Before Burnout

Effective radiology leaders should seek out unspoken concerns to bolster staff wellness.

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While definitions of wellness and burnout vary, most agree the absence of one drives the prevalence of the other. As rates of burnout among radiologists continue to rise, radiology leaders responsible for safeguarding the performance of their team and the care of their patients must be proactive.

“It’s important that the conversation is changing from burnout to wellness,” says Cheri L. Canon, MD, FACR, chair of radiology at the University of Alabama at Birmingham’s School of Medicine. “It’s fine to talk about the data and statistics around burnout, but you can only dwell on it for so long. Focusing on the wellness of radiologists is honestly the first step once you have recognized the problem.”

While there are unique qualifiers for physicians when compared to other members of the national workforce, the correlation between mental and physical wellness and overall job performance still applies. Studies show that 42 percent of employers offer some type of wellness program for employees — with 41 percent of employees willing to take a pay cut to work in a setting where their wellness is a consideration.1

Drivers of burnout include emotional exhaustion, a diminished perception of personal achievement, and a disconnect between colleagues and patients. Radiologists may experience feelings that inhibit creative problem-solving and attention to quality care.2

REDEFINING RESILIENCY

When addressing wellness, it behooves radiology leaders to remove the stigma associated with asking for help. Encouraging staff to take care of themselves and inviting them to come forward when they need help is vital. This can be a challenge for physicians with an ingrained notion of resiliency.

“Radiologists are hard-working, committed, and passionate,” Canon says. “We feel obliged to bounce back from emotional challenges. There is increasing demand for productivity and a changing healthcare landscape. We are expected not only to handle those things, but to adapt while meeting the challenges and become stronger.”

“I think the term burnout incriminates the physician, as if he or she is not resilient,” says an early-career radiologist practicing with a large radiology group in the Northwest (who wishes to remain anonymous). At a previous practice setting, she said she felt valued, productive, and had a strong sense of camaraderie with
colleagues. In her current position, she feels accountable for quality and safety issues, but with no real authority to bring about change.

It can be difficult to fulfill daily responsibilities when it seems no one is listening to validate concerns. “Administrators sometimes gaslight physicians to make them feel they are wrong in raising quality or safety issues,” the anonymous imager says. In her previous work setting, she says there was clear and open conversation.
“If there were any issues, everyone present in the room had a part in open communication,” she says.

TIMELY TALKS

While there is no way to guarantee that staff feel valued, comfortable speaking freely, or a sense of camaraderie with coworkers, managers can still take steps to ensure staff don’t feel the opposite of these things, says Felix S. Chew, MD, FACR, section chief of musculoskeletal radiology at the University of Washington School of Medicine. “Let team members find their own meaning in their work, and thus satisfaction in their jobs.” Giving people pointless work to do or overriding their judgement puts them at risk of physical or emotional harm, Chew says.

Radiologists who are feeling stressed, unappreciated, or overwhelmed may begin to perform poorly on the job, Chew notes. Turnover may increase along with more early retirement. “An understaffed workforce then adds additional stress to those who remain,” he says. “It can all lead to a diminished patient experience.”

According to Canon, at the first sign of atypical behavior by a team member, you should ask if something is wrong. “Privately sit the person down in a comfortable environment as soon as possible and explain that you are asking out of concern for them as a person, not as their boss or the practice’s leader,” she says.

As a leader, you won’t be able to solve everyone’s problems, Canon says. For instance, they may be struggling with the PACS or having trouble raising productivity. “But you can help by sending a positive message. Show them you’re receptive when they come to you — be non-judgmental and listen to them,” she suggests.

This can only happen when someone is willing to come forward or if a manager or colleague spots a potential problem. “What you often see are radiologists acting differently or doing things they don’t normally do,” Canon says. “What you see may be subtle, but potentially destructive.”

GROUP TRUST

Hesitation to speak with or place trust in practice leaders can spiral into an overwhelming sense of isolation. “We need to continually grow,” the anonymous radiologist says. “When we feel stuck and isolated, we fear retaliation, don’t get to share experiences, and it hinders long-term growth.”

