Deborah Abrams Kaplan

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.

 “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.”

 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.”

 “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.”

 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.

 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.

 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.

 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.

 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.

 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.

Articles

Radiologist burnout is getting worse and action needs to be taken.

Stop Burnout in Radiology Before It Starts

 (AI) is booming in all areas of business and medicine. But it’s taken a special hold in radiology. 

 had its first machine learning showcase, highlighting the companies and technologies already changing how radiology is practiced. About 30 

AI brings a mix of feelings to those who practice radiology, including fear, hope, and hype, said Woojin Kim, MD, a Chief Medical Information Officer for Nuance’s healthcare division, and an MSK radiologist.

Media have bombarded the radiology field with talk of AI.

“Even in mainstream artificial intelligence articles, for some reason, radiology is often used as an example of where machines will replace humans,” he said. What’s inspiring that fear, hope and hype, and is it justified?




“When I see some of the experts in AI talking about radiology, it is evident that they have a very simplified view of what we do as radiologists,” Kim said.

But even some radiologists and those considering the field are fearful. Andrew Ng, a Stanford adjunct professor, and well-known machine learning expert who co-founded Google Brain and recently led Baidu AI Lab, posted an email from a radiology resident on 

. The third-year resident asked whether to quit and do something else, questioning how close radiologists were to being replaced. “It’s clearly affecting the mindset of those who want to go into radiology or who are currently in training,” Kim said. 

Fear of technology is nothing new. With desktop publishing, many typographers may have lost their jobs, but the number of graphic designers increased, he said. Another example is the “Luddite fallacy,” in which English textile workers destroyed textile-making machines out of fear that the technology would put them out of work. Instead, the machines caused the price of textiles to drop, and more people bought them. The textile industry grew.

Just as with these examples, Kim said that technology will not replace radiologists, but will create new opportunities and new ways to provide value.




AI algorithms are getting easier to create. “You can get a set of images for an imaging finding you’re interested in, and with several lines of code or by using a deep learning development environment, you can train deep neural networks,” so much so that it’s almost a cookie-cutter operation for some. Because of that, many algorithms are popping up. If they’re created by someone without deep clinical radiology knowledge, though, the algorithms won’t work well. A granuloma is not the same as a pulmonary nodule, for example. “Coming up with a good medical imaging AI algorithm is a difficult task and still takes a lot of effort,” he said.

From what Kim is seeing, not all AI developers fully leverage radiologists’ knowledge. “That’s what makes our job complex. We need to know about things that can mimic disease, so I don’t call an artifact or benign finding a disease.” That subtle knowledge makes a huge difference in interpretation.

A study published in September 2017 in the

 used IBM’s Watson to determine if a patient should get contrast for a musculoskeletal MRI, based on the study’s free-text clinical indications. The machine performed well in this situation, with 83.2% clinical accuracy for the test set, compared to the original protocol. When compared to the test set and the second radiologist reader concordance, Watson was in agreement 90%.

That’s great news and shows promise. However, if those running the artificial intelligence system don’t understand how the decisions are made in the deep learning algorithms, that can be a problem in medicine, said Kim. This “black box” problem happens when a bad decision is made, but no one understands how the deep learning program arrived at the decision.

In the study, Watson committed 25 classification errors in the 280-case test set. One, however, was potentially fatal: assigning contrast dye to a patient with end-stage renal disease. Watson had a high confidence level for that decision, showing that radiologists can’t rely on AI just because of high confidence levels. If a person makes a mistake, they usually know why, said Kim. Until the black box problem is solved, radiologists must be heavily involved.




The goal should not be replacing radiologists with deep learning algorithms, but making radiologists better. With artificial intelligence working in the background, diagnostic accuracy can increase.

Radiologists and others have tunnel vision for how artificial intelligence can be used in the field. It’s not just about making a finding and auto-generating a report, Kim said. AI can be used in every step of the medical imaging process, including patient scheduling, imaging protocols, workflow, creating actionable reports, communication, quality assessment, and patient safety and follow-ups.

“If I have to make measurements on a bunch of lymph nodes and compare them to two prior studies, that’s a repetitive task that AI is nicely suited for,” said Kim. “I know the really cool thing right now is having the machines make the findings on images, but there are many ways AI can benefit radiology.” The technology can be adopted more quickly when using it for lower hanging fruit than diagnostic use, partly because of the FDA 

One way it can help is by pulling up applicable clinical history and records. “We know we can do a better job as radiologists if we have good clinical information about the patient,” said Kim. A lot of times, that’s missing, and it’s cumbersome to get the needed data. “I don’t need the entire medical history of the patient for every exam I interpret, but it is extremely valuable to have pertinent information from the patient’s medical record that can help me make a better diagnosis.” To do that now, he has to go through dozens of screens and mouse clicks to see if there’s useful information. “This is where artificial intelligence can help out.” It can go through patient’s medical records, looking for lab values, pathology results, and past family, medical and surgical history that might be helpful, and provide a single summary.

AI can help with repetitive work, anything the radiologist has to do more than once a day is a good use for AI. Many academic centers ask doctors to protocol exams in advance, to increase efficiency, so when a patient arrives, the protocol is ready. “Artificial intelligence can help, depending on prior protocols and clinical indication,” Kim said. The AI protocols can be presented to the radiologist, who can agree or disagree, making necessary changes and allowing the neural network to learn to make better future decisions.

patients, like vRad and MetaMind are doing to detect intracranial hemorrhages as part of the workflow.

