Stop Burnout in Radiology Before It Starts

Radiology is rising in the burnout ranks, compared to other specialties. Radiology is now the seventh highest specialty for burnout in the 2018 Medscape National Physician Burnout and Depression Report, compared to being 20th highest in 2017 and 10th highest in 2016. Of the 15,543 physicians surveyed for the 2018 report, 42 percent of all physicians reported burnout, with 45 percent of radiologists reporting the same.

Burnout can be defined as emotional exhaustion, feelings of decreased accomplishment and depersonalization. It has high costs not only for the physician’s mental and physical health, but can impact patient health, causing adverse care events and errors as well. Healthcare organizations lose productivity and money if a physician leaves or isn’t working at their best. “Leadership has to recognize that there’s an economic effect to burnout,” says Peter Moskowitz, MD, clinical professor emeritus at Stanford University Radiology and executive director of the Center for Professional and Personal Renewal in Palo Alto, a physician career and life coaching practice.

Though Moskowitz hasn’t seen many organizations or institutions combatting burnout in a meaningful way in the past few years, he says it’s starting to be taken more seriously. “I am encouraged to see the number of articles addressing radiology burnout over the last 12 to 18 months. The subject is getting discussed more than it used to be,” he says. “That’s positive.”

In another sign that at least one well known institution is tackling the issue, Stanford Medicine hired Tait Shanafelt, MD, last fall as chief wellness officer. Stanford is the first U.S. academic medical center to create a position like this, and they specifically acknowledged that physician burnout is reaching an all-time high. Previously, Shanafelt held a similar position at the Mayo Clinic, running a successful program to combat physician burnout, improve wellness and increase doctors’ sense of fulfilment. Shanafelt’s Mayo Clinic initiative targeted leadership, organizational culture, the practice environment and systems, bringing burnout rates down 7 percent over two years, while at the same time nationally, the physician burnout rate rose 11 percent using the same metrics. A subsequent survey showed that the burnout rate decreased around 66 percent compared to national rates.

What individuals can do to combat burnout

It’s important for individual physicians to take charge in handling their feelings of burnout, whether that’s though exercise, spending time with friends and family, mindfulness and staying in the present. Here are some other ways physicians can take control.

Remember why you became a radiologist: “All doctors went into the field because they found it meaningful,” says Jay Harolds, MD, professor at Michigan State University College of Human Medicine, and a radiologist with Advanced Radiology Services in Grand Rapids. “Sometimes as a result of years of being in the field, people feel trapped with the work and stress, and lose track of the fact that the field really is important. The images we read are not just shadows on a PACS station, but they represent human beings and their families. Everything we do impacts how they fare health wise.”

Positive psychology: It is possible to change the way you think, which can affect a person’s outlook and success. An example is learned optimism, says Harolds. Optimists tend to be more successful, confident and believe that positive events are permanent, not just blips on the radar. Defeats are not reflective of life as a whole, but transient. Optimism can be learned. “Many physicians are hyper critical people, perfectionistic,” he says. They may focus on what is bad or inadequate about themselves, including mistakes. “Instead, it’s better to focus on what’s good, and long and short-term accomplishments.”

What organizations can do to combat burnout

The workplace can positively impact burnout in a number of ways and should be done in tandem with individual physician efforts. “Burnout will not go away simply by spending more time exercising and sleeping,” says Moskowitz. “We need to change the whole culture of the radiology work environment and that is largely dependent on organizational leadership and practices.”

Change assessment structure: “We need to move away from RVU productivity as the sole defining assessment for physician effectiveness,” says Moskowitz, as he says it’s killing people. He believes this is a growing issue in radiology as he recently started getting frequent calls about this. “I’m in a unique position to hear about it, because radiologists feel comfortable talking to me confidentially, whereas they might not talk about it to their hospital directors, practice partners or friends.” Radiologists want compensation structured not just on production numbers, but participation in hospital committees, respect from referring clinicians and teaching activities as well. “I know of multiple instances in which radiologist’s status within their practices are being threatened by their inability to reach an RVU production level that is arbitrarily established by non-physician managers.”

Decreasing administrative work: High on the list of factors increasing radiologist burnout from the 2018 Medscape report are bureaucratic tasks and feeling like a cog in the wheel. Both Moskowitz and Harolds recommend that organizations hire reading room coordinators to triage phone calls and track down records or doctors needed for consultation, allowing radiologists to focus on reading.
Reading room set up and ergonomics: Creating healthier work environments includes ergonomic work stations and reading rooms. That means appropriate lighting, stations and frequent work breaks (five minutes every 45-60 minutes). “You’d be surprised how many radiologists say they’re so busy they don’t have time to take a break or eat lunch, because they’re too busy,” says Moskowitz. Individual reading rooms create isolation, which promotes burnout. By designing open reading rooms for multiple radiologists, they can interact with their peers personally and professionally.

Strengthen team relationships: Changing the reading room set up can help strengthen team relationships. With organizations increasing in size, it’s harder for radiologists to interact with their colleagues and referring physicians. Building relationships can be done by scheduling fun activities outside the workplace, or just sharing meals and taking breaks together at work.

Give meaningful work: Radiologists tend to work in large groups now, which can easily accommodate doctors with different professional interests. If it’s possible to give radiologists the types of images they prefer to read, they’ll be more engaged with the work.

Find good leaders: Leaders shouldn’t just be people who have been around the longest, but those who communicate well and encourage others to find new ways to solve problems. “If a person is a good leader, the followers have less burnout and more resilience,” Harolds says. A good leader will make work less complex and consult others before implementing changes. Leadership is important in combatting burnout because many radiologists don’t want to talk about the subject. Some haven’t experienced it or dealt with it in their own careers, and are uncomfortable trying to make changes on their own.

Increase independence and control: Another reason for burnout cited in the report is a lack of control or autonomy. “Now with larger and larger groups, they have less independence and more measures of productivity,” Harolds says. Organizations can find areas that the individual physicians can have control over. Even minor changes can increase morale.

National meetings and curricula: Radiologist burnout should be incorporated into national physician meetings, with sections devoted to wellness and burnout. This is a way to share best practices and research, and to show the importance on a national level. These groups can help develop curricula to teach wellness principles residents and fellows.

If not addressed, burnout has the potential to get worse. “As time goes on, I would think the pressures are going to be greater, not less, on physicians because of the costs (of medical care). There will be more pressure in the future,” Harolds says.