It is no secret that radiologists are leaving their jobs. In fact, over 41% of radiologists changed their jobs over a 4-year period, according to a recent study.1 The study included 25,228 radiologists who were associated with 4,381 practice groups across the country. Practice separation rates were 47% for multi-specialist groups as opposed to 38% for radiology-only practices.
Burnout, workload, and inability to participate in nonclinical work, such as professional development and practice building, are the primary drivers.2 But the demand for radiology and medical imaging has only increased in our post-COVID world.
Even with this uptick in demand, radiologists still say they need to focus more on nonclinical work to improve their accuracy and outcomes. In fact, 56.9% of respondents indicated that they made reading errors because they were rushed by increased workloads. This situation hurts providers and patients alike.
But what about the impact of these trends on practices and their leaders? A critical, but under-discussed, downstream impact of the Great Radiology Resignation is the impact it has on practices and practice leaders.
Practice leaders are scrambling to protect their precious workforce. Radiology’s resignation trends are having a major impact, not just on individuals and patients, but also on practices and their leadership. But it is not too late.
The way a practice leader recruits and trains radiologists affects the entire practice - not just the radiologist. There are two primary downstream impacts when practices invest in their radiologists:
At the individual level, the retention of highly-trained radiologists is a good thing for the practice overall. Good retention rates can indicate radiologists are happy, they are not burnt out, and they are working productively and efficiently. More radiologists staying in their roles also means that overall morale and camaraderie are likely to be high.3
One bonafide path to improving retention and morale is to invest in radiologists’ training and professional development. By investing in radiologists’ training, practice group leaders send a message that they care about their providers’ growth, well-being, and commitment to the field. This investment improves specialty range, recruitment, and coverage.
Because of lack of supply and increased demand, radiologists in private practices must be able to pivot and read outside of their specialties. Practices no longer have the luxury of remaining siloed by specialty. This can actually benefit leaders.
With proper investment in professional development and training, especially through innovative avenues like microlearning, practice leaders can develop a nimble workforce with confidence and competence. This results in expanded practice capabilities, quicker turnaround times, and a wider breadth of offerings.
For example, a practice that may have been limited to one or two specialties, now could offer cardiac CT or breast imaging, when that practice may not have been able to before. This also means that practices may be able to solicit business from a wider range of hospitals, clinics, and outpatient centers.
Radiology business leaders try to entice highly-skilled radiologists with bonuses, extra vacation time, and wellness perks. While these tools may work in the short-term, radiologists want to work in a place where they feel that their leaders care about their growth, well-being, and satisfaction.
The most obvious and effective way to retain radiologists long-term is to offer consistent and ongoing access to training and professional development, especially in innovative ways. This approach is, often, more cost-effective for practices than ever-increasing bonuses, increased salaries and paid time off. When practice leaders invest in their providers, word spreads and the reputation of the practice grows. Over time, this allows the practice to organically attract and retain excellent providers.
The available literature about radiologist burnout, retention, recruitment, and resignation focuses almost entirely on the impacts of these challenges on individuals. However, it is time for the imaging community, especially practice leaders and business managers, to understand the market and economic landscape, focus on the impact it has on their practices and proactively develop solutions so they can continue to grow.
Very few radiologists work exclusively in siloed subspecialties. As other areas of medicine specialize and subspecialize, it becomes increasingly important for radiologists to increase their range and grow more nimble across many specialties. Dr. David Youmans of Princeton Radiology Associates says that “multispecialty radiologists are…likely to become even more valuable as more referrals originate from less rigorously trained providers.”
Historically, a generalist was defined as a non-fellowship trained radiologist. This is no longer the case. Now, a generalist is “a practitioner for whom no single specialty represents a majority of their billed relative value units (RVU’s).”1
Over 55% practicing radiologists meet the definition of a radiology generalist. However, the term “general radiologist” may be antiquated. This is because, among general radiologists, over 85% of them derive their billable work from two or more distinct subspecialty areas.
Multispecialists are the way of the future. About 98% of radiologists are fellowship trained. Because of the trend towards multispecialists, most radiology programs offer 4-6 month mini-fellowships in the 4th year of residency. This illustrates academic centers’ recognition that a single fellowship is, likely, not enough for today’s radiologist to succeed. This shift towards multispecialists may be especially important in rural and underserved areas because multispecialty radiologists can cover many different types of common exams and lower complexity procedures.
A number of factors contributed to the increase in multispeciality radiologists.
Workload and volume have massively increased, resulting in massive shortages nationwide for mammographers, pediatric radiologists, cardiothoracic radiologists and more. To keep up with volumes, radiologists have to practice beyond their core specialty because hiring additional FTE and even outsourcing is no longer viable.
