Addressing burnout among mid-career radiologists at RSNA

December 13, 2021
by John W. Mitchell, Senior Correspondent
Radiologists experiencing burnout are at greater risk of leaving the profession. With medicine projected to lose up to 122,000 physicians by 2032, according to the AMA, and pre-pandemic radiologist openings up by a third, a panel at RSNA 2021 made the case that practices need to be taking preemptive steps to retain mid-career radiologists.

The panel presented a wide range of insight and strategies in a session titled “Engaging the Mid-career Radiologist: Challenges, Retention, and Opportunities."

Some of the mid-career angst has its roots in advancing technology, according to Dr. Brent Joseph Wagner, a radiologist in Reading, Pennsylvania, and the executive director of the American Board of Radiology. He said the increased volume is driven by the increased capability of faster imaging technology intersecting with increasingly understaffed departments.

“Especially for radiologists like me, getting on into that mid/late juncture is the increased rate of urgent cases,” he said. “There was a time not too long ago where the rate-limiting step in a call shift was the speed of the scanner — the radiologist could keep up … [but] the scanners won. Now we can’t keep up.”

Keeping up with the rate of scanners is changing expectations about job satisfaction. Wagner cited a study noting that processing speed and memory decline in the 20s, requiring mid-career radiologists to rely more on their experiences.

“How are we going to get the work done?” he posed to the audience. “It brings us to this idea: what do you value more, income or time? There's going to be a difference of opinion [in a practice] on what you value."

He said one solution might be to give up some income to hire additional radiologists into the practice so that mid-career radiologists can have more time off.

Another speaker spoke of the signs to be aware of that could indicate a challenge for a mid-career radiologist, that amount to blind spots for practice/department leaders.

“The reason the mid-career is so challenging is that it doesn’t have the same distinctive benefits — you're not full of potential where great things are expected … you're past that phase. People have already started to identify how you operate, what your speed is, and what your skills are,” said Dr. Brandon Patrick Brown, a fetal and pediatric radiologist, Indiana University School of Medicine. “You’re also not at the end, where you’re emeritus … you’re revered. It’s sort of this no man’s land in the middle.”

Brown added that much of the inherent “thrill” of what radiologists do starts to fade in mid-career. He used placing a PIC line in a premature baby as an example. The first time, he said, a radiologist may wonder how they will be able to do it. After a few dozen cases, there is a thrill and satisfaction from being competent in such a specialized way. But eventually, after a hundred cases, the procedure becomes ordinary and is less fulfilling.

Such feelings are normal — and a warning, as work complacency can lead to neglect and patient harm, known as disappointment syndrome. This manifests in feelings that a professional is letting people down and not living up to expectations. It can, Brown said, cause radiologists to quit mid-career.

"The more our work is routine and ordinary and transactional, the less fulfilling it can become,” he noted. “The less it becomes real to us in the way we were called to become a physician.”

Brown had recommendations to address the needs of mid-career radiologists. These included:

– Overhaul awards and recognition: Traditionally, awards are based on academic research teaching and clinical service models. However, recognition should be given for behaviors that help prevent mid-career angst. For example, he advocates recognition for mentorship, compassionate care, or service to consulting physicians. In other words, the non-transactional parts of radiology work.

– Recognize that “we are all horrible” at maintaining perspective: Often, careerists don't have a handle on the positive impact they have on others — they devalue their contribution. Brown cited the example of Michelangelo, who painted the ceiling of the Sistine Chapel as a young artist early in his career. Later, he suffered from disengagement. In his 80’s, after working ten years on the sculpture the Florentine Pietà, he was so unhappy, he destroyed the statue with a sledgehammer. Ironically, many art historians consider the sculpture his technically finest work. But Michelangelo was so disconnected, he didn’t see it. Radiology colleagues must remind each other of their value and contribution.