Money Woes Spell Burnout for Radiology Residents

Michael McNeeley, MD, wanted to set one thing straight: "radi-holiday" is a myth of medical education.

"The big thing here is radiology has always been one of those lifestyle specialties," said McNeeley, a senior radiology resident at the University of Washington in Seattle. "Meaning, it's known for reasonable work hours, being well-compensated and not having a lot of intense patient contact. There is this image that we are sequestered away, below the radar, working bankers' hours.

"It's not true these days; it's not realistic. I don't think we've really done ourselves by allowing that myth to be perpetuated. But in general, radiology clerkships are notorious as vacations: a radi-holiday. That skews expectations of those entering the field."[[{"type":"media","view_mode":"media_crop","fid":"14200","attributes":{"alt":"","class":"media-image media-image-right","height":"106","id":"media_crop_4739336934867","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"711","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"margin: 5px; float: right;","title":" ","typeof":"foaf:Image","width":"148"}}]]

McNeeley knew his training in the field was far from stress-free. But, when he decided to debunk the long-standing lifestyle myth, McNeeley didn't rely on antidotal evidence of long-hours, the shrinking job market, and the increased pressures of patient centeredness. Instead, he did what his medical education taught him and turned to science.

McNeeley designed a study that sought to capture the burnout rates of radiology residents. But he also decided to focus on the role the growing financial burden most young doctors must incur plays on inducing burnout.

What his study, which was published last month in Academic Radiology, found wasn't entirely surprising to him.

Of the 249 radiology residents who completed the survey that was the basis for the study, McNeeley found they had slightly higher burnout levels than what was measured in previous studies looking at internal medicine residents.

Secondly his decision to focus on the role money plays in leading to burnout in radiology residents proved enlightening.

"Finances may be an underappreciated contribution to burnout," he said. "But it isn't about the financial balance sheet, it's all about attitudes about money."

At first glance the results may seem counter-intuitive, McNeeley said, because burnout didn't correlate to hard established facts like income or debt. Instead, radiology residents were more likely to burn out simply because they felt a huge financial strain. The trainee's financial perception, and not his or her financial reality, was the better predictor of burnout, he found.

"If [radiology residents] are feeling a sense of financial scarcity," McNeeley said, "I think that is more important because we're dealing with emotions and feelings, and that's where dysphoria springs from."

To evaluate burnout, McNeeley incorporated a modified version of the Maslach Burnout Index into the survey, which was emailed to 1,389 residents and fellow junior members of the Association of University in January 2012. (The study had a response rate of 19 percent).

In general, McNeeley found the survey results on burnout aligned with his perceptions of stress among his fellow trainees. The findings included:

• 53 percent of respondents described emotional exhaustion at least weekly

• 49 percent of respondents reported feelings of depersonalization on a weekly basis

When it came to the measurements of financial strain, McNeeley was deliberate in noting the statistically significant associations between burnout symptoms and financial perceptions, including:

• 55 percent of respondents said they somewhat agreed, agreed, or strongly agreed that their financial situation is a "serious strain."

• While 25 percent reported at least some trouble playing for housing and utilities, 42 percent said it was difficult to pay for mandatory work-related expenses such as American Board of Radiology dues and licensing costs.

• As the values for subjective financial strain increased so did the levels of emotional exhaustion and depersonalization, while measurements of quality of life decreased.

His hope is the study builds awareness that radiology trainees are not immune to burnout despite some of the traditional stereotypes of the specialty. He also said he hopes program managers take note that small steps to ease the perception of financial strain could go a long way to reducing burnout in radiology trainees.

"I saw a lack of that data in this area and realized there was a need that hadn't been addressed," McNeeley said, noting that he had seen many papers addressing burnout in other physician specialties but not his own.

"Residency is a tough period, and there is a big, steep learning curve coming into radiology because you don't get a lot of it in medical school. When you're finished with your internship you come out knowing, 'I can keep a ward full of people alive.' But you come in on day one of radiology and you're back to nothing. … The psychological challenges are unavoidable."

But he suggested with awareness of the situation program directors and other leaders in the field working to mold new radiologists should look for ways to ease burnout rates. Minimizing out-of-pocket expenses may also help to reduce perceived financial strain, he said. But programs should take note of other studies that have shown workers provided with good time structure, collective purpose, social contact and stimulating activity fair better emotionally and are less likely to burnout.

"Keeping residents focused on the bigger picture of patient care and reminding them of their place in broader healthcare system can go a long way," he suggested.

That's something Mary Scanlon, MD, vice chair of education for the Department of Radiology and the University of Pennsylvania School of Medicine, said she is conscious of in working with her residents.

In addition to trying to cover as many expenses are possible for the students by providing money for books and conferences and identifying moonlighting work, Scanlon said she focuses on giving them power to control some things in their highly regulated lives.

Long hours, tightening government regulations and hours of reading are most likely fueling burnout, Scanlon said, but money and the struggle to find the well-paying jobs once guaranteed to radiologists is likely also a significant stressor.

"They are burned out from the gloom and doom of radiology and doom and gloom of there being no jobs out there," she said.

While many of those factors are beyond individual control, she said residents should control some things in their work life. So, for instance, when they complained about a run-down and uncomfortable resident lounge, she asked how they would like to redesign it.

"Now they have a brand new resident lounge," she said. "If you feel like you can be a master of your own fate and solve problems and make a difference that helps. … If people think they can be in control of problems and fix them, that's a big way to control burnout and improve morale."