For radiology practices to thrive, radiologists need to expand their intellectual and professional horizons beyond the boundaries of radiology. Detection and analysis of lesions, formulation of differential diagnosis, making recommendations for further evaluation, and performing diagnostic and therapeutic procedures are the core of radiology practice, but if those doing the work do not learn to see the larger sociological, economic, political, and philosophical contexts in which they work, they will likely play little role in governing themselves, instead coming to resemble passengers on a professional bus whose course they do not control or even understand.
One of the American scholars who did the most over the past 50 years to illuminate the larger contexts of professional life, and in particular the conditions for professional self-governance, was Elinor Ostrom, the only woman and the first noneconomist to receive the Nobel Prize in economics . Although she was not a radiologist, her groundbreaking work provides deep insights into the governance of radiology as a profession. Because she is unknown to most radiologists, we begin with a summary of her life and work, followed by a synopsis of her writings on the conditions of self-governance and the timely insights they provide to radiologists who aspire to play a role in charting their own course.
Life and Work
Born in Los Angeles in 1933, Ostrom was the only child of a musician and a set designer . Her parents divorced when she was young, and she grew up in Beverly Hills under straitened circumstances. After graduating from Beverly Hills High School, she attended University of California, Los Angeles, from which she graduated with honors with a degree in political science in only 3 years. She married a classmate, whom she helped to put through Harvard Law School. After their divorce, she applied to the PhD program at University of California, Los Angeles, in economics, but was rejected, so she switched to political science. There, she met her second husband, Vincent Ostrom, whom she married in 1963, and received her PhD in 1965.
Ostrom accompanied Vincent to Indiana University, where he had accepted a position in political science that same year. Several years later, she began staffing an inconveniently timed 7:30 am American government class that no faculty members wanted to teach, and soon she gained a permanent faculty position. In 1973, she and Vincent founded the Workshop in Political Theory and Policy Analysis, which they ran for 39 years. Over the years, she published many papers and books in the fields of political science, management and administration, and organizational theory. Some of her special interests were the management of common resources and polycentric models of governance.
Among the important empirical investigations she helped to conduct were studies of consolidation among municipal police departments and school districts. Of course, consolidation of medical practices, hospitals, and health systems is an important theme in contemporary radiology. Ostrom found that among police departments, small- and medium-sized departments generally outperformed larger ones in terms of rates of victimization, police response times, citizens’ readiness to call police, and relationships between police and community members . Likewise, multiple small school districts generally outperformed one large one .
Before Ostrom’s work, many political scientists and public administrators had assumed that average citizens were too uneducated, inexperienced, and preoccupied by other concerns to govern themselves effectively. What they needed were experts with masters and doctoral degrees in business and social science fields to chart the appropriate course for them. Elinor and Vincent Ostrom found, however, that many supposedly intractable problems—including how to protect and sustain communal resources such as the natural environment—could be solved quite successfully by ordinary community members operating at the local level.
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Eight Conditions of Self-governance
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Excellence in Self-governance
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References
1. Nobelprize.org : Elinor Ostrom—biographical. Available at https://www.nobelprize.org/nobel_prizes/economic-sciences/laureates/2009/ostrom-bio.html Accessed December 1, 2017
2. Tarko V.: Elinor Ostrom: an intellectual biography.2016.Rowan and LittlefieldLondon
3. Ostrom E., Parks R.B., Whitaker G.P., et. al.: The public services production process: a framework for analyzing police services. Policy Studies J 1978; 7: pp. 381-389.
4. Ostrom V., Ostrom E.: Public choice: a different approach to the study of public administration. Public Administration Rev 1971; 31: pp. 203-216.
5. Ostrom E.: Governing the commons: the evolution of institutions for collective action.1990.Cambridge University PressCambridge
6. Ostrom E.: A behavioral approach to the rational choice theory of collective action. Am Polit Sci Rev 1998; 92: pp. 1-22.