A diminished state of wellness can damage family relationships, lead to increased drug and alcohol use, create feelings of exasperation in dealing with patients, and worsen physical health. Physicians who feel isolated may binge eat, sleep more, cancel plans, show up late for work, and express less enthusiasm for their job
duties.3 One survey showed that nearly two-thirds of physicians identifying as suffering from depression and/or burnout have not sought professional help. Some report they have become accustomed to being overworked, exhausted, dissatisfied, or discontent.3

“If you develop a relationship of trust with your team, you have a better chance of finding out what’s going on with them,” Canon says. With few exceptions, she says, people want to do a good job and want to produce for the team. “When they aren’t doing that, there’s a reason behind it,” she says. “And it could be something they don’t even realize.”

REALITY BALANCE

As practice managers strive to listen to concerns and build trust, encouraging a realistic work-life balance should also be a systemic goal. Radiology leaders should expect staff to attend to their own well-being and dispel the notion that self-care and patient care exist at odds.4

“Asking your employees to become more resilient on their own is the same as blaming them for their own burnout,” Chew says. Radiology has great potential for long-term job satisfaction if leaders encourage opportunities for professional growth and achievement, he says.

Experts recommend the usual suspects for combatting burnout and bolstering wellness. Physical exercise, taking adequate (non-device) breaks from work, getting enough sleep, and eating well are all on the list. Being aware of how work responsibilities are affecting home life should also be on the radar. Time away from work altogether — vacation, volunteering, or spending time on interests outside of radiology — can do wonders for emotional and physical fatigue.5

“It’s important to have interests and life outside of work,” the anonymous imager stresses. “When things get so heavy at work that they infringe on your personal life, problems begin.” Still, she says, you need to remind yourself regularly why you entered medicine: “Every image we read is a patient, and he or she deserves our best effort.”

Personal efforts by staff to better themselves can mitigate the effects of an unhealthy work culture. Communication skills training, mindfulness programs, and small group activities to avoid isolation are practical examples. Finding meaningful work in professional duties is integral to general wellness. And research shows that physicians who spend less than 20 percent of their time on meaningful activities at work have higher rates of burnout.6

It is up to radiology leaders to engage their team and learn what motivates each of them — and to take what they learn into account when assigning work.
Organizational leadership drives the wellness of staff, and top-down attitudes and practice habits are seen and felt by all staff, Canon says.

Telling stressed out radiologists to exercise, practice mindfulness, or spend more time with their friends and family is not bad advice. “But as Stanford Medicine’s
Tait D. Shanafelt, MD, has pointed out before, ‘you can’t yoga your way out of burnout,’” Canon cautions. It is up to leadership to empower their teams
to achieve a sensible balance. “You should empathize with their issues,” she says, “while being frank, transparent, and offering solutions when you can.”


By Chad Hudnall, senior writer, ACR Press

ENDNOTES

  1. Staples Workplace Survey Results 2019: Does your workplace deliver? October 2018. Available at bit.ly/Staples_Survey. Accessed March 22, 2019.
  2. Mendoza D, Holbrook A, Bertino F, et al. Using wellness days to mitigate resident burnout. J Am Coll Radiol. 2019;16(2)221–223. Available at bit.ly/WellnessDays_JACR.
  3. National Physician Burnout, Depression and Suicide Report 2019. Medscape. Accessed March 17, 2019. Available at bit.ly/Medscape_Burnout.
  4. Bohman B, Dyrbye L, Sinsky CA, et al. Physician well-being: the reciprocity of practice efficiency, culture of wellness, and personal resilience. NEJM Catalyst. Aug. 7, 2017. Available at bit.ly/NEJM_PhysWellBeing. Accessed March 29, 2019.
  5. Chelten AL, Chan TL, Ballard DH. Addressing burnout in radiologists. Acad Radiol. 2018. Available at bit.ly/Burnout_AcRad.
  6. Kruskal JB, Shanafelt TD, Eby P, et al. A Road Map to Foster Wellness and Engagement in Our Workplace — A Report of the 2018 Summer Intersociety Meeting. J Am Coll Radiol. Available at bit.ly/2018_IntersocMtg.

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