When a radiologist (who wishes to remain anonymous) joined a small private practice where she was the only woman, she found she didn’t have a workspace to make her own. Nor she did have any personal space. According to this radiologist, “Most of us who work in private practices sit in a different seat every day, by ourselves, and have no place that is our own — no place to put a coffee cup or a handbag or a picture of our kids.”
Because of the work schedule of full-time practice, the isolated work environment, and the premium placed on productivity, there was little opportunity for this radiologist to build a community at work or outside of work. “With a different call night or shift schedule every week, I couldn’t commit to take a class outside of work or volunteer to coach a child’s team,” she says. Within a few years, her practice eliminated the last remaining social events that had provided a sense of group cohesion, like the annual holiday party and retirement parties for departing colleagues.
The anonymous radiologist did her radiology residency in one part of the country and her fellowship in another part. On top of that, her fellowship area was physically separated from the rest of the hospital. “Aside from the other few fellows in my subspecialty, I didn’t meet the larger radiology community or department at all,” she says.
This radiologist’s feelings of isolation and disconnection are common in people who identify as being burned out. But many wonder — is this happening to these people individually, or are they describing the logical outcomes of existing in a flawed system? According to Richard B. Gunderman, MD, FACR, chancellor’s professor of radiology at the Indiana University School of Medicine, “Some conceptualize burnout as a strictly individual problem, to be addressed by individuals, yet in many cases burnout results from widely shared systemic and cultural factors. For example, physicians are told to exercise, get more rest, and take all their time off, which does nothing to address factors at work — such as programs to increase productivity at the expense of quality, which cause burnout in the first place.”
Taking a Step Back
Mansi A. Saksena, MD, a radiologist at Massachusetts General Hospital (MGH), experienced burnout after entering full-time practice in 2011. Initially, Saksena was surprised to find that she was struggling — she wasn’t sleeping, was anxious all the time, and was uncharacteristically irritable. She approached her chief at MGH, Constance D. Lehman, MD, PhD, FACR, and told her that she thought her current workload may have become untenable. Fortunately, Lehman was very supportive of Saksena taking a step back. “Instead of working a full 100 percent, I now work 60 percent,” Saksena says. “I work 50 percent clinical and 10 percent research. I’m hugely happy. It was the best decision I’ve ever made.”
Having more time — and having control over her time — was what ultimately saved the anonymous radiologist as well. She quit her job and moved overseas for a brief period where she was exposed to a work schedule and culture that she found energizing and fulfulling. “People were super collaborative there,” she says. “You never felt like you were bothering someone by showing them a case. Part of it is the time pressure was less.” She adds, “In the U.S., you’re measured on how quickly you get the report out. So I found it to be a little more thoughtful, because it’s not driven so much by productivity.” Like Saksena, the anonymous imager found a part-time job as a radiologist that allowed her control over her schedule. The extra time enabled her to develop an approach to her career that she now calls her new theme in life: “Step outside of your building.”
With her flexible schedule and reduced hours, the anonymous radiologist was able to start attending conferences and meetings. “I went to the Radiology Leadership Institute® Summit, and it was the first radiology conference I’d attended where we actually talked to each other,” she says. “The whole point was to work in groups — not just to sit in a hall and have someone lecture to you.” That following year, she went to various conferences that felt rewarding, including the ACR Annual Meeting and several non-industry meetings. She was able to network and collaborate with people outside of medicine and engage in larger discussions about healthcare and radiology. “Even though the meetings were expensive and required a lot of travel — which wasn’t easy — it paid off,” she says. “I began to recognize some of the same people at various meetings and really started to feel that sense of community I’d been searching for.”
Changing the Culture
The question remains — how can radiologists begin to change the systemic and cultural factors that contribute to burnout? According to the anonymous imager, the first thing the profession needs to do is reduce the stigma around it. “We need to change the way burnout is talked about,” she says. “Leadership often asks: ‘How can we make you more efficient?’ They should be asking: ‘How can we add more value? How can we play to people’s strengths. How can we be more interactive with each other?’ It’s about creating a place where you feel engaged and respected, where you are part of a team, and where you actually could take a break to go for a run or eat a meal with a colleague in the middle of the day.”
Primarily, though, it seems the crux of the issue is time. According to Saksena, radiologists want and need more time — to network outside of work, to build community, to spend with their families and friends on their breaks, and to explore other areas of the field that hold interest for them. “Allowing flexible and reduced hours for those who need or want it could be instrumental in changing the experiences of those who are burned out,” says Saksena. “We wonder why there aren’t more women in the workplace and we talk a lot about helping women reach leadership positions. I think one of the key pieces of being able to retain women in the workplace is to allow them flexible hours.”
According to Gunderman, “If you know a change needs to be made in your radiology department but you don’t know where to start, simply start by talking to one another. At my institution, it took months to realize that we needed to convene informal groups of people to discuss issues around burnout. It has dramatically enhanced our understanding of the problem and helped us better promote fulfillment in the work we do.”