How to Stop Radiologist Burnout Before It Stops You


Burnout is widespread among physicians. Research published in the Journal of the American Medical Association (JAMA) and elsewhere finds that it afflicts both generalists and specialists, interns and mid-career physicians, and men and women of all ages. As no medical professional is immune from burnout, all should recognize its warning signs.

Just how prevalent burnout is among radiologists is unknown. John Cronan, M.D., believes radiologists are “much better off than other physicians” but sees burnout “starting to percolate” into the community. Cronan, chairman of radiology at Brown University Medical School, points the finger at a host of causes: today’s “production-line” atmosphere, growing isolation, maddening tangles of red tape, bureaucratic bean-counting, and more.

Describing technology as a “double-edged sword,” Cronan welcomes the quantum leaps in diagnostics and outcomes but believes the huge gains in productivity come at a steep price. “We radiologists now sit isolated, basically shackled to a computer screen, reading images faster and faster, and then dictating studies and correcting the dictation — all with no break,” he says. “Physicians say, ‘I'm exhausted at the end of the day. When I get home, I can't even open a journal.’ ”

Early-stage burnout is often overlooked because it’s a difficult diagnosis, and radiologists are accustomed to pushing themselves long and hard in a profession that focuses on the well-being of other people. Left to run its course, burnout can wreck havoc on one’s clinical accuracy, reputation, home life, and general health. The JAMA researchers note a vicious spiral, as symptoms of burnout can lead to physician error, which reinforces burnout.

Some of the key, clinical indicators are anger, cynicism, irritability, sleep disturbances, exhaustion, and a decreased sense of personal accomplishment. The radiologist once known for his upbeat, affable ways may become a cranky, tired, unmotivated ghost who feels little pride in his work and is prone to headaches or gastrointestinal upsets. Angry outbursts or sarcasm may cause colleagues to walk on eggshells. Rather than take pride in her work, a radiologist may become a habitual clock-watcher who drags into the office late and escapes early. In some instances, people become suspicious, take uncharacteristic risks, or simply feel besieged like a medieval castle.

Female radiologists should take note. One study found female physicians 60 percent more likely than their male counterparts to report burnout.

The best defense is a good offense that focuses on self-care and balance. The JAMA article underscores the importance of a strategy that includes:

· Spending time with supportive family and friends

· Religious or spiritual activity

· Proper nutrition and regular exercise

· Finding meaning in work

· Setting limits at work

· Focusing on successes, not problems

· Mentoring

· Adequate administrative support

For some radiologists, putting the freeze on early burnout may entail a minor tweak here, a moderate tweak there. In more serious cases, it might mean reinventing professional and personal lives. Cronan, striking a balanced-lifestyle theme, notes that whereas radiologists of his generation “lived to work,” today’s new crop work to live. “They have a life outside of medicine to keep them rejuvenated and refreshed,” he notes. “Some choose to minimize their involvement in the overall practice and sidestep offers to join a hospital or university committee.” Cronan believes that striking a healthy balance in our lives might mean accepting the financial penalty of working (and earning) less but living more deeply away from the world of radiology. “It is becoming more and more essential that [radiologists] have some free time outside,” he says. “You have to restructure and give yourself a break.” The more stressors in one’s life, the greater the need for positive counterbalances.

In their 2006 article in Radiology (“There Is More to Life Than Lifestyle”), Kelly Horst, B.A., and Richard B. Gunderman, M.D., Ph.D., suggest that radiologists reconnect with the world through altruism and community service. “We radiologists [can] recover our best selves and the altruistic motives that led many of us to choose careers in medicine in the first place [by] use of time, talent, and treasure to enrich the lives of others,” they say. Radiologists who compensate for declining reimbursements by working feverishly may find themselves (and their relations) poorer in spirit, health, and mental outlook.

Mayo Clinic neuroradiologist Peter Kalina, M.D., believes professional satisfaction among radiologists “is very high” but notes that burnout can stem from “any number of causes,” both occupational and otherwise. Among the possible workplace factors, he says, are excessive workload, understaffing, the particular demands of a specialty, and the litigiousness of that specialty. “Radiology,” he says, “is an exceptionally technology-driven field. That keeps us interested, intrigued, … and energized.”

Nevertheless, Kalina says, in today’s challenging environment, it’s a good idea for radiologists to be on the lookout for burnout. “Recognition of the problem is probably the most difficult step,” he says. “Should a radiologist have concerns, he or she might seek feedback from a colleague, family member, or friend.” As Chair of the ACR Committee on Ethics, Kalina notes the ethical responsibility among radiologists “to do the best job we are capable of doing.” For some radiologists experiencing burnout, he suggests that the proper remedy might be to restructure their work routine, take needed breaks, or simply slow down. For others, professional help might be warranted.

Echoing JAMA research, Kalina embraces the idea of prevention. “Many of my colleagues in radiology and other fields of medicine wake up early to go to the gym, go for a swim or jog, or lift weights. These are in part done preventively to maintain a balance in life along with dedicated time with family and friends.”

Experts in burnout also counsel learning how to say no, to delegate work, to reduce commitments at work and home, and to eat well, exercise often, rest as needed, and not skimp on sleep. Administrators also may wish to set a tone that encourages balance.

At Brown University Medical School, Cronan and the department’s some 60 radiologists have restructured their routine to reduce the likelihood of burnout. “Spending more time together, talking and discussing cases changes the pace and helps prevent monotony,” he notes. “We might work in one area in the morning that is very tedious and in the afternoon go to a completely different area, such as the ER. The day’s continuity is interrupted somewhat, “but it beats sitting in one area nine hours each day, doing the same thing.”