You won’t know until you ask.

Such a simple and rational concept, but the frightening part might not be asking but managing what comes after. There’s the worry of being labeled “a complainer.” And when the question is related to your livelihood — asking for a change in your schedule, environment, or even your duties — it can feel like a lot is riding on the whole exchange. Your trepidation might even be enough to prevent you from asking the question. But your well-being is worth it.

One radiologist experiencing burnout was extremely unhappy in her position, so she did what many do: She started looking for a new job. When she was ready to resign, her manager asked what it would take to make her stay. “For me, tackling burnout was identifying the answer to the question, ‘What does it take to make me happy?’” she says. She wanted to make changes to her daily duties and to her role, so she put together a proposal. “My chair was willing to try something different,” she says.

Factoring in the cost for practices to recruit and train new staff, plus the time and effort for employees to find, apply for and interview for new jobs, it’s logical to approach your leaders with your feedback before you jump ship — and equally important for them to want it. “That would be my message,” says the radiologist, who preferred to remain anonymous. “Talk to your boss before you start looking. Maybe for burnout it’s a matter of asking, ‘What does “better” look like for me?’ Is it more flexibility? Is it something I could change if I make the right request?”

In some cases, the issue is a fundamental mismatch with the job. “Sometimes the problem is something you can’t change, like the hospital system asking me to read 200 RVUs a day,” she says. “In that case, what are my options?” Either way, naming the items on your wish list is a helpful exercise in clarifying the problem and identifying solutions, whether they lie in transforming your current role or seeking a position elsewhere.

Rocking the Boat

Changing just a portion of your day to include work you’re passionate about can lift your mood. According to the Mayo Clinic, spending at least 20% of your time in meaningful work can have a protective effect against burnout.^1,2 “I try to hit 80–90%,” says Priscilla J. Slanetz, MD, MPH, FACR, who is surprised at the statistic’s seemingly low percentage. “You want to be sure you’re spending at least some of your time doing things you’re passionate about. But I would aim higher than 20%.”

Slanetz, a member of the ACR Well-Being Committee, became the acting section chief of breast imaging at Boston Medical Center in March 2022 and knows what it’s like to want to tweak a position to improve well-being and work-life balance. “Early on in my career, I didn’t speak up quite as much as I did later on,” she recalls. “But when I had three kids under age five and was regularly getting home at 10 p.m., I went to my chair and said, ‘This is not working.’” Slanetz proposed switching to part-time academic work, but leadership wasn’t open to that change at the time. “They told me, ‘This is the job. You figure out how to make it work.’ When I resigned six months later, they were surprised.” A year later, she adds, they started offering part-time academic positions.

As for the evolution of such decision-making, “some people come to the same conclusion at different rates,” says Delphine M. Lui, MD, associate medical imaging director at Winchester Hospital Breast Care Center in Winchester, Mass. “I’ve seen it happen. A few people offer a suggestion, and it takes a while for others to realize that things need to change.” For example, a few members of her practice group suggested adding another radiologist to their team to better balance an overwhelming workload in recent years, but the idea wasn’t a slam-dunk initially. “It wasn’t really that easy,”
Lui says. “We only just recently agreed to move forward.”

Lui believes the ability to come forward and ask for changes gets easier as you begin to understand your value. “Early in my career, I didn’t speak up,” she says. “After 23 years, I believe in myself. I’ve paid my dues and am comfortable expressing my opinions. Things change when you’re confident about your position in the group. When you know you’re valuable, then you feel like you have a little leverage.”

Considering Group and Leadership Culture

Leverage and confidence mean nothing, however, if you’re faced with leadership or a culture that emphasizes the status quo. It’s important to ask yourself, “Is this an environment in which change is possible?”

Demonstrating a positive, open culture — one that values change — starts with communication, Slanetz says. “It varies for every group, but honestly the most effective way to gain respect is to be on the floor doing some of the work,” she says. “That is how you build relationships with your peers, and they become comfortable coming to you with feedback. You can really learn so much just by listening.”

