7 Reasons Rads Burn Out-And How to Cope

Let’s face it - the dream job doesn’t really exist. Even if you love your position and your institution, there are going to be times when you’re frustrated and tired or when you feel ineffectual. In essence, at some point, you’re going to feel burned out.

But, when that feeling becomes the norm, that’s when the real problems occur. And, according to the 2016 Medscape Physician Life Report, burnout is the reality for 50 percent of radiologists. As a result, job satisfaction falls, patient care suffers, and workflow management becomes inefficient.

Related article: Stop Burnout in Radiology Before It Starts

Consequently, many industry leaders say it’s vital to identify why burnout occurs and pinpoint some methods, both individually and institutionally, to counteract the effects or side-step it altogether. Ignoring the problem, they say, could have grave consequences.

“Burnout threatens our existence as a specialty,” says Peter Moskowitz, MD, executive director of the Center for Professional and Personal Renewal in Palo Alto, California. “There are increasing numbers of people leaving the field prematurely. And, at the same time, medical students are shrewd. They will see what’s going on in radiology and will look elsewhere for a career.”

What’s causing the fizzle?

Knowing what’s behind the loss of enthusiasm in radiology can be integral to fixing the problem. These are some of the most common factors at play.

1. Increased imaging volume

This problem is two-fold, says Moskowitz, clinical professor of radiology emeritus at Stanford University School of Medicine. Not only has imaging utilization crept up, but the number of images taken per study-particularly with cross-sectional studies-has ballooned, as well.

In fact, according to a recent article published in the Journal of the American College of Radiology, imaging workload has grown by 26% in the last 12 years. Unfortunately, the rise has outpaced practitioners’ abilities to keep up.

"Many MRI sequences and CT reconstructions are not necessary for diagnosis,” Moskowitz says.  “We must find a way to reduce unnecessary images."

2. PACS and electronic medical records

While these technologies carry several benefits, interoperability problems still exist. When systems don’t communicate fluidly, it can cause frustrations and decrease radiologist efficiency.

3. RVU focus

Overall, the industry puts too much emphasis on physician RVUs, Moskowitz says.

“Physician salaries and bonuses, status within groups, partnerships - all of these decisions are now made almost exclusively on physician productivity,” he says. “And, it’s killing people.”

4. Educational debt

Nearly 55% of new trainees report student debt weight contributes heavily to their work-related stress. Most graduates and trainees enter practice with between $150,000-$200,000 of debt, he says.

Related article: Why Radiologists Are Bad With Money

5. Generational differences

Frequently, work values between older and younger radiologists differ, Moskowitz says, causing anxiety.

“It’s not that one group is correct and the other is wrong,” he says. “Their values are simply different and it results in friction in the work environment.”

6. Declining reimbursement

Dips in payments, as well as the impending switch from the fee-for-service payment model to value-based, has caused trepidation. The lack of clarity around how the payment system shift will ultimately impact reimbursement rates has created worries, he says.

7. Isolation

The nature of radiology calls for practitioners to frequently work alone, so patient and co-worker interaction opportunities are limited. That disconnected feeling can prompt radiologists to feel dissatisfied, says David Larson, MD, associate professor or pediatric radiology and vice chair for education and clinical operations in the Stanford University School of Medicine radiology department.

“Without a connection with professional colleagues, we can become isolated and feel like we don’t really have a team,” he says. “In the work environment, that puts us at risk for feeling like cogs in a machine that don’t have any control over our work.”

Re-igniting the flame

Despite these many factors, it’s possible to rekindle your passion for diagnostic imaging. However, it requires some changes in your own activities, as well as in the office.

From a personal perspective, concentrate on taking care of yourself, Larson says. Get enough sleep, eat a healthy diet, and exercise frequently. Take walks when you can or practice mindfulness meditation or yoga.

Additionally, says Samir Parikh, MD, a radiologist at the Henry Ford Health System, relax when you get home from work. Enjoy dinner with your family or watch movies or shows that make you laugh. Those are effective supplementary methods to keep you calm and help you release the daily stresses, he says.

Just don’t rely on these tactics alone, Larson cautions. They won’t be enough.

“The evidence shows these individual methods make some difference, but they can’t completely protect you from a toxic work environment,” he says. “Those who say to focus on those things primarily, I’d say they lose credibility because more needs to be done at the company or health system level.”

Related article: Strategies for Reducing Physician Burnout

For example, he says, rather than engaging in peer review, radiologists could benefit more from peer learning and support. This type of system removes harsh judgement and replaces it with opportunities for improvement. Instead of pointing out mistakes, peers coach each other and offer feedback to augment performance.

In addition to looking for ways to reduce the number of images per exam, Moskowitz says, radiology’s culture must change. Individual providers must make their own mental and physical health a priority.

“We need to learn to say no to outrageous demands from other physicians,” he says. “And, we need to set more reasonable boundaries on our work hours.”

Work hours and rotations must be more flexible, giving providers the opportunity to adopt the work-life balance that is best for them. Practices should also develop strategies for recognizing non-RVU performances regularly.

A greater balance between the number of images needing to be read and a provider’s expected output is also paramount, Larson says. The constant drive for more productivity can be overwhelming and lead to burnout.

“We are often victims of our own successes in terms of developing more diagnostic techniques and greater possibilities for our systems,” he says. “That comes at a price of increased complexity, often leading to us bearing the brunt of the heavier cognitive load.”

Radiologists can also avoid burnout by creating more hospitable reading rooms. Select ergonomic equipment that accommodates both sitting and standing, and take frequent breaks away from your work station. Hire reading room assistants to answer routine phone calls, Moskowitz says. And, consider adding exercise equipment, such as stationary bikes or treadmills, in the reading room so providers can take short exercise breaks during work hours.

Spend your lunch break outside the department and the reading room. Interact socially with referring physicians every day outside the reading room, without feeling guilty.

“Little things like that can make a difference,” Moskowitz says.

These larger changes are also imperative, he says, because they attack the root cause of the burnout. Many providers could be resistant to such large systemic shifts. So, to be successful, secure buy-in from both your departmental leaders and administrators.

Ultimately, Larson says, addressing the factors behind burnout is critical to reducing provider mistakes, improving patient care, and workflow efficiency. Ignoring the problem isn’t an option, he says.

“This is real. Even though it’s very difficult to measure and difficult to articulate, it’s a real phenomenon,” he says. “We have to take it seriously, and we need to make sure we’re as rigorous as possible in the ways we address it.”