The Domino Effect: Improving PFML in Radiology

By Alexander Utano, associate editor, ACR Press

Burnout prevention has been a focal point in radiology as the ACR, like other healthcare organizations, tries to promote a healthier work-life balance for its members. Part of that effort includes having practices supporting radiologists during significant life events, such as the birth of a child or a major illness or injury. This is where the discussion of improved paid family and medical leave (PFML) plans begins. “These life-altering events, like a major medical problem, are not planned,” says Elizabeth H. Dibble, MD, president of the Rhode Island Radiological Society. “When someone's going through a major life-altering event, we need to be supportive.”

At ACR 2025, a discussion centered around hiring difficulties within radiology practices brought this topic into the spotlight. The presentation, which took place during the Council session and was presented by Kirti Magudia, MD, PhD, assistant professor in the Duke Department of Radiology, along with Dibble, associate professor in the Brown Department of Radiology, noted how a radiologist is increasingly likely to change practices when their work-life balance is more geared toward work, and that improving PFML plans within practices can increase your chance of retaining employees for the long haul. This very well could lead to a domino effect across the specialty that sees the workforce shortage issue and burnout slowly starting to dwindle. 

Shared Experiences

Working as a radiologist can cause difficulties in finding a sustainable work-life balance that allows physicians to tend to their busy schedules — while also finding time for the ones they care about outside the workplace. This is something that Elizabeth K. Arleo, MD, FACR, FSBI, FAAWR, professor of radiology at Weill Cornell Medical College, former American Association for Women Radiologists (AAWR) president, discovered almost two decades ago. When she was only offered six weeks of leave as she was preparing to welcome her first child to the world, she realized she had a big decision to make. “It was the first time I was really confronted with having to decide between developing a career in radiology, which I really love professionally, and building a family,” Arleo says. 

 

Magudia encountered similar experiences when starting her career. “What we realized was that the stresses that parents had to endure due to multiple aspects of child rearing — like pumping and childcare — were really significant,” Magudia says. “When I came into radiology, I saw that those issues persisted. Paid family and medical leave rose to the top because it seems to be an issue that is addressable and actionable and really benefits the workforce at large.”

Collaborative Efforts

ACR members like Arleo, Magudia and Dibble decided that it was time to do something to help their fellow radiologists. Their research led them to the 1993 Federal Family/Medical Leave Act that allowed for up to 12 weeks of unpaid leave for qualified employees. This meant if the practice had more than 50 employees, individual employees would have had to have worked 1,250 hours with the practice to qualify. Arleo began working with a law firm, as well as with the AAWR, to find a solution. She began to press her institution to make sure that this leave would be paid to help her colleagues. “If you’re not paying for leave, then you’re negatively affecting people who can't afford to take the leave even though they're eligible for it,” Arleo says.

In July of 2020, the American Board of Medical Specialties decided that by July 1, 2021, each of the 24 specialties under their respective organizations would be required produce a policy around employees’ leave of absence. Arleo, Magudia and Thomas Ng, MD, PhD, a radiologist with Massachusetts General Hospital, led the charge to come up with their policy, working many late nights to get everything right. The trio led a team and published an editorial in Radiology, with Magudia as the first author and Arleo as the senior writer. 

“Once we had this literature, we used it as a basis to write a first resolution draft for the ACR,” Arleo says. “In the spring of 2021, we advocated for 12 weeks of leave — nothing about paid at this point. That got passed. The same week, Magudia and Arleo began working on a draft resolution for at least 12 weeks of PFML.” Kristin Porter, MD, PhD, former AAWR president, Arleo and Magudia used the fall of 2021 to get ACR chapters to sign on in support and submitted the resolution in January 2022. At the 2022 ACR Annual Meeting, Resolution 13 was proposed to the ACR Council and passed with great support. The resolution recommended that practices allow radiologists, medical physicists and trainees to have 12 weeks of PFML. 

The Bigger Picture

Recent research has shown that an alarming number of radiologists are willing to look for new work rather quickly after joining a new practice. Dibble, who is a member of the ACR Commission on Human Resources, has published results from several surveys that demonstrate the radiology workforce shortage and pressure points. “70% of radiologists now are reporting that they are working in an understaffed practice, an overwhelming majority,” she says. “Eleven percent of radiologists self-report that they're extremely or very likely to seek new employment within the next year, and 6% of radiologists are planning to retire in the upcoming year, so there is a lot of workforce turnover. We also know from those surveys that radiologists are more likely to seek new employment when they feel their life is balanced more toward work than life, and when they’re in the first five years of their careers. PFML policies can address many of these issues by helping with hiring and retention and mitigating burnout.” This finding was also supported by an ACR sponsored survey of ACR, AAWR and Society of Women in Radiation Oncology members that showed that PFML was an important factor in choosing to remain at or considering a new practice/department or training program. 

According to Dibble, practices improving their PFML could cause a domino effect, alleviating issues like the workforce shortage and physician burnout. “An appropriate work-life balance can help prevent burnout, can increase employee retention and can help productivity,” she says. “This is why radiologists are so passionate about this issue, and we have hope that practices will continue to improve their PFML plans thanks to this resolution.”