While AI can provoke a healthy dose of fear factor, it’s a useful technology for radiologists. “We should embrace it, and not put our heads in the sand and ignore it. As a field we have to engage and embrace it, so we can guide the direction of where artificial intelligence should go.” Otherwise, other AI experts will direct it. By staying involved, radiologists can mitigate any negative impact it can have on the field.

How to do that? A hospital administrator may not appreciate the true value of a radiologist, preferring the AI algorithm that works 24/7 at a lower cost. In the future, an algorithm may be able to provide nicely structured and formatted reports with a high degree of accuracy. Radiologists should play an integral role at the hospital, from information technology to hospital management. “If we don’t have close relationships with the hospitals, they’re not going to see our value. We need to be constantly engaged, showing how we provide value and that we’re part of the care management team,” Kim said.

While trained radiologists and those in training may be nervous about AI, they should learn more about it. “That would help alleviate some of the fears,” he said. They can see how AI can play an integral role in their future practice. He recommends that radiology training programs incorporate informatics.

Those wanting to learn more can find information through medical societies like the ACR, RSNA, and SIIM. Kim recommends attending the 

SIIM Conference on Machine Intelligence in Medical Imaging (C-MIMI)

. For hands-on experience with deep learning, the 

 platform allows users to easily design and train neural networks.

Whether radiology tasks will be streamlined as a result of AI remains to be seen. The number of medical images is increasing, as is demand for medical imaging. Medicine relies more heavily on technology for diagnoses. “It’s not a simple formula,” said Kim. “We have to wait and see.”
 

Radiologists have mixed feelings about AI.

Fear, Hope, and Hype For Artificial Intelligence

It’s a struggle for radiology services to balance the complexities of running an efficient and high-quality imaging service, while ensuring that patients get the best experience.

Sometimes they are at odds. Some machines are slow. Appointment times book up far in advance. Staff members’ to-do lists never end. The flip side is that patients who are comfortable are more likely to remain calm and still during studies, improving the image quality, and not needing to redo the study. And patients who are happy with their experience are more likely to return when they need additional care, and tell their friends.

Philips recently published a 

about the patient experience, surveying more than 600 American and German patients about their journey through the imaging process. While the results weren’t shocking, they’re still good reminders about what’s important to patients, how they perceive their treatment by medical staff, and their process in radiology’s care.

Jalal B. Andre, MD, said the study results were similar to what he sees in his practice. “They want faster turnaround time, and to have their time respected,” said Andre, director of neurological MRI at Harborview Medical Center in Seattle, and a University of Washington associate professor of radiology.




The patients’ opinion matters. Medical centers and providers have become more savvy from a business perspective in improving patient care and recognizing that patients are customers, and can choose to go elsewhere.

Historically, doctors placed less emphasis on the patient’s time versus their own, not on purpose, but due to the medical training and busyness of the job. Andre calls it the “conveyor belt approach,” partly driven by insurance demands. The model favors the doctor’s time over the patient’s. However, that’s shifting, as the internet allows patients to share information, giving them more power and choices than they had before. Sharing an experience on social media can sway other people. This is radically shifting how medical staff approach patients now.

“In order to thrive, we really do want to make sure patients want to come to us for their care. If we’re not showing them that compassion, and we’re not open to that patient experience, somebody else will, and they’ll fill that niche,” said Paula Gonyea, director of radiology at UVM Medical Center.

The Philips study showed that radiology offices need to keep their eyes on patient and family-centered care, said Gonyea, something her medical center already does. They have patient and family-centered care teams in all departments. In radiology, that team includes radiologists, managers, and technologists, and each modality has its own quality team. At each quality team meeting, they come up with one or two new things to welcome patients and families. “Welcoming is a big thing in our hospital right now, across the board,” she said.




UVM includes patient advisors on their committees. These are patients who volunteer their time to share personal insights. During a recent hospital renovation project, they redid their waiting rooms and dressing rooms. Two patient advisors on the committee shared what they thought about when waiting for a test, like how to involve their families and make them more comfortable. They also wanted additional dressing rooms, with some redesigned to better accommodate wheelchairs. A lot of what they brought up was the softer side of medical care, Gonyea said.

She agreed with Philips’ study results, that patients want technologists and nurses giving extra care and presenting confidently that the patients are there for the right test for the right diagnosis. At UVM, that might mean the technologist addresses the patient by name, confirming that they are present for a CT scan for a specific diagnosis. Of course, the technologist will also ask about any additional concerns, and share the process for conducting the exam and sharing the results. They scan in the patient’s wrist band bar code to make sure the imaging study goes to the right medical records location.

While not all patients see radiologists as part of their visit, Gonyea said UVM is reviewing their workflow, to see if they can find ways for radiologists to interact with some patients to answer questions. They might try identifying patients who seem anxious when checking in, as good candidates to chat with a radiologist. Currently, a patient not scheduled to see a radiologist has to ask the technologist to see one. “We’re looking to be proactive to offer that,” she said.




Timing is everything when getting patient feedback. Catch someone right after they came out of the scanner when they’ve had a negative experience, and you may get a different answer than when you wait an hour to ask. Wait a week or two, and the response may be completely different.

