Slowing the Burn
Radiologists search for strategies to thrive in a demanding environment.
Whoever said it’s better to burn out than to fade away probably wasn’t receiving care from a medical professional suffering from burnout.
Actually, it was Neil Young (in his song, “Hey, Hey, My, My”), and he wasn’t talking about the growing psychological syndrome becoming a systemic problem in this country’s workforce — particularly among physicians.
Although burnout rates vary among types of physicians at different stages of their careers, burnout is still higher among physicians as a whole when compared to the rest of the working population.1 Some believe radiologists are particularly prone to its disruptive and far-reaching consequences.
Burnout emerges as a prolonged response to chronic job stress and feelings of dissatisfaction. The Maslach Burnout Inventory (MBI) is generally recognized as the leading measure of burnout. To seek out the condition, MBI incorporates questionnaires that address three main contributors to burnout: emotional exhaustion, depersonalization in the workplace, and feelings of inadequate accomplishments or success.2
“Studies of burnout in physicians of all specialties show radiologists to be in the upper half in terms of burnout rates,” says Felix S. Chew, MD, MBA, section chief of musculoskeletal radiology at the University of Washington in Seattle. And when burnout is measured using emotional exhaustion as the only indicator, as some studies now do, Chew says, the prevalence of burnout among radiologists can be underestimated.
Burnout in medicine has been linked to deterioration in professionalism, increased medical errors, and early retirement. Because of the central role of radiology in modern medical practice, a poorly performing radiologist can cause a cascade of medical errors and suboptimal patient care. Features of burnout have been described as feelings of inadequacy combined with callousness or apathy toward patients and peers. People describe feeling like just a cog in the wheel. Burnout can lead to depression, substance abuse, and suicide. It is also linked to inappropriate workplace behavior, reduced productivity, absenteeism, and staff turnover.3
Feeling a Disconnect
“Radiologists in many ways are at greater risk for burnout than other physicians,” says Cheri L. Canon, MD, FACR, chair of radiology at the University of Alabama School of Medicine in Birmingham. “The reading room environment can be isolating, exacerbated by the implementation of PACS, and our role on the health care team is not always understood, particularly by our patients.”
Radiologists are often consumed by trying to meet regulatory requirements and bureaucratic demands. They feel generally overworked, with not enough time to complete tasks, while struggling to meet productivity expectations. “All of this can lead to a sense of detachment,” says Canon, “and we run the risk of forgetting that each image, each pixel, represents a patient.”
Burnout in radiology is often tied to a disconnect from patients and colleagues, says Thomas M. Grist, MD, FACR, chair of the department of radiology at the University of Wisconsin-Madison School of Medicine and Public Health. Grist noted that physician surveys have demonstrated an increase in reports of burnout over the last five years. “Radiologists sometimes have a depersonalization of medicine, in general. When we don't have a lot of contact with patients or referring physicians, we don’t have time to talk about cases or share interesting experiences from our day,” Grist says. “That makes us susceptible to burnout.”
In addition to feeling cut off from patients and peers, experts attribute burnout to heavy workloads and an intense demand for productivity. In general, physicians work longer hours during a work week than the rest of the workforce.1 Couple that with more job-related fatigue and greater dissatisfaction with work-life balance, and the stage is set for unwanted outcomes.
Recognizing the Problem
“Physician burnout is a serious problem that thwarts our ability to deliver serious health care,” says James A. Brink, MD, FACR, chief of radiology at Massachusetts General Hospital in Boston and chair of the ACR BOC. And the signs of burnout can be subtle.
On a practice level, more scheduling problems or a shift in staffing patterns with increased turnover could be a sign that some staff members are experiencing feelings of burnout. When it comes to individual physicians, uncharacteristic complaints may be made about a staff member’s demeanor. Colleagues may notice cynicism and a general lack of enthusiasm during day-to-day operations. Collaboration between departments and specialties begins to erode when communication seems unimportant or too challenging. More serious indicators include increased medical errors and missed opportunities to connect a patient with follow-up care.