After a decades-long focus on increasing subspecialization, many of today’s radiologists are caught off-guard by the need to be a multi-specialist. That is why we must now undertake two changes:
In 2020, the American College of Radiology passed Resolution 47. Resolution 47 established a taskforce to explore the concept of the “Multispecialty Radiologist.” The taskforce discovered that radiologists do not care about the title of multispecialty radiologist, nor do they agree upon an exact definition.2 That said, there is no debate as to whether there is an ever increasing trend towards radiologists as jacks-of-all-trades. As a result, it is imperative that the broader radiology community embrace this concept and all of the doctors who fall into this category.
Once that occurs, the next thing that has to happen to curtail massive burnout, resignation, and discontent among radiologists today is to support this new reality. To do this, we must maximally equip multispecialty radiologists with the tools that they need to be confident, competent, and efficient reading across specialties. Because this is a shift in how we think about radiologists and their training needs, an appropriate shift in how we train and equip them needs to follow suit.
This shift cannot be slow. We need to invest now in new and innovative ways of training radiologists so that they can read across specialties. These investments include digital microlearning, peer-to-peer mentoring, classic CME across a range of subspecialties, and conference opportunities. When this happens radiologists reading across specialties will become more facile, confident, and competent. The downstream impacts of this will be at the practice level. As more radiologists become more competent and confident, more practices will become more profitable, nimble, and successful at retaining and recruiting top talent.
 The definition used in this document is one of many others. The author feels that this definition accurately describes the concept being discussed.
Radiology may be the only medical subspecialty that touches every other subspecialty. This means that radiologists are critically important for a properly functioning medical system. But, increasingly, radiology practice managers and leaders are facing unprecedented and magnified problems. If they do not find solid solutions, all of medicine will suffer. Practice managers are battling retention, recruitment, burnout, and workload challenges to ensure that their quality and revenue remain high. Each of these challenges comes with its own nuance and needs.
The majority of radiology practice managers cite staffing levels as their biggest and most pressing challenge. There is a national shortage of radiologists. A 2020 Journal of the American College of Radiology (JACR) study indicated that in the preceding 4-year period (2014-2018), practice separation rates increased by 38% and 41% of all radiologists left their jobs in that same period. Early-career, late-career, and general radiologists were most likely to leave their jobs. This was all before COVID. In fact, a major 2017 survey in the European Journal of Radiology indicated that 36.9% of neuroradiologists contemplate early retirement. Burnout, workload, and inability to participate in non-clinical work, such as professional development, and practice building are the primary drivers of this burnout and resignation. In addition to a desire to focus more on nonclinical work, 56.9% of respondents indicated that they made reading errors because they were rushed by increased workloads. These errors impact provider confidence and competence, as well as patient safety.
The nature of radiology has changed. COVID-19 accelerated changes that were slowly creeping into the profession. Now, radiologists are often likened to emergency medicine doctors. This is because they are expected to be available 24/7 to read films from ER’s fielding more workload than ever. This is especially true for safety-net hospitals where the majority of patients often originate from the ER. There are two major downstream consequences to ER and remote demands dominating many private and academic radiology practices.
These demands are causing many radiologists to throw up their hands and quit, leaving practice managers with huge staffing shortages.
Prior to COVID, it was obvious that radiology practice leaders and chairpersons needed short term wins and longer term goals to be successful. COVID forced these leaders to live in fight-or-flight mode to survive two years of economic uncertainty, patient volume variation, staffing challenges, and enormous stress. Anyone who lived through COVID cannot say with full confidence that things will be more steady but, it appears that radiology patient loads will return to 2019 levels. This means that it is time for leaders to plan for the long game.
The best way to do this is to invest in good people. Practice leaders inherently understand that investing in their doctors leads to greater growth, revenue, retention, and recruitment. However, this intuition was abandoned during COVID when practice leaders lived on a razor’s edge at every moment. Now is the time to resort back - to invest in the long term in good doctors, leaders must understand what they need and stay up with the times. To do this, practice leaders must understand the root causes of retention and recruitment challenges. The primary cause today is burnout.
Physicians, especially radiologists, are suffering from real and serious burnout. A medscape survey revealed that 49% of radiologists report feeling burnt out and 54-72 percent have symptoms of burnout. The reasons for this burnout are multifactorial.