UVM has comment cards at the reception desks. When the patient checks in, the receptionist encourages them to take a card and hold on to it, dropping it off at the desk on the way out. The comment cards give instant feedback so UVM staff can more quickly track issues needing attention. From comments made on these cards, UVM increased the variety of magazines, learned that patients liked the new mammography waiting room music and the adult coloring pages and pencils offered. “When we make changes, we seem to get more comments,” Gonyea said.

While Gonyea doesn’t have statistics for how many patients fill them out, she said that at one point, they received hundreds of cards per month.

UVM also participates in Press Ganey surveys, mailed a week or two after the appointment. While helpful, those comments tend to be more vague, like the patients said they waited longer than expected, or that things were great.

There are other 


The Philips survey asked patients for the one thing they would change about their imaging experience. The most common answers were that patients wanted their results faster, and didn’t want such a long gap between scheduling and the actual appointment. Fortunately, UVM hasn’t received many complaints about report turnaround time, but the latter issue is common.

“What every hospital struggles with is waiting time to get in for tests with limited equipment, and juggling those appointments,” she said. Most patients understand that there are a lot of people waiting for the same test. “There is only so much you can do,” she said. They work with patients who have coordinating appointments, to get their imaging done in time, and patients appreciate being added to a cancellation list for a possible earlier appointment.

The amount of time that imaging exams take was an issue for some in the Philips study. Radiology groups understand that too. Due to economic pressures, there’s a push for  greater patient through-put in the machines. However, scanners can only go so fast, said Andre. While CT scans may take a few minutes, MRI scans can take 90 minutes.

“Most developers think a 15-minute sequence is reasonable, whereas most clinicians think it has to be under five minutes,” he said. It’s critical for patients to hold still, as motion is a problem. Patient frustration with the long wait time is understandable and can’t always be resolved.

Patients in the survey also asked for more comfortable experiences, which can be difficult when the patient is in pain. Andre said he has been in the scanner many times as a volunteer, having pleasant experiences and often falling asleep. However, he had a wake-up call when in pain, he needed an emergent 45-minute MRI exam two years ago. “Every time the machine pulsed, I felt it go through my body in a way I hadn’t felt before. It hurt lying on the hard surface. The whole thing was a very different experience,” he said. He realized there was probably more they could do to make the patient comfortable, and that they historically haven’t done a good job putting themselves in their patients’ shoes.

Vendors are trying to improve the patient 

, through lighting, distraction, and entertainment options.




With long waits and uncomfortable scans, it’s more important than ever to communicate with the patient and share the status and what to expect. Hospital culture affects how staff members treat the patient experience.

“Patient experience plays a larger role in the discussion. People try to be active listeners in a place like Seattle, and that was new to me, versus what I’d experienced in the past,” said Andre. The good news is that the culture has changed since Andre’s training in New York Where there was less focus on the patient experience.

Image quality and report turnaround time aren’t the only indicators of a successful radiology group.

Listen To Your Patients

Radiology burnout is a topic of frequent discussion among radiologists, and studies continue to look at causes and ways to alleviate it. While three of the radiologists interviewed for this article proactively mentioned burnout as a key issue in radiology today, none of them cited it as a reason that they changed careers.One did warn, however, that burnout and long hours aren’t restricted to doctors. Those looking for a way out may think the grass is greener elsewhere. “Not true,” said Nicholas Argy, MD. “Lawyers work their tails off. Architects work their tails off. Engineers work their tails off.” These featured physicians may be working their tails off in other areas of health care, but some of them say it doesn’t feel like work, as they’re enjoying it so much. “Physicians have passions beyond radiology,” said Argy. They key is to find that passion.

Slideshows

Radiologists who found careers outside of the reading room.

Radiologists Following a Different Path

The good news about women in radiology is this: in 2016, the 

 put diagnostic radiology in the top ten specialties for women, coming in at number nine. That is great news to inspire female medical students considering their specialty choices, but the number of women entering radiology residencies hasn’t changed in the last few years.

“We still have the same issues: a very low percentage of women compared to men in radiology, even though there is almost an equal number of men and women in medical school,” said Margaret Szabunio, MD, president of the American Association of Women Radiologists (AAWR), and professor of radiology at the University of Kentucky.

Since 2007, the total number of female residents and physicians grew 43%, according to the 

.  That includes 376,500 female doctors, with 42,000 currently enrolled in medical school in the US. About 46%–47% of medical students are 

 women, and how does that compare to other specialties?


When looking at physician age distributions, the 2017 ACR Commission on Human Resources Workforce 

 showed that there are more women in the younger age groups (under 45) practicing radiology.

“That’s where we’ve seen slight increases in women, and that’s a promising trend,” said Katarzyna Macura, MD, PhD, chair of the ACR’s Commission for Women and Diversity, and a professor of radiology at the Johns Hopkins Medical Institutions. Radiologists in the older group (over 56) are more male-dominated. “These are good indicators that younger women seem to be increasing in the workforce,” she said.

In the 35–45 age group, 32% were women, the same as last year and slightly lower than the 33% in 2014. In the older groups, 46-55, 56-65 and 65 and older, the 2017 figures had decreased or stayed the same from previous years.

Why does it matter whether there are equal numbers of men and women? One radiologist asked “who cares” in the comments on our 

 about why women were a relatively small percentage of the specialty. To AAWR’s Szabunio, it’s important to patients. Whether it’s diversity in sex, religion, or ethnicity, diverse populations bring a different outlook and respond differently to patient care than a homogeneous workforce responds.

