Diagnosing radiologist burnout and prescribing the right changes to cure it

December 02, 2016
by John W. Mitchell, Senior Correspondent
Some studies suggest radiologists may be among the unhappiest of physician specialists, with as many as 10 in 26 suffering burnout. This, despite other studies that show radiologists are in the top five for physician income.

“Money is not everything,” said Dr. Richard Gunderman, chancellor professor of radiology and philosophy (among several areas of academics) at Indiana University, one of three experts addressing this issue at a Tuesday morning RSNA session.

Radiologists may be at special risk due to the nature of their work. They often work alone — even remotely — and are judged on how many reads they accomplish in a day. According to Gunderman, this plays into several characteristics of burn out: a lack of peer community, lack of control, and a perceived unfair workload. These in turn are some of the root causes of cynicism and inefficacy – or a perceived lack of power.

“This creates a gap in ideals about why we became physicians and it feels like it’s not our idea of good medicine,” Gunderman said. “Our time is limited, we want to make a difference.”

He said that in his opinion, some of the biggest contributions to burnout are treating the characteristics of success – such as wealth, power and honor – as ends, rather than the byproduct of a life and work that has meaning. Radiologists should not define themselves, he advised, by the number of pages in their CV.

“Most people think they are unhappy because they can’t get what they want,” he shared. “But people are unhappy because they don’t know what they want. Anxiety and depression are trying to tell us something about ourselves we don’t understand.”

The good news, he said, is that radiologists are good at diagnosis and the solution to burn out is a diagnostic solution.

The second speaker, Dr. Norman Beauchamp, Jr., dean of the College of Human Medicine at Michigan State University, offered a range of strategies radiologists could use to examine what they want from their lives and careers. He shared his own struggle with burnout and fear early in his career.

“Insecurity doesn’t make you weak, it makes you human,” Beauchamp said. “So begin with the end in mind – what makes sense and what makes you feel proud?”

Even though he noted that stress could be positive, he is a believer in the notion that we see what we know. Insight to how we view our world is critical to happiness – the natural antidote to burn out.

Among his strategies were:

- Seek out mentors and learn from others who have sense of joy about them.
- Build a team and be generous with credit for the team members. Do not fear adding team members who may have better skills than you.
- Include family in your work. Talk to your family about your success and challenges. Cultivate a balanced life and be in the moment.
- Learn how to manage your time.
- Believe in yourself and don’t internalize failure. View failure as an opportunity to learn.
- Treat everyone with respect, regardless of position.
- View negative behaviors on the part of others as symptoms of their pain; don’t take it personally.
- Don’t compare yourself to others. Your circumstances are different than theirs.
- Exhibit joy and optimism and the world will become a friendlier place; smile!

The final speaker, Dr. David Fessell, a musculoskeletal imaging professor at the University of Michigan Health System, spoke about resiliency and gratitude.

"It brings me great joy to speak to you about this topic,” he said in his opening statement.

Fessell advocated being positive in our words. He cited research that showed there was a five to one ratio of positive to negative words in a successful marriage. This compared to a one to one ratio in marriages likely to end in divorce.

As examples of resiliency, he cited prisoner of war and Admiral James Stockdale, Captain Chesley Sullenberger, Mother’s Against Drunk Driving founder Candy Lightner and Holocaust survivor Viktor Frankl. All of whom, he said, held common core beliefs, which included:

- Optimism
- Facing fear
- A moral compass to do what was right
- Cognitive and emotional flexibility
- Social support

A poor response to stress can include jumping to conclusions, tunnel vision and personalizing. For radiologists, Fessell said, this can lead to out of proportion reactions that can create stress, which makes it difficult keeping up with the demands of clinical work, administrative duties, CMEs, hospital meetings and family events. The bottom line is radiologists believe they should be able to handle anything and do it really well or else they will not be loved.

He advocated moving to a ”zone of control” rather than being ruled by fear, anger and frustration. This is characterized by paying attention to such positive and negative behaviors such as:

- How often we say I love you and thank you
- Practicing gratitude and smiling
- How much time we spend thinking about our past
- Being judgmental
- Trying again after setbacks
- Appreciation for what we have

Gratitude, Fessell said, is especially vital to preventing burnout. This he defined as a life orientation toward noticing and appreciating the positive of life. Lack of gratitude, he noted, has been associated with psychopathology, particularly depression.

In closing, Fessell cited a quote by Frankl: “Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”