“Realizing the problem is the huge first step,” says Chew. “Then burnout can be addressed by changing the job, by changing one’s psychological response to the job, or both. Our studies have shown that life-work imbalance and a perceived lack of control over important aspects of work are the two most commonly self-identified sources of stress among radiologists.” Issues related to decreased reimbursement come in third, he adds.
“Maintaining life-work balance might require shorter and more flexible working hours, with the concomitant trade-off of having a larger workforce at lower pay,” Chew says. Mindfulness training — or bringing one’s full attention to the present moment and task at hand — has been shown in some circumstances to affect psychological responses to job-related stress, he notes, but “giving radiologists mandatory mindfulness training before or after their normal workday is probably not the way to go.”
At the 2017 ACR-RBMA Practice Leaders Forum in Orlando, Fla., moderators offered recommendations to reduce workplace stress and achieve a more favorable work-life balance (read more at bit.ly/RBMA_ACR). It could start by simply saying no when you feel like reasonable boundaries are being crossed on the job. And while getting more sleep, eating better, and striving to strengthen relationships outside of work are always beneficial, session presenters also suggest simple pleasures — getting a hobby or a pet. Sharing your frustrations or concerns with coworkers could also stave off burnout.
Encourage your institution to provide opportunities for professional development. Experts agree that stagnating in a work environment — especially for highly educated professionals — is harmful to creativity and to building new relationships with coworkers. A sense of community, says Grist, is an important part of interacting within the health care value chain.
There are online self-tests for burnout similar to the MBI that health care administrators use, Chew notes. It’s worthwhile to explore burnout on your own, he says, but often “there is an overlap between burnout and depression, for which you should consult a mental health professional.”
Despite the alarming number of reported burnout cases in recent years, promising weapons are on the horizon to aid radiologists struggling to manage too many bureaucratic tasks, long work hours, and integrating patient medical and imaging records.
Easing the Burden
Moving forward, radiologists will need to hand off their most time-consuming and mundane tasks to rein in burnout. This will foster creativity and the mutually rewarding experience of connecting with colleagues and patients. Employing reading room coordinators and putting AI solutions to use could help.
To cope with busy environments and increasing clinical volume — as well as pressure to perform noninterpretive tasks such as follow-up consultations — radiologists could benefit from hiring a reading room coordinator. This person can boost health system efficiency by assisting radiologists with phone calls, relaying patient exam information down the line, and other administrative tasks. Reading room coordinators also facilitate communication between radiologists and referring physicians and even handle technical requests by technologists. Essentially, the coordinator serves as a first point of contact for routine tasks that may not require a radiologist’s expertise or attention.
The monotony of certain tasks in radiology is a big contributor to burnout, says Grist. “I think that’s where AI might really improve the quality of our profession. I have great hope that it will make our workflow easier so we can really focus on the more interesting parts of the services we provide,” he says.
AI is positioned to handle the lion’s share of tedious interpretation down the road, and the benefits of its speed and accuracy, many think, will be a game changer for radiologists. “Ironically, maybe computers can reduce the sense of depersonalization,” says Canon. “The value of AI and its envisioned support role for radiologists will allow us more focus on the activities we find so rewarding,” she says. “Engaging with our patients, clinical colleagues, and other members of the health care team is often the very reason we entered radiology. Only these connections can fend off burnout.”
A number of resources are available (see sidebar) to help physicians and health system leaders address the critical rise of burnout. Tapping into those resources is a realistic starting point. “It’s important not to lose sight of why you’re doing all of the things you’re doing,” says Grist. “When you lose your motivation, burnout becomes possible. The motivation is always about the ‘why.’ And the why is patients.”
It takes an incredible amount of training, resources, time, and commitment to become a radiologist, Grist points out. “So if we lose this vital cohort of people who are at risk of burning out, who are often still mid-career,” he says, “we’re losing a tremendous resource for taking care of a growing number of patients who need their expertise.”
By Chad Hudnall, managing editor, ACR Press