“In breast imaging, especially, patients prefer to have a woman physician,” she said. Workforce 

 have shown that those with gender and ethnic diversity respond differently to patient care, and patients are more likely to receive higher quality treatment and care when they 

 some of these backgrounds with their physician. Diverse leadership can also affect health care policy of a practice or institution, to and be more inclusive of the population they’re treating.


Where are the female doctors? A 2015 Association of American Medical Colleges (AAMC) 

 said that women make up more than half of these residency programs:

, here’s the percentage of women in these specialties:

 Psychiatry: 42% women (child psychiatry is 53% women)


To make changes, “think locally versus nationally,” said Szabunio. “We’re trying to do this successfully at the local level.” Then the word will spread at the national level.[[{"type":"media","view_mode":"media_crop","fid":"63954","attributes":{"alt":"Women in radiology","class":"media-image media-image-right","id":"media_crop_3860777685432","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"8165","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":"height: 200px; width: 300px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Â©Robert Kneschke/Shutterstock.com","typeof":"foaf:Image"}}]]

More exposure in medical school through leadership

: Radiology isn’t typically a required course or part of the curriculum, and many students aren’t exposed to it until a fourth-year elective. By then it might be too late, as the student has already committed to a residency area. Radiologists need to take leadership in the medical school and influence the curriculum. Szabunio said a radiologist became assistant dean for education at her school, giving the field more influence. The radiologists at University of Kentucky created electives in the first or second year of school. She created a breast imaging elective, and other radiologists did electives on their subspecialties, where the students can shadow the radiologist for a semester. The students can share what they learned and saw with their fellow students, increasing awareness. Lecturing is another way to provide exposure. If mostly men are lecturing, women won’t know there are women in the field, so Szabunio gave a breast imaging talk. “They see me as a woman talking about an exciting area of radiology. It’s eye-opening for them,” she said.

: Without enough female radiology mentors, medical students see the field as male-dominated. If female radiologists can mentor women before they choose a specialty, they’ll be exposed to different parts of radiology they may like, perhaps those with more patient contact like interventional radiology, pediatric radiology, or breast imaging. Students impressed with their mentors may go into those specialties. The lack of female role models and mentoring over the years is a significant deterrent.

. Some deans aren’t open to changing the curriculum to bring in radiology earlier, said Szabunio. Radiologists can create outside programs as well. The University of Kentucky and several other medical schools conducted a weekend radiology fair and invited all medical students. They gave didactic lectures and had stations on how to do some radiology procedures and provide exposure to radiology.

 If women are more visible in local and national leadership, that makes it easier to provide younger women with mentors and encourage them to enter radiology. The ACR is trying to appoint more women to ACR leadership positions, said ACR’s Macura. The board of chancellors is about 30% women, she said, slightly above the 27% of women in residency positions and above the 

 of women in radiology practice overall, she said. At state chapter levels, more women are taking on vice president and president positions. Most radiology societies are forming committees for women.

“Most importantly, next year we’ll have our first woman chair of the ACR board, Geraldine McGinty, MD, who is currently vice chair. She’ll be the first woman in the 95 years in existence of the College,” Macura said.

In addition, the ACR just funded a project through its innovation fund to implement a major survey to address barriers to a diverse workforce in radiology.

“I believe once we have results, maybe mid-next year, we should have some concrete policy directions,” said Macura. “Based on that, I’m hoping we’ll move forward with more focused strategies.”


There is a big opportunity to influence students. Not all medical students know what they want to specialize in at the beginning of medical school. An 

 compared specialty preferences of graduating students to those who also filled out a matriculating student questionnaire. When matriculating, 14% of students who eventually chose radiology residencies were undecided, whereas 16.5% knew they wanted radiology at matriculation, and stayed with that decision when graduating. A full 60% of those choosing radiology as a specialty at graduation started off medical school with a different specialty preference.

While results from the many formal and informal initiatives may take eight to 10 years, said Macura, there are interesting and encouraging trends. The engagement of younger women is amazing, she said, especially as they use social media. That’s helped to spread concepts in radiology and encourage more women to join, diversifying the workforce. “We’re beyond the awareness. We’re in the implementation phase to making some changes. I hope the flat line will tip up a little.”

Women have been notoriously underrepresented in the radiology workforce, a 2017 update to the issue.

Women in Radiology: A 2017 Update

If last year’s job market looked good for radiologists, this year is even better. That’s great news for radiologists looking for work, but not so much for those who need to hire. It will cost more to bring on new radiologists and those on the hiring end may need to rethink their traditional business model.

One statistic that best shows this trend is that radiology is now the 10

 most recruited specialty for physician search firm Merritt Hawkins. The company, which has been tracking permanent physician placements for 24 years, saw radiology jump from number 19 last year to the number 10 position this year, in its 

Merritt Hawkins’ 24th annual Review of Physician and Advanced Practitioner Recruiting Incentives

. It’s the first time radiology has been in the top 10 in a decade. In the last year, Merritt Hawkins conducted 80 retained searches for radiologists, double the number from the previous year, and up from 22–24 searches during the two prior years.

“We’re a direct indication of the market difficulty,” said Travis Singleton, a senior vice president at Merritt Hawkins. “No one will pay me for something they can do for free. We’re the best barometer out there.”

The ACR also shows a hiring increase. It’s been releasing its annual 

ACR Commission on Human Resources Workforce Survey

 since 2012. The current survey estimates that 1,569-2,037 radiologists were hired in 2016, and they’re predicting increased hiring in 2017. They estimate 1,826 to 2,370 radiologists will be hired, a 14% increase over last year’s numbers.