Changes are sometimes inevitable and driven by workforce retention, regardless of culture. ACR Well-Being Committee Member Dianne L. Johnson, MD, a diagnostic radiologist with RadPartners in Jacksonville, Fla., wasn’t surprised her leadership wanted to tackle major scheduling concerns in her seven-person team, but she was somewhat amazed by their approach. “They made breast imaging its own section,” Johnson says. “No more weekends, nights, holidays. They said, ‘Here’s your own schedule — you figure out among yourselves how you’re going to cover the work with the people you have.’ It went from a system that was highly competitive between partners for days off, which was incredibly stressful, to an intensely collaborative approach.”

Things change when you're confident about your position in the group. When you know you're valuable, then you feel like you have a little leverage.

Now she and her fellow breast imagers manage the schedule, which previously was created by non-mammographers, and they’ve created some flexible shifts, allowing radiologists to select work they can do whenever they want. “We created some screening mammography rotations, so you can read after work, on the weekend, it doesn’t matter,” Johnson says. “But it gives you the chance to go to the dentist or attend an event at your child’s school.” The latter was especially important to Johnson: “After the pandemic, I really looked at what was important to me, and I was no longer willing to miss those things.”

Residents and fellows may have a slightly easier time approaching leadership, primarily because of structured feedback processes. Otto G. Schoeck, MD, chief radiology resident at Einstein Hospital in Philadelphia, explains that at the end of each academic year, the radiology residents come together to grade each attending on areas like education, communication and professionalism. The anonymous feedback also includes suggestions for improvements. “This is a true example of one suggestion,” Schoeck says. “Our resident bathroom needed updating. The next year they changed it. The chair really pays attention to the end-of-year suggestions, and they put money into those problems.”

Outside of the annual feedback process, Schoeck sometimes relies on his mentors to address concerns, including those related to burnout. “We feel like that’s a safe place,” he says. “You go to your mentor, who can anonymize and articulate problems in a way that is more effective, and then the mentor will approach the chair if needed. My mentor will speak on my behalf if I don’t feel comfortable. That’s just inherent to a power dynamic, and residents may get nervous and worry about perceptions that they’re complaining.”

Avoiding Appearing as a “Complainer”

To eschew the complainer label, “be thoughtful, and come in with an ally, if possible,” Lui says. “You must be organized in what you want to say. Practice it, because you don’t want to sound like you’re complaining. Better even, there’s often an ally — someone in the group who sees what you see the same way, so you can come to leadership and say, ‘We’ve been talking,’ which can give it more weight. If it’s about you and your job, then consider how to make it work for the group before you make your proposal.”

Of course, one of the additional worries is that whatever you want to change might be taken personally by leadership. “My experience has been when you do go to a manager or someone in a position of power, they seem to think it’s a poor reflection on them,” Schoeck says. “It takes someone with experience to understand that you’re not critiquing them. We’ve all kind of faced that. The comfort level comes from the top down — a sense of, ‘You can come and talk with me and we won’t be upset.’”

Every workplace is different, and the key is in decoding the dynamics where you are. “You need to understand who the players are and the culture,” Slanetz says. “The leader of a practice or department sets the tone. In some places, you can’t even bring up any issue because you’re dubbed a complainer. It’s nothing to do with you. You’re bringing up an important point and have a
constructive solution, but the leader doesn’t want to hear it.”

Finding the Right Fit

Given the current environment, with the shortage of radiologists and the numerous practices and departments wanting to hire, it seems like a no-brainer for leadership to be open to working with its members, particularly in ways that support well-being. “People are shuffling to higher-paying jobs or jobs with better vacation time or access to more committee time,” Schoeck says. “So now more than ever, I feel like the power is with the person who is applying. There are so many jobs out there, you have to give people what they want to maintain the workforce.”

What people usually want is a job that aligns as much as possible with their own priorities, which is no small feat. “I don’t think you’ll ever get to 100% alignment,” Slanetz says. “But many times, people don’t take the time to say what’s not working. What can I change to make it more aligned with my priorities? You have the power to try to do that, to give yourself a more satisfying career. Some leaders or cultures will not allow you to get to that point, and you need to be willing to look elsewhere. It’s a loss for them.

“It’s about finding the right environment. Someone else will embrace you and allow you to thrive. People need to thrive.”