People leave jobs for varied reasons — dissatisfaction, more money, more responsibility, less responsibility. While these same drivers affect medicine and radiology, few causes can trigger a move more quickly than those related to well-being. Issues ranging from intense volume and overscheduling to disrespect from colleagues and a lack of autonomy can quickly turn a work environment toxic. Fortunately, practice managers, department chairs, and other future leaders can demonstrate the way toward healthier well-being — and potentially less staff turnover — by addressing these valid concerns. Here’s how.
Fairly Allocating Shifts and Non-Clinical Work
Overscheduling is not just about hours but about complexity of cases. “For residents, if you have someone doing a month of ER evenings followed by a month of neuro and high-volume vascular and interventional call, it can be extremely difficult on well-being,” says Carolynn M. DeBenedectis, MD, associate professor of radiology at the UMass Chan Medical School and co-chair of the ACR Well-Being Committee. Similarly, attendings repeatedly scheduled with more difficult shifts (or more difficult sites in a multi-site practice) may struggle. “You’re just exhausted,” explains DeBenedectis. “When making sure everyone has about the same number of harder shifts, people burn out less.” Finally, administrative time, particularly for residency program managers, should be thoughtfully
doled out. “We do a lot outside of our clinical work and the number of admin days impacts our well-being, particularly if admin days are given unevenly,” says DeBenedectis.
“Much of the burnout among radiology residents comes from doing non-clinical work and dealing with constant interruptions,” says Yasha P. Gupta, MD, chief radiology resident at Mount Auburn Hospital. “One of the greatest ways to overcome burnout is to help redistribute some of these tasks and minimize interruptions by utilizing reading room assistants, for instance, to help mediate the number of interruptions and phone calls during the day.” Automated paging systems to convey important results can also remove hours of non-clinical work that often falls onto residents. “We spend too much time locating the appropriate physician to contact (and waiting on hold to discuss results),” says Gupta.
Addressing Colleague Disrespect
“We all want to feel respected, valued and like we belong, and disrespect from colleagues, both intentional and unintentional, can affect those feelings,” says Lori Deitte, MD, FACR, professor of radiology and vice chair of education at Vanderbilt University Medical Center and chair of the ACR Commission on Publications and Lifelong Learning. Examples include interrupting another person during a meeting or making comments that result in another person feeling marginalized. According to a recent Medscape article on the reasons for burnout, 60% of respondents felt that lack of respect was a top contributor for burnout.1
Workplace policies and leadership can help address some of these issues. “However, as leaders, we need to be role models and upstanders,” says Deitte. “In a situation where a microaggression is directed towards another person, I might say, ‘Can you please repeat what you just said? Help me understand what you meant by that comment.’ This is a way to call out an inappropriate comment in the moment and help the person who said it reflect on their comment.” What if the microaggression was truly unintentional? Responses should focus on supporting the person receiving the microaggression. “Intention does not necessarily equal impact, however, a negative impact is still not okay,” notes Deitte.
As physicians, radiologists seek to make an impact on the lives of patients. If a radiologist is not permitted or allowed the time to discuss results or other information with a patient or a referring physician, it can be defeating. Being able to act in the best interest of the patient or speak up to make a change to your own work environment is important to the well-being of radiologists. “You want to be more than a service that just spits out lab results,” says Christopher P. Ho, MD, associate professor in the department of radiology and imaging sciences at Emory University. “As radiologists, we want to add value for our referring physicians and patients. We’re always doing what’s in the best interest of the patient, and if we’re restricted, that limits our ability to do good work and weighs on our well-being.”
Likewise, “having input on practice policies and feeling like I’m being heard so that I can do what’s right for my patient is huge,” says Ryan B. Peterson, MD, assistant professor in the division of neuroradiology at Emory University. “I want to feel like I’m making a contribution, making a difference,” he says.
Autonomy can suffer when leadership and administration become reactionary and don’t listen to their staff. “When I was a fellow, a resident missed a non-critical finding overnight. The hospital’s leadership decided that every CTA of the head or neck had to be over-read by a neuroradiology fellow overnight. We were being called all night long which really affected our well-being,” says Peterson. “The policy changes weren’t based on data or feedback from the staff but were reactionary to appease the most vocal person involved in the case.”
When the ACR asked radiologists to answer the question “What keeps you from being
the physician you want to be?” through the Well-Being Index (see sidebar), a large percentage
said that the high volume of imaging studies negatively affects their well-being.