Work-life balance, or lack thereof, is a major driver of this epidemic in radiology. Of the radiologists who feel burnt out, 50% attribute that burnout to a lack of control or autonomy. In fact, 62% of radiologists polled said they would be willing to reduce their pay in exchange for better life-work balance. Dr. Richard Duszak, Chair of Radiology at the University of Mississippi, said that CME accreditation requirements are serious contributors to burnout for radiologists today. Young parents and women, in particular, are hard hit by work-life balance struggles in radiology.
A recent American Medical Association survey reported that 92% physicians under age 35 felt that work-life balance is important, but only 65% felt that they had achieved this goal. Radiology is especially hard-hit. While the number of women enrolled in medical schools exceeded that of men in 2017, only about 27% of radiologists are women. In the previously cited Medscape survey, only 44% of men reported feeling burnt out as compared with 65% of women. All of these statistics indicate the need for radiology practice managers to take burnout very seriously, especially among younger and female faculty.
In Minneapolis, radiology giant, vRad, recently partnered with Vital WorkLife, a behavioral health consultancy, to address burnout among its radiologists. Vital WorkLife found that two of the top drivers for burnout and dissatisfaction among radiologists at vRad are inflexible schedules and work-life imbalances.
What radiologists need is fulfillment, flexibility, and motivation. Once practice leaders understand the root causes of radiologist burnout and defection, they can implement solutions that work. Practice managers must, first and foremost, recognize that radiologists are humans. This may seem painfully obvious, but it merits mentioning. By understanding that radiologists are eager to learn, want to feel fulfilled, and need to be appreciated, practice managers can start to make changes that will curtail the great radiology resignation. By investing in radiologists’ professional development, growth, and overall success, practice managers can buck the trend of burnout and resignation and reignite their workforce with enthusiasm, energy, and commitment. Further, by investing in these elements now, practice managers can generate a reputation that attracts new talent to increase revenue and production. Today’s radiologist is often expected to be a renaissance person.
Practice managers should, therefore, create opportunities to upskill in high-growth, high demand areas rather than letting radiologists figure out how to navigate this landscape on their own.
In addition to classic professional development and medical education, it is prudent for practice managers to think innovatively about new and different ways to increase competence, happiness, and productivity in radiologists. Today, people - including doctors - are accustomed to having what they need at their fingertips. This is true of food, rides, exercise, and entertainment. Virtually everything can be delivered, streamed, or brought to people’s homes. This is yet to be true of medical education and professional development for radiologists. But that is about to change.
In addition to general investment in radiologists' wellbeing and development, proactive leaders could set themselves apart by investing in the newest and best technologies to bring tech-based, innovative opportunities to advance radiology careers to their doctors. Microlearning is a great example of how this approach could create happier, more efficient doctors while generating more revenue and workplace satisfaction. This type of investment works for two reasons:
First, allowing doctors to learn and progress at their own pace, in their own place, and on their own schedules will offer the autonomy, trust, and flexibility that radiologists crave. Offering this as an option gives doctors a clear message that their leaders trust them, believe in their work, and care about their lives.
Second, giving doctors access to the world’s best faculty to better understand how to read challenging cases, especially those outside of their subspeciality of focus, opens a world to doctors to become more competent, confident, accurate, and efficient. By learning and growing in their field, doctors will feel as though they are valued and respected. This is especially important in recruiting and retention.
Like burnout itself, the antidotes to the problem are multifactorial and complicated. Practice managers must be innovative and nimble when addressing burnout. While solving this problem, practice managers, no doubt, also consider revenue and RVU’s and productivity. There is a shortage of radiologists so giving more of them time off helps the individuals but may hurt the practice.
Radiology leaders are pushing back. As Dr. Michael Recht, Chair at NYU Langone Medical Center emphasizes “we can’t tell everyone just to do clinical work. Radiologists need to take the time to talk to their referring physicians, to go to interdisciplinary conferences, and fulfill their educational mission.” When leaders ask radiologists just to increase clinical workload, radiologists leave. It’s that simple. Today’s radiology leaders must understand that there is a long game for success.
That is why it is time to figure out how to give radiologists more autonomy, more work-life balance and more satisfaction at work. A recent poll indicated that 60% of burnt out radiologists attributed those feelings to a lack of respect. When leaders invest in radiologists’ professional development, those leaders make it clear that doctors’ skills growth, pride, and confidence in their work - rather than just in RVU’s - matter.
Investing in professional development and innovative ways to increase fulfillment, autonomy, and trust will not solve all of practice leaders’ challenges in a post-COVD world, but it is a strong step in the right direction. This investment, among others, will allow leaders to remove some of the yoke imposed by COVID to plan for the future, attract and retain the best and brightest, and succeed in increasing revenue and improving patient care.