In Give and Take, Adam Grant divides people into three types: givers, takers, and matchers.
- Takers try to get more than they give.
- Matchers aim for even trades.
- Givers help without expectation.
Grant argues that givers are both the most and the least successful (because people like givers, but they are also the easiest to take advantage of):
“Givers are overrepresented at the bottom and the top of the success ladder.”
Radiology practice is no exception. The culture is the people, and it arises organically from the people in the organization working within the constraints of the clinical work.
Picker of Cherries
Consider cherry-picking in radiology:
- Takers cherry-pick to get more RVUs, easier cases, or both.
- Matchers behave appropriately, unless they are working with known takers or see taking behavior, since people generally don’t like being taken advantage of.
- Givers read down the list and jump on the grenades left over by the others. This can result in looking less efficient by various metrics.
Conditional Behavior
The reality is that people’s behavior is both variable and domain-specific. Someone may run amok on the list but be willing to do tedious extra administrative work that no one wants to do. Someone may be a huge team player at the hospital when they’re part of a small group where they feel seen, but a bad actor when part of a massive shared list.
We need to acknowledge that 1) hiring matters, 2) culture matters, and 3) we should try to build better systems that make it easier for people to behave nicely and win.
It’s impossible, even in easy times, to hire right all the time. The solution, in the old days, was to make partnership contingent on good behavior (and, sometimes, high productivity). The problem of course is that, like tenure, that doesn’t fix sloth or selfishness among partners. And certainly in the current market, dropping people when staffing is tenuous isn’t trivial when the work has to get done. Rug pulling too often would seriously harm a group’s reputation, and warm bodies don’t grow on trees.
Workflow-wise, too many metrics and too much surveillance are extremely toxic. No one wants to have their movements tracked like an Amazon warehouse worker to make sure their bathroom breaks are industry-conforming. The reality is that an open list where you select your next case is a big temptation for takers. And it only takes a tiny sliver of takers in an organization to spur the suboptimal behavior of matchers. That leaves everyone feeling like a distrusting victim.
Giving, More Broadly
Not all giving is equal. And not all of it scales.
“Being a giver doesn’t require extraordinary acts of sacrifice. It just involves a focus on acting in the interests of others.”
Matching is about dividing the work pie fairly, but giving often involves other gifts of time, energy, knowledge, skill, and emotional support. Teaching is a gift. Administrative duties like committee work, medical directorship, and practice leadership often disproportionately fall on givers. The “reward” for doing these tasks well (or even just being willing to do them) is often being given more responsibilities.
We can’t let giving be a suckers game:
“If you don’t protect yourself, giving can be dangerous.”
Give to matchers, and you build reciprocity.
Give to givers, and you build culture.
Give to takers, and you burn out.
Takers exploit. Matchers track. Givers build.
We need systems with guardrails to ensure that opportunities for exploitation are rare and that bad behavior can be policed effectively. If your group is using independent contractors for list support, that might mean giving them access to only a specific list or specific cases instead of letting them graze freely.
The problem is that if takers dominate, everyone becomes a matcher. Generosity becomes naïve. Trust becomes weakness. And the whole system corrodes.
“The more often people give without strings attached, the more others start to match their generosity.”
Practices thrive when givers can lead with open eyes and no remorse.