“Beyond making sure that the studies are appropriate, we can’t really change the volume,” says Kristin K. Porter, MD, PhD, associate professor at the University of Alabama at Birmingham. “The ratio of doctors to other healthcare workers is now 1:16, up from 1:14 two decades ago. Of those 16 workers for every doctor, only six are involved in directly caring for patients — nurses, for example. The other 10 are in purely administrative roles.2 This makes sense when we acknowledge that there are just more and more layers of nonclinical work that hospitals and physicians’ offices are being asked to do. Increasing documentation and regulatory requirements have added to the demand beyond caring for the patient in front of you. Imaging is necessary for quality medical
care, and the volume is here to stay.”
Porter highlights the need for more physicians. “No one goes to medical school to provide superficial care and fill out regulatory paperwork,” she adds. “We need more physicians so that we can provide quality care. And we need an overhaul of the layers of documenting and regulatory requirements so that we can reduce the amount of time and money focused on this aspect of medicine.”
People want to be visible, and they want to be heard.
A lack of connection with colleagues and teammates can erode the passion that radiology staff put into their work, according to Syam P. Reddy, MD, clinical chair at UChicago Medicine Ingalls Memorial Hospital and practice president with RPChicago, Radiology Partners.
“We use WhatsApp for more social interaction to acknowledge a new baby or wedding, as examples,” says Reddy. “We have recently adopted Microsoft Teams as our daily chat system to connect with other radiologists for support as needed. Sending a morning emoji or gif can really brighten the start of the day.”
Providing tools and encouraging staff to interact can help increase collaboration, trust, and team cohesion. Simple things like congratulating radiology staff after a big conference or pointing out a great catch on a difficult case can have a profound positive impact on a team. Additionally, coaching circles give staff a place to confidentially share pressing issues whether work related or not (read more in the Imaging 3.0® case study). “Sometimes little things — listening to people vent, or sharing stories about successes/struggles — give us a more intimate way to recognize a person that can be more impactful to their well being,” says Reddy. “People want to be visible, and they want to be heard,” he says. “Often times we do not realize how magnified a problem has become because we are truly feeling isolated with that issue. If we approach these needs to connect on both a large and small scale, we can make large strides toward increased satisfaction and overall happiness.”
Paying Attention to Appreciation
Recognizing an individual’s contributions can positively affect their self-worth. “The human need for recognition in the workplace is very real. Recognition for work that goes above and beyond breeds assurance and a feeling of acceptance by coworkers and leadership in the workplace,” says Jay R. Parikh, MD, FACR, professor of diagnostic radiology and division wellness lead within the division of diagnostic imaging at MD Anderson Cancer Center. “Radiology practice leaders can implement formal recognition committees who can recognize peers for the value they bring every day in being the glue that holds the practice together,” Parikh says. “It is critical that radiology practice leaders now recognize and value their radiologists.”
Listening to Your Colleagues
Do not underestimate the power of listening to the ideas of your staff, says Darcy J. Wolfman, MD, FACR, clinical associate at Johns Hopkins School of Medicine and a member of the ACR Commission on Human Resources. “Some ideas will not be feasible — some will be too expensive. However, many ideas are small, cost little money, and can have huge effects on morale,” she notes. For example, adjusting scheduling so that shifts fit each staff member’s needs when possible is a small, free area to address. “We have done it, and people have been thrilled,” Wolfman says. “The key to this change was asking and listening to the radiologists about what changes would make their day better.”
Feelings of disengagement and a lack of control over workplace issues can lead to negative feelings about the workplace. “A seemingly simple decision — refusing to be flexible with scheduling, for example — can end up with a radiologist looking for another job,” Wolfman says. “When creating and instituting policies, it is important for leadership to understand how these policies will affect the workplace and what changes would improve the workday for staff. If not considered, policies that seem like a good idea and seem to be promoting wellness may not actually be well-received in practice.”
Protecting Your Workforce
The main target for solutions to protect the well-being of staff and employees is in the health system itself. According to the AMA, “The very high rates of physician burnout are not related to a deficiency of resilience within physicians,” said Christine Sinsky, MD, vice president of professional satisfaction at the AMA, in relation to a 2020 study.3 “It is the work environment that drives physician burnout.”
Staffing shortages, scheduling problems, colleague disrespect and microaggressions, and other issues can plague practices and could be solved if leaders prioritize well-being. Unfortunately, when push comes to shove, well-being often does not make the cut. “I think that with all that has happened throughout the pandemic — including workforce shortages, many unanticipated retirements for a variety of reasons, and communication struggles — well-being resources have been challenged,” says Claire E. Bender, MD, FACR, former chair of the ACR Commission on Human Resources.
For those leaders, however, who want to keep their radiologists and want to help them be the physicians they want to be, it is possible to protect your workforce. “It is never a mistake to listen,” says Wolfman. “Taking the time to talk to staff and find out what changes would improve their day is the key to success.”