This year’s radiologist job trends also include an increased demand for urban hiring and higher salaries.


According to the Merritt Hawkins survey, the average salary for a radiologist hired in 2016-2017 is $436,000. There tends to be a magic number for hiring, even if the funds are allocated in different ways, said Lauren DeJesus, principal at the Medicus Firm, another physician search company. “The buzzword for radiology as a whole is $400,000–$450,000 across the board,” she said. “All in, if we don’t have a “4” in front of the number, we’re not doing anyone any favors. We won’t attract the right candidates and the health system is not playing ball,” she said. That all-in figure may include a sign-on bonus and incentives. A base salary of $350,000–$375,000 will lead to that target pay.

There used to be “new grad” pay and “experienced” pay. The current difference for that pay is $20,000. The time difference between calling someone a new grad versus an experienced radiologist can be as little as one year. In the past, the sign-on bonus was based on location and need. Now, $20,000 is the going rate for urban sign-on bonuses. DeJesus knows one candidate who completed a rural residency program and was offered a $50,000 bonus to stay on.


Practices aren’t recruiting for specific amounts of experience, said Singleton. It’s across the board. Practices are looking for succession planning, plus the number of films a physician can read, and the types of films. The more appropriate conversation is about quality and technology and whether the radiologist can adapt to and use the technology.

DeJesus agrees that the hiring is across the board, based on experience, training, and subspecialty. During one recent week, she placed a 32-year-old and a 62-year-old radiologist. “They just want the right candidate,” she said.

The ACR survey showed that in 2017, the most recruited subspecialists would be neuroradiologists, general interventionists, after-hours radiologists, and body imagers.[[{"type":"media","view_mode":"media_crop","fid":"62769","attributes":{"alt":"Radiology job market","class":"media-image media-image-right","id":"media_crop_7560943695691","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"7991","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":"height: 190px; width: 200px; float: right;","title":"Â©iQoncept/Shutterstock.com","typeof":"foaf:Image"}}]]

The need for after-hours radiologists is due to increased demand for general and subspecialty radiologists, as well as demands for higher pay and better quality of life. Hospitals and radiology groups increased the number of nighthawk radiology opportunities in the last five years so general radiology candidates won’t have to work nights and weekends. Nighthawk has become another radiology subspecialty. DeJesus has been placing radiologists to work in this role at full-time salaries. The hours are 7 p.m. to 7 a.m. one week on and two weeks off. That’s working 17 weeks a year. Or radiologists will split the night shift, working 4 p.m. to 12 a.m. or 12 a.m. to 8 a.m., one week on, one week off.

She likened this position to the creation of the hospitalist position, as some doctors only wanted to do outpatient work. “We have to have nighthawk to make general radiology attractive again,” she said. “They want money or they want quality of life, the same as any other specialty.”

These nighthawk radiologists might be stationed at one hospital, but provide night and weekend reads for other hospitals in the system. The physicians average 120-150 reads during their 12 hour shift. There’s a high rate of burnout, and it’s hard to make it through the three-year contract. “They’re young, right out of fellowship,” she said. “Once they do this role, they often move within the system into their specialty.”

The subspecialization of the radiology service line has made the general radiologist position higher on the desired list. “No one is wanting to do all bread and butter radiology,” she said. To meet radiologists’ demands, a lot of hospitals are adding subspecialty practices. While building it up, they’ll guarantee that radiologist 40% of their reads in their subspecialty and they’ll share the general call pool. They promise to transition them to 80%–90% of their specialty reads later on. That way they can build up their program while still serving their general reading needs.


Teleradiology continues to hire in spades. “Really over the last 15 months, the teleradiology business has gone bonkers,” Singleton said. The groups can’t keep up with the volume and are growing too fast. These groups can find radiologists, but not enough who can meet the quality standards and are licensed to read in states within their time zones. Also, it’s tougher to find radiologists at the price that teleradiology companies want to pay. Singleton said recruiting for teleradiology is twice as hard as it was two years ago.

“People still talk about it as if it’s a new phenomenon,” Singleton said. It’s been around for a decade plus.” Teleradiology is now better 

, with higher quality, affordable technology, and better communication. Radiologists now see this as a viable career path. It’s reached critical mass.

Singleton says his firm is staffing for almost every large and small teleradiology company out there. Radiologists no longer only use teleradiology as a source for additional income, some are making it their career.

And teleradiologists on average are out-earning traditional radiologists. “For the first time ever, teleradiologists averaged more compensation than boots-on-the-ground radiologists,” Singleton said. While the average radiology salary was $436,000 (strictly salary from their traditional job), the average teleradiology salary was $494,000, for those doing 100% teleradiology.

Employment arrangements have changed for teleradiology. Four to five years ago, teleradiologists offered contract labor arrangements, not a salary. There were limited, if any, benefits. Their perk was quality of life. Now, that’s not enough. To fill their contractual agreements with health systems and to attract radiologists, they’re now offering competitive salaries and guarantees, along with signing bonuses. In return, the radiologists must guarantee a certain case load. “That’s a pretty new and changing dynamic for teleradiology companies,” Singleton said.

While DeJesus doesn’t recruit much for teleradiology positions, when she gets inbound physician calls about job opportunities, 60% of the time they ask her about available teleradiology positions.


