, as seems to be the case with the new generation of Human Resources. That’s a job for humans. And besides, as I mentioned at the top, PACS is a pretty small world, and if you need that much help to review a dozen CV’s, well, that’s a problem.

So why does this bother me especially since I am semi-retired and spending my retirement volunteering with RAD-AID and galavanting around the world with Mrs. Dalai, visiting cute animals in weird places? Well, you might not know this, but I had once very seriously considered going to work for one of the vendors after I retired from private practice. Thank G-d I didn’t follow that path! But I do have a few friends who have years and years of solid experience in the medical imaging field who can’t even get up to bat with some of the imaging companies let alone hit a double, or more likely for them, a home-run. These are also people who, if given the chance, can hit a grand slam for the company time and again. Their knowledge and experience is deep but we have a new system which “knew not Joseph” if you get the Biblical reference.

In the meantime I have to deal with those who, as Peters puts it, have “risen to a position that they can no longer do well and have reached their level of incompetence.” I would NEVER advocate firing anyone (well, I have done that a couple of times when the situation was that onerous) but there are some folks out there that should not be interfacing with the paying customers. Find ‘em a spot in the shipping and receiving departments, writing operational manuals or, virtually any other place where their interaction with end-users is greatly limited.

There are companies out there who need serious help in marketing their products (most PACS-related marketing almost as abysmal as some of the PACS themselves) and in putting together a long term strategy for growth that meets the needs of the marketplace. This includes incorporating artificial intelligence (AI) as an electronic assistant, Big Data analysis, business analytics, and other areas - and goes well beyond PACS advancements that were considered state of the industry several years back like zero footprint viewers (ZFV), VNA’s, speech recognition (booo, hissss) and others. If you don’t keep evolving you remain stagnant and frankly there are way too many stagnant companies in this industry as it is.

There is a saying “He who plows a straight furrow is in a rut”. I see this a LOT. Part of the problem, of course, is that those who pay for PACS are generally not those who USE PACS. Which makes it even more critical that those who sell us these often misbegotten behemoths employ true visionaries who can steer the products and services in a manner that will deliver the right thing to the right place, to address the total needs of the marketplace. This will better serve the customers (particularly us end-users) and will lead to growth of the company that does it the best.

If you happen to need or even want a visionary or just someone who can pull you out of the rut just let me know and I’ll hook you up with a few people I know who would make a great addition to your team. It’s ironic really...PACS is a collection of machinery, but they are built by people. We want the best and brightest people delivering this technology. CV-reading AI’s won’t understand, but we do. Trust me on that.