Has Burnout Become an Epidemic in Radiology?

Emerging literature suggests a seemingly insurmountable wave of physician burnout in radiology. While the recently enacted Dr. Lorna Breen Health Care Provider Protection Act offers the promise of increased awareness, education, and funding to help prevent burnout, an increased commitment and flexibility from institutional leadership may also be key to erasing stigmas and driving meaningful change.

Physician burnout appears to have permeated many different fields in health care and it is particularly pervasive in the radiology community. A recent Medscape survey found that 47 percent of radiologists polled are suffering from burnout.1 It has also been reported that between 54 to 72 percent of diagnostic radiologists and interventional radiologists have symptoms of burnout.2 In another recent survey of 247 radiology residents, over 36 percent of those polled had burnout with 64.8 percent reporting sleep-related impairment.3 In the Medscape survey, 62 percent of radiologists indicated a willingness to reduce their pay in return for better work-life balance or more free time.1

“Burnout is endemic. It is out there. It is real,” noted Richard Duszak, M.D., a professor and vice chair for Health Policy and Practice in the Department of Radiology and Imaging Sciences at Emory University.

In a recent Diagnostic Imaging podcast, Dr. Duszak said a variety of factors contribute to clinician burnout, ranging from continuing medical education module requirements and heightened expectations about turnaround times on imaging reports to clunky software and reduced in-person interaction with colleagues during the pandemic.4 The combination of increased imaging volume, declining reimbursements and shortages in the radiology workforce due in part to increased retirements and insufficient radiology residency positions also leads to an undeniable domino effect with burnout, according to Amy K. Patel, M.D., the medical director of the Breast Care Center at Liberty Hospital in Liberty, Missouri.

“Throughout the house of medicine, we have a convergence of a number of things, a sort of systemic death, if you will, of a thousand cuts,” explained Dr. Duszak. “ … The easy things you read online about eating healthier and doing more yoga (do not) get to the root problems. There has to be a real commitment from practice leaders and institutional leaders to acknowledge (burnout) is real. Simply saying ‘suck it up’ might work for a train wreck with people needing to work an extra shift or two but it doesn’t work on a sustained basis. Our institutions need to drive this change.”

On March 18, President Biden signed the Dr. Lorna Breen Health Care Provider Protection Act into law.5 The bipartisan legislation, named after an emergency medicine physician who committed suicide in April 2020, will reportedly establish funding for the training of health-care providers (HCPs), residents, and students on evidenced-based best practices for reducing the risk of burnout, mental health conditions and suicide. The law will also provide grants for education, peer-support programming, and treatment for mental and behavioral health conditions among HCPs. Other aspects of the law will involve the development of national awareness campaigns as well as a study of burnout among HCPs with an emphasis on the impacts of the COVID-19 pandemic.

Dr. Patel said the law is long overdue and could go a long way toward removing the stigma surrounding mental health issues for HCPs.

“Although approximately 60 percent of physicians are reporting experiencing burnout, only 13 percent of providers have sought treatment to address pandemic-related mental health concerns,” noted Dr. Patel, an assistant professor of radiology at the University of Missouri-Kansas City (UMKC) School of Medicine.6 “This legislation will ensure there is funding for resources and support for health care providers and is an immense step in eradicating the stigma that comes with health care providers admitting when they need help. Now is the time when we as a medical community need to be talking about this and supporting each other to leave no colleague behind or feeling helpless and/or hopeless.”

Dr. Patel said one of the factors contributing to physician reluctance to come forward with mental health issues is a perception that doing so will have a negative impact on their careers. Citing a 2017 report in Mayo Clinic Proceedings, Dr. Patel noted that nearly 40 percent of physicians said they'd be reluctant to get mental health care out of concern over receiving or renewing their license.7

“This fear needs to end, and hopefully, with this legislation, this will be an effective start,” said Dr. Patel, the president-elect of the American Association for Women in Radiology.

Josh Cooper, the vice-president of government relations and economics for the American College of Radiology (ACR), noted the ACR was one of several physician groups that supported the legislation.

“The ACR is pleased that funds and programs specifically dedicated to the prevention and treatment of physician burnout will be more available and more easily accessible to health-care providers, including radiologists,” noted Cooper. “ … The ACR hopes its members who are experiencing any of the symptoms of burnout will have a much better opportunity to seek help and alleviate workplace stress factors as a result of the passage of this legislation.”

The aforementioned Medscape survey noted that 65 percent of radiologists affected by burnout were women.1 Dr. Patel and Darcy Wolfman, M.D. were not surprised by this statistic, noting that women often balance work responsibilities with being the primary caregivers for their children.

“Any practicing physician surprised by those numbers is not being honest,” maintained Dr. Wolfman, section chief of genitourinary imaging at the American Institute for Radiologic Pathology and a clinical associate in the Department of Radiology at the Johns Hopkins School of Medicine. “(When one is ) giving 150 percent at work and then giving 150 percent at home, something is going to give.”

“I personally know female colleagues that are having a difficult time keeping their heads above water and juggling it all, regardless of practice type, resulting in less sleep, anxiety, and depression,” acknowledged Dr. Patel.

She also pointed out the impact in the academic radiology world, noting that less women are currently publishing in comparison to men.