One of the biggest changes in this year’s job market is the increased hiring in urban settings. The Merritt Hawkins survey showed that 55% of their searches were for cities with 100,000 people or more, which was the highest percentage in the company’s 24-year survey history.

One reason that urban settings are having a harder time is that residents aren’t staying at their health system when they finish their training, as they might have done before. Programs used to replenish their outward migration of radiologists with inbound residents. “They’re not afraid to go outside of their training program because they’re offered a lot of money to do it,” said DeJesus. These urban health systems now need additional financial resources to recruit.

DeJesus said she’s gotten increased interest from cities and regions that typically don’t need recruiting help, including jobs in Orlando, Florida and Santa Fe, New Mexico. “These places are not usually hard to recruit to, or that come across our desk very often,” she said. “There’s an uptick of locations that are needing our services nationwide.”

As tides shift, radiologists are now more in the driver’s seat. “I tell hospitals and health systems, you had many years where it was in your favor, and you were getting them cheaper. Now it’s starting to catch up with you,” Singleton said.

Job market trends benefit radiologists, finally.

Job Market Looks Good for Radiologists

As a radiologist, you’re already paying a lot of expenses to do business. There’s professional liability insurance, medical society memberships, board certification fees, and other professional dues. And then there’s CME costs. Those with time-limited ABR board certification or continuous certificates issues in 2012 or later are looking to fill 75 AMA Category 1 CME credits every three years, with 70% of them in diagnostic imaging or a related area, and the other 30% in clinically relevant 

. And of course, you may have requirements from other organizations.

That can get expensive. The good news is that free CME is available. It may not be enough to fulfill your entire requirement, but it can chip away at the hours, and provide some good education at the same time. Our 2013 story on 

 CME still stands, so this more than doubles the educational opportunities.

None of these organizations focus solely on radiology, and most offer a minimal number of radiology courses. But some are related and some fit into the “clinically relevant” area, like ethics or practice management. 


MyCME.com offers about a dozen free radiology CME courses for 0.5 to 1 credit each. They use webcasts, slide lecture series, round tables, and patient case studies on topics ranging from breast screening to diagnosing Parkinson’s disease. You can take paid courses with them as well, these are easily distinguishable with the green notation and dollar sign.


If you are already a Doximity user and not taking advantage of their free CME, you’re missing out. Doximity DocNews provides free Category 1 CME, when you read and submit eligible articles you’re probably already reading (no test required). Certification comes from the University of Pittsburgh Medical Center. Each eligible article earns you 0.5 credits.        


Free CME focuses courses in other specialties, but there are a few that might be interesting to radiologists. For example, you might learn about monitoring MS disease progression with MRI or emergency treatment of acute decompensated heart failure, which includes discussion of imaging assessment tools. Search by specialty (radiology is not included), clinical topics, audience, and media format. You can generally earn 0.5 – 2.0 CME credits per course.


The ACP offers a number of free CME courses, some of which are relevant to radiologists. These include courses in ethics, pediatric case studies (including diagnostic testing and management across settings), and online interactive high value care cases (on eliminating unnecessary health care costs and improving patient outcomes through cost-effective cancer screenings, eliminating health care waste, and estimating the impact of insurance on patient outcomes). These courses each offer one CME credit, and they’re delivered via live meetings, listening or watching recordings, and working online. If you’re an ACP member or subscriber, there’s a greater number of free courses available. Look for the tag line under each category.

https://www.acponline.org/cme-moc/cme/earn-cme


University of California Davis offers around 10 hours of free CME courses through its website. Many of them are designated only for its staff members, but if you look through the section titled “Online Activities for UC Davis” you’ll find some that are open to all health care professionals, and a few are pertinent to radiologists. Generally, they are 1-credit courses. The ones of interest and open to the public include one on safe operation of fluoroscopy equipment and one on digital radiography (image quality and radiation dose).


Elsevier offers free CME courses for a number of specialties. Unfortunately, the radiology listing is small, with one course currently listed, but it’s still worth 1.5 free CME credits. At this time, they’re offering a course on diagnosing (and treating) glioblastoma multiforme. There may be some in other clinical areas that are relevant, so look through the various listings.

https://www.elseviercme.com/specialties/radiology/


The Cleveland Clinic has some courses appropriate for radiologists, but nothing focused directly on the specialty. Look for free 0.5 - 1 credit CME webcast courses in treating non-small cell lung cancer using stereotactic body radiotherapy, or on critical limb ischemia.


Pri-Med offers some free online CME credits, though primarily aimed at PCPs. You may find a few courses appropriate for clinically relevant areas, like practice management, and clinical issues like diagnosing child abuse. Earn 1 credit or more for these courses.


Education provider Prime Inc. offers courses for internal medicine and oncology, though radiologists might find some helpful related courses on practice management topics like engaging patients and other stakeholders, delivered by the Patient-Centered Outcomes Research Institute (PCORI), and collaborative approaches for treating breast cancer. You’ll usually earn 1 credit per course.


With free CME courses from Physician’s Weekly, you’ll be looking for courses in the “related” area – not diagnostic radiology (though they have some for interventional radiologists, like on cardiac catheter labs). Diagnostic radiologists might look for the course on which physicians are prone to malpractice claims, and why. Earn 0.5 credits for courses successfully completed.

http://dev.physiciansweekly.com/cme-corner/


Reach MD has a few CME courses under its radiology tag, though these are for radiation oncologists. Completion earns the physician 0.5 to 0.75 credits. Check back to see if they add new ones, as they do have some educational videos (no CME credit) relating to radiology.

