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The Struggle to Keep Up

Daily workload is an issue for radiologists — at any stage of their career.

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Not only is medicine one of the most intellectually challenging careers, it includes an incredibly demanding workload. Not to mention increasing responsibilities and pressure at work can have a huge impact on mental health. You’ve likely heard the alarming statistic: approximately 300–400 physicians die by suicide each year in the United States. That means the suicide rate among physicians is more than double that of the general population.1 “Every year we lose the equivalent of two medical school classes,” says Scott M. Truhlar, MD, MBA, MS, FACR, a radiologist at Radiologic Medical Services, P.C., in Coralville, Iowa.

The term burnout, coined by psychologist Herbert Freudenberger in 1974, is defined as the physical or mental collapse caused by overwork or stress. Radiologists, in particular, are experiencing increasing burnout at work, which is among the highest of any medical specialty.2

There is no single reason burnout is on the rise. Research cites inadequate staffing, prolonged stress, an inadequate sense of control, isolation from colleagues, and a lack of lifestyle balance as several of the relevant factors.3 But why are radiologists burning out now more than ever?

RISING PRODUCTIVITY DEMANDS

According to James Y. Chen, MD, a radiologist with the VA San Diego Healthcare System and University of California San Diego (UCSD) Health, the emphasis on ever-increasing relative value unit (RVU) targets has had downstream effects. The heightened speed of interpretation, decreased time for training residents and fellows, reduced research output, and diminished time for practice building (such as quality improvement projects and administrative committees) have all led to burnout among radiologists.4 “The rise in productivity demand has resulted in some practices requiring the use of specific work-output RVU targets as thresholds for compensation or hiring, without adequate regard for their effects on workers or potential limits to human task performance,” says Chen.

Claire E. Bender, MD, FACR, chair of the ACR Commission on Human Resources and professor emerita in the department of radiology at the Mayo Clinic in Rochester, Minn., agrees. “We’re being asked to do more with less,” says Bender. “In the electronic and regulatory environment, you may work more, and if your quality of work suffers, your relationships with colleagues also suffer as a result.”

While additional work responsibilities could be part of burnout, Truhlar points to a more nuanced issue. “The greater issue is meetings where your voice doesn’t matter, or other pointless duties,” he says. “The problem isn’t added roles like helping out colleagues. Those duties are ones that help us avoid depersonalization.”

Truhlar, who is on the board of directors for the Iowa Medical Society, has been looking at burnout across the state’s physicians. “It exists for both those in academic and private practice, for residents, early and mid-career physicians, and seniors,” he says. “It’s a problem many people identify in themselves professionally.”

FINDING SOLUTIONS AT ALL LEVELS

Combating burnout goes beyond the individual level. According to Bender, “If you’re in a leadership role, it might be as simple as recognizing someone needs help.” She adds, “One of the problems most physicians have is the professional pride and fear of disclosure. But I think it has become less taboo to talk about.”

Chen, who serves on the UCSD School of Medicine’s Physicians’ Well-Being Committee, agrees. That’s why his committee launched its Healer Education Assessment and Referral program in 2009 — which helps spot people at risk of suicide and depression through self-assessment and offers access to counseling for UCSD medical students, residents, fellows, and faculty. Bender notes that her radiology department hosts sponsored luncheons as a safe place to discuss issues like burnout face-to-face with colleagues. “We have to open up forums at our institutions for authentic discussion about burnout and physician well-being,” she says.

According to Truhlar, private practices must also find solutions to burnout. “All of our partners are very aware that our practice is focused on a sustainable lifestyle and a long career,” Truhlar explains. “This means that radiologists work at a more sustainable pace than what is found in many practices nationally — because the practice has hired additional radiologists to avoid being understaffed.”

Chen believes that while solutions at each practice and department will vary based on needs, putting individual wellness first should never be considered a radical decision — it should be viewed as the only logical and necessary one. “Well-being committees are a good first step toward any significant improvement because they raise awareness,” says Chen. “But we need solutions to address the underlying problems and not just put a Band-Aid® on the symptoms.”


By Nicole B. Racadag, MSJ, managing editor, ACR Bulletin, and Alyssa Martino, freelance writer, ACR Press

ENDNOTES

  1. Farmer, B. “When Doctors Struggle With Suicide, Their Profession Often Fails Them.” National Public Radio. Available at bit.ly/DoctorSuicideRate.
  2. Holmes EG, et al. Taking Care of Our Own: A Multispecialty Study of Resident and Program Director Perspectives on Contributors to Burnout and Potential Interventions. Acad Psychiatry. 2017; 41(2):159-166. Available at bit.ly/TakingCareOfOurOwn.
  3. Rosencrantz AB, et al. The Reading Room Coordinator: Reducing Radiologist Burnout in the Digital Age. J Am Coll Radiol. 2018; 15(1):65-58. Available at bit.ly/ReadingRoomCoordinator.
  4. Chen JY, and Leka FJ. Baseline Survey of the Neuroradiology Work Environment in the United States with Reported Trends in Clinical Work, Nonclinical Work, Perceptions of Trainees, and Burnout Metrics. Am J Neuroradiol. 2017; 38(7):1284-1291. Available at bit.ly/Burnout_Perceptions.

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