Telerads and Burnout

November 12, 2019

It’s supposed to be a cure for burnout, but is it?

I received some spam-recruitment today that gave me a little chuckle.

This one was from a company I used to contract with. Aside from the silliness of receiving their recruitment-pieces throughout the mere ten months after I left them-no, guys, I didn’t suddenly have a change of heart and want to come crawling back to you-the talking-points in this particular mailing served as an excellent reminder of why one might not want to (re-)enter their fold.

It led with the theme of burnout, and suggested that working with them might be the cure for what’s ailing the reader, who’s presumably a stressed-out doc. I’ll refrain from breaking down the mailing point by point, or for that matter delving into anything resembling a scholarly examination of what burnout is and how to deal with it.

Telerad Burnout

What I will say is that, for me (and more than a few other rads I’ve known), the style of teleradiology I experienced at the company-and offered by most other telerad companies-is a pretty reliable formula for burnout.

Think about it: You’re putting yourself into a situation where your entire compensation is based, in a very granular fashion, on the units of work you produce. Those units, and their financial value to you, are as small as the market will permit. Your monthly paycheck will be impacted by every single case you read-or fail to-and nothing but. If you want that direct-deposit to rival, let alone exceed, what it would have been in any other gig, you glue yourself to your workstation and churn out case after case after case.

Go ahead, take a break if you want-but the clock will be ticking, and any moment you spend not reading cases is earning you zero. What’s that, your internet went out, or your company’s network went down? Is it a slow day and your worklist is empty?

Your income is diddly while you sit there and hope the situation improves-at which point you’ll be trying to make up for lost time. Maybe you start working extra hours to recoup, or get a little ahead once in awhile-even though one of the reasons you got into this gig in the first place was the promise of more time off.

Related article: 7 Reasons Rads Burn Out-And How to Cope

One might liken it to running on a treadmill, or working on an assembly-line: People can be very harsh taskmasters over themselves, especially if they’re physicians who had to work hard and out-compete other go-getters for years-on-end to even become docs in the first place. I know I begrudged myself coffee-breaks far more when I was working per-click than I ever did when I was salaried.

The irony is, the very stuff that would have broken up the steady stream of reading cases in a conventional job-doing hands-on procedures, transacting with technologists, meeting with patients or referring clinicians, doing organizational stuff for the radgroup or department, heck, just running into other personnel in the hallway and chatting for a minute-is hyped as having been stripped away in the model of “efficiency” that big telerad entities offer.

Treadmill Readings

Get rid of that heterogeneity in a rad’s workday, and reduce things to an endless parade of “open case, read case, pull next case-and hurry, because time’s a-wastin’” and how can you not be inducing burnout? You’ve got no reliable hope of eventually graduating to some other level where your day might mix some higher-order stuff in between reading those cases.

Obviously, there’s no one-size-fits-all solution: Some rads would be perfectly content doing nothing but plugging away at worklists for 10 or more hours at a stretch, perhaps for the entirety of their careers. Others maybe don’t have as much of a financial need, and can work at a more relaxed pace for noncompetitive payment in exchange for the flexible schedule of working selected days and hours from a home office.

And there is an appeal to the notion of doing more radwork and less, well, nonsense. I certainly wouldn’t have spent this many years in telerad if I didn’t like the idea. I used to semi-joke, in my pre-telerad job rife with its interruptions and hassles, about how nice it would be to lock myself in a closet with a stack of studies for a few hours. The notion of full-time, nothing-but-reading-cases telerad work seemed a dream come true at the time.

Indeed, it still does-but the dream has become a little more nuanced. I am, after all, still working via telerad. Now, however, it’s for a private radgroup, whose docs number in the few-dozens instead of hundreds. The group is owned and run by the docs, not some corporate suits. They read cases, just like everyone else, and have no desire to inflict burnout on themselves or their teammates (onsite or remote). It’s surprising how little you have to tweak a telerad model to change its atmosphere from that of a virtual assembly-line to collegial.

Not Just Telerad

Not only that-even conventional, onsite rad jobs can hack away at burnout-inducing factors. Telerad is not a magic bullet in this regard. I’ve seen radgroups of similar sizes and situations demonstrate vastly different cultures from one another in terms of how they approach their challenges and marshal their resources, including the docs who populate them.

The simplest, most common-sense approach does wonders:

First, you periodically ask the rads what’s burning them out, or otherwise unsatisfactory. Then, you visibly do something about it. Sometimes you can even skip over the first step if the answer is painfully obvious.

What you definitely don’t want to do is go through the motions of the first step and then skip the second. All that does is highlight that, yes, you know burnout exists-indeed, your very own policies are probably causing some of it-but it’s just not a priority for you to do anything about.