Our 2017 round-up of resources for free radiology CME.

12 Places To Get Free Radiology CME 

 and the sit/stand desk movement become more mainstream, many radiologists are making tweaks or complete overhauls to their reading rooms.

This allows radiologists to customize their work space while allowing better flow and collaboration among other radiologists and also with referring physicians.

As a certified ergonomist, Dawn Harman, encourages radiologists to use a sit/stand desk, and to stand for at least 20 minutes an hour. “So many times when I go in, they’re doing “turtleneck,” with their face close to the screen and their shoulders hunched over. “It’s not proper positioning,” she said. That leads to neck, back, and shoulder issues. Moving around is important for a person’s health.

Harman is also a sales manager with Evolve Ergo Workplace in New Hampshire, providing reading room design consultation. After the company installs the products, she returns to make sure the radiologists are using the equipment properly and getting the ergonomic benefits from their new equipment and design.

Here are ergonomic reading rooms that have affected work flow and comfort for the radiologists working there.

This reading room at the University of Pennsylvania, was designed by RedRick Technologies to be an open and collaborative environment.

“Often you’ll find that radiologists don’t like their backs to people coming up behind them. In an academic setting this works well,” said Greg Patrick, RedRick’s President. That’s because there’s more collaboration in this environment, and it’s easier for physicians to gather around a station or move between stations this way. “When something interesting is being reviewed at a particular work station, they’ll push back and roll over (in their chairs), to gather around that work station.” The sit/stand desks quickly adjust to the reader’s preference.

While not sound-proof, this room has sound-absorbing panels on the walls to reduce echo and reverberation in the room. The ceiling tiles have a high noise absorption rating, higher than normal acoustic tiles, Patrick said. The panels between the work stations also absorb sound. The floor is made from recycled rubber. Not only is it environmentally friendly, it’s more comfortable to stand on and also absorbs sound. “It’s not much better than carpet (for absorbing sound), but carpet can become a house keeping nightmare.”

The ambient light source is behind the monitors, creating a soft glow along the walls and reflecting from the ceiling. The main fluorescent ceiling lights are turned off, and there’s no light source from the top coming down. “You want to balance the illumination between the monitors and the visual field surrounding the monitors. This is proven to help reduce eye fatigue,” said Patrick. “You don’t want a dark room or an overly bright room.”

When George Bisset, MD, chief of pediatric radiology at Texas Children’s Hospital interviewed there more than seven years ago, he found that the reading rooms were fragmented, scattered around the hospital. Previously, referring physicians might have to seek out subspecialty readings from several reading rooms around the hospital for information on a single patient. For a cancer patient, for example, that physician might go to one station for a chest CT searching for lung metastasis, a reading room elsewhere for primary tumor activity in PET scans, and a third office for an MRI of the lower extremity.

“One thing I had experienced at other institutions before was that if you’re trying to get collaboration from a research and teaching perspective, and even clinically consulting with your colleagues, you’d like to be able to take advantage of that expertise in the same room,” Bisset said. He told the Texas Children’s Hospital CEO that he wanted to create a large reading room where radiologists could work individually, but have group workstations for larger discussions.

They created a reception or concierge station at the entrance, with two facilitators stationed there. They answer incoming phone calls and direct referring clinicians to the right workstation.

Bisset describes their reading room as large, with about 20 workstations. The room has some artificial divisions, with the body imagers on one side, nuclear medicine along one wall, and neuroradiology along another wall. The workstations in the middle are “flex stations,” which can be used by any subspecialist.

The room uses back-lit lighting from behind the workstation, which makes it a calming environment and promotes a quiet atmosphere. Previously the lighting in each separate reading room at Texas Children’s Hospital was different, as was the ergonomics of the workstations. Each time a radiologist switched to a different room, that physician needed to adjust to the phone location, log-in area, microphone location, desk type, soundproofing, etc. Now it’s standardized.

Each station has a small gooseneck light coming from the left side of the work space, which is good for consulting a book, like if a radiologist needs to look up bone age calculations. The light positioning does not disturb other radiologists.

At the Texas Children’s Hospital reading room, people approach the radiologists’ reading area from the periphery, not the back. “It still serves a collaborative environment, but gives the radiologist a little more seclusion for getting the work done,” Patrick said of the RedRick-designed room.

Each station adjusts for desk height (standing or sitting), which takes 10 seconds – it’s electronically controlled. The monitors are adjustable, as are the chairs. “They are more comfortable and now I don’t hear anyone complaining about their backs. I haven’t heard a single complaint about ergonomics in this environment,” Bisset said.

The feedback about the room has been outstanding. “When people come from other institutions to visit us, they’re wowed by the appearance.” If Bisset were to tell the hospital’s radiologists that they were going back to the old system, he said there would be a revolt.

This Breast Imaging Center at Juravinski Hospital in Hamilton, Ontario, is similar in layout to University of Pennsylvania’s reading room. This one has three stations and is a collaborative environment as well. “A lot of surgeons come in the morning. They entertain a lot of visitors in this room,” said Patrick. “This has been quite a success for them, to enhance their relationships.”

Juravinski’s room uses acoustical partitions, blue lighting, and sit/stand work stations, Both the desktop and monitor sets are independently height adjustable. There’s no cable clutter on the floor. While not a specific ergonomic issue, cables can trap dust as well as create tripping hazards. The cables are incorporated into the desk, and the computer CPU doesn’t sit on the floor.