“(The impact of burnout) does concern me as a woman radiologist,” noted Dr. Patel. “(For) whomever is reading this and feels these things, please seek help, talk to a colleague, reach out to me, anything to ensure you're not suffering in silence.”

Dr. Patel, Dr. Duszak and Chris Mattern, M.D. all said that social isolation, exacerbated during the COVID-19 pandemic, is a significant contributor to burnout in the radiology community.

“We know there is a strong relationship between our mental well-being and our physical well-being,” said Dr. Mattern, a Greensboro, N.C.-based neuroradiologist, in a recent video for Diagnostic Imaging.8 “Over time, we have become more sedentary, particularly in the field of radiology, where we’re often sitting alone in a dark room working at our read stations for an extended period of time.”

Dr. Mattern urged radiologists to perform some form of physical activity, either before, after, or sometimes during breaks in work.

“Keeping up with whatever fits your lifestyle is important,” added Dr. Mattern, the Associate Chief Medical Officer of Radiologist Experience at Radiology Partners. “When I’m making time to do my cycling, everything seems to fall in place a little better.”

While there are individual measures that can be taken to reduce burnout, Dr. Mattern concurred with Dr. Duszak that there must be a leadership commitment to counteracting potential burnout.

“Removing obstacles is one thing I think about,” added Dr. Mattern. “How do we reduce the friction so everyone can work in the space they are best trained to work at, where they are best serving their practice, corporation, and their communities?”

At times, management is not on that page. Dr. Wolfman recalled discussing wellness initiatives for residents with a colleague and that colleague’s response: “If we’re going to talk about yoga and going for a walk, we’re not having that conversation.”

However, Dr. Wolfman said little things can have a significant impact on morale. She remembers one situation in which radiologists were being asked to complete CT time stamps by 5 p.m., but if another CT scan came across at 4:59 p.m, there was an expectation that the radiologist would stay late to complete the read. When management changed the requirement for the day’s CT time stamps to be completed by 4:30 p.m., Dr. Wolfman noted the change was well received and appreciated.

In another example, she brought up a friend in a different radiology practice who sat down with his team and asked about the issues affecting the team. He found out there were a lot of phone calls during the day but five folks in different roles were covering the phone. Dr. Wolfman noted when one person was assigned to handle phone calls on a given day, this prevented work interruptions for four people. Not only did this help in terms of efficiency but Dr. Wolfman said this allowed the doctors to focus more on academics and research,

Citing the work of the author Daniel Pink on motivation, Dr. Mattern noted that one of the key lessons from the pandemic was embracing a more flexible approach to how work gets done.9

“We can keep people engaged through developing more flexible ideas about how people work: when, how and where they contribute that best support to the team and allowing them the autonomy and mastery (of their work),” maintained Dr. Mattern. “As we become more flexible in developing the ways that people can work, we are giving them that space that helps prevent burnout.”

References

1. Baggett SM, Martin KL. Medscape radiologist lifestyle, happiness & burnout report 2022. Medscape. Available at: https://www.medscape.com/slideshow/2022-lifestyle-radiologist-6014784#1 . Published February 18, 2022. Accessed March 24, 2022.

2. Canon CLK, Chick JFB, DeQuesada I, Gunderman RB, Hoven N, Prosper AE. Physician burnout in radiology: perspectives from the field. American Journal of Roentgenology. 2022;218(2):370-374.

3. Higgins MCSS, Siddiqui AA, Kosowsky T, et al. Burnout, professional fulfillment, intention to leave, and sleep-related impairment among radiology trainees across the United States (US): a multisite epidemiologic study. Acad Radiol. 2022 Feb 28: S1076-6332(22)00105-2. doi: 10.1016/j.acra.2022.01.022. Online ahead of print.

4. Diagnostic Imaging Staff. The reading room podcast: emerging trends in the radiology workforce. Available at: https://www.diagnosticimaging.com/view/the-reading-room-podcast-emerging-trends-in-the-radiology-workforce . Published February 11, 2022. Accessed April 21, 2022.

5. President Biden signs into law the bipartisan Dr. Lorna Breen Health Care Provider Protection Act, co-led by Congressman Krishnamoorthi. Available at: https://krishnamoorthi.house.gov/media/press-releases/president-biden-signs-law-bipartisan-dr-lorna-breen-health-care-provider . Published March 18, 2022. Accessed April 21, 2022.

6. Kane L. Medscape National Physician Burnout, Depression & Suicide Report 2019. Medscape. Available at: https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056?faf=1 . Published January 16, 2019. Accessed April 20, 2022.

7. Drybye LN, West CP, Sinsky CA, Goeders LE, Satele DV, Shanafelt TD. Medical licensure questions and physician reliuctance to seek care for mental health conditions. Mayo Clinic Proceedings. 2017;92(10):1486-1493.

8. Diagnostic Imaging Staff. Essential keys to preventing burnout in radiology. Diagnostic Imaging. Available at: https://www.diagnosticimaging.com/view/essential-keys-to-preventing-burnout-in-radiology . Published February 18, 2022. Accessed April 21, 2022.

9. Pink DH. Drive: The Surprising Truth About What Motivates Us. New York, NY: Riverhead Books/Penquin; 2011.