“With ergonomics, you think of the chair being adjustable or the desk going up and down,” said Patrick. “Ergonomics is the relation of the human in the work place. Everything in the zone that affects the human being is part of the discussion, including clutter in the workspace. It’s important to have all the things you need in the workplace positioned appropriately without your feet getting caught up. That may not be a physical stress, but a mental one.”

This reading room at Elliot Hospital in New Hampshire contains three work spaces, with two seen in the photo, and the third behind the bookcase. Elliot is a smaller community hospital, not an academic environment. “It’s a place for radiologists to be sequestered and get the work done,” Patrick said. RedRick used lines and curves to create a customized environment to give the radiologists privacy to focus, along with a collaborative place in the middle for colleagues to gather.

In addition to the adjustable desks, monitors and chairs, the phone is on an articulated arm. That keeps the phone in reach, but off the desk.

RedRick created a collaborative reading room for a research hospital in Tennessee. They designed it with two zones, one for neuroradiologists and one for body imagers. The groups are separated by glass panels so they could still have a good visual connection with colleagues through the glass, but maintain some acoustic control. “One group could be more vocal, but each group has different styles of working,” Patrick said. The workstations face inward for increased collaboration and conversation.

As with other ergonomic work stations, they incorporated acoustic panels on the wall, blue ambient lighting, and sit/stand desks with adjustable monitor stands.

With goals of saving radiologists’ time, increasing the flow, and decreasing radiologists’ physical stress, John Mukai, MD, and David Bader, MD, of St. Vincent Hospital’s Department of Radiology in Worcester, MA, and Eliot Siegel, MD, from University of Maryland School of Medicine, are developing work stations that include six to eight monitors, and wireless headsets that allow radiologists to talk on the phone and dictate, while not physically connected to the computer.

Mukai said that previously he used two work stations, one with four monitors and the other as a two monitor specialty station, like for PET imaging or cardiac CT. Their innovation was to use the same six monitors, but attach them to one computer and run both applications on that computer, with one keyboard and one mouse. Their specialty monitors were, portrait (tall) ones, giving better visualization. 

Mukai estimates that a four-monitor workstation already costs about $20,000, and modifying it to be a six monitor station only cost another $1,000 for the additional monitors and video card, or $2,000 for four monitors. Their system uses a sit/stand table from RedRick. In this photo, the station uses six30-inch monitors in portrait style. These are 4MP fusion monitors reengineered by Barco. Working as 

, Mukai, Bader, and Siegel have a workstation design laboratory in Worcester where they test out their designs.

Examples of ergonomic radiology reading rooms. 

Ergonomic Radiology Reading Rooms

Physicians continue to use their smart phones and tablets for work at high rates. According to a Wolters Kluwer Health survey, 42%-44% of physicians use smart phones to access medical research, communicate with staff, and access clinical reference tools when with patients. Tablet usage was higher for accessing medical research (63%) and using clinical reference tools (50%).While the internet is useful for looking up web-based information, mobile apps sometimes make it quicker to access the information from a specific site. And some information and functionality can only be found on a mobile application.For this year’s list, we combed through best-of lists and scoured the internet for apps that radiologists need. Here are nine of the best. (If you haven’t seen our past selections, check out our 2016 list, our 2014 list and our 2013 list, which contain apps still highly recommended for radiologists).Did we miss any? Tell us your favorites in the comments.

Our 2017 round-up of top apps for radiology. 

Top Apps for Radiology 2017

With concerns about the commoditization in radiology, making personal connections and maintaining good relationships with referring doctors can make the difference between your practice getting more patients or those patients going elsewhere.

“It’s probably more important than it’s ever been,” said David Levin, MD, chairman emeritus of the department of radiology at Thomas Jefferson University Hospital. Levin was lead author on a recently published 

 article on marketing a radiology practice.

With an increasing emphasis on value, radiologists must show that they’re providing high quality care, or they won’t get paid, he said. Referring physicians are also concerned with high quality providers for their referrals. “You can’t ride along on past referral patterns. You have to show your referring physicians that you’re providing high quality care. You can’t just tell them,” he said.

Here are some ways to build better relationships with referring physicians.


Report and study quality is important, but so is service. “[Referrers] are getting busier and busier, so service has to be impeccable,” said Arl Van Moore, Jr, MD, chairman of Strategic Radiology, a consortium of large radiology practices. Part of that service is also helping referring physicians manage resources appropriately, including appropriateness criteria. When a physician calls with a question, use that as an educational opportunity. Also important is turnaround time, whether a physician requests routine reports or the radiologist uncovers an unexpected finding.

Service is important for patients too, they want a positive experience. If the patient is happy with the experience, they may return to your practice instead of finding a different one. If the experience is negative, though, that can impact the physician relationship as well, even if you have a great relationship with the referrer, said Moore. “You need to work on all fronts to preserve a relationship.”


Combine service and education by offering referring physicians access to a consultant of the day in each radiology department section, and make them immediately available to answer questions. Publicize the subspecialist’s phone number at the hospital or in a newsletter. The assigned radiologists sit at those work stations that day. The subspecialists will then provide help to referring physicians while also doing their daily work. In Levin’s experience, “there’s not that many interruptions during the day. That consultant is actually reading cases.” The upside is that referring doctors always know there’s someone available to help, and it’s a way to build good will.

Tips for radiologists on creating and improving relationships with referring physicians.