During this fireside chat, CEO & Co-Founder Daniel Arnold and Dr. Catherine Jones, Cardiothoracic Radiologist Lead, Professor of Clinical Imaging Science at the University of Sydney and the lead AI researcher at I-MED Radiology, discuss:
Transcript
Daniel Arnold
Thank you for joining us here for our fireside chat. My name is Daniel Arnold. I’m the CEO and Co-founder of Medality, formerly known as MRI Online and I’m joined here by my good friend and partner, Dr. Catherine Jones, who is a Cardiothoracic Radiologist and the lead AI researcher at I-MED Radiology. Start us off, tell me a little bit about I-MED.
Dr. Catherine Jones
So for everybody who’s not from Australia, I-MED is a really large private practice. We have over 300 clinics and we cover public hospitals, private hospitals, teleradiology and a large number of community clinics. We have over 450 radiologists and I guess the thing that makes us interesting is that we don’t have a large number of radiologists who are coming through, who are subspecialty trained.
I know that here in the U.S. there’s a lot of subspecialists, a lot of people do fellowships after they do residency where that’s not so much the common pathway back in Australia. So we very much have a general radiology perspective and probably between 30 and 50% of radiologists have a subspecialty interest. So I first first met Daniel and the team at Medality probably about four or five years ago now, and we started to work together to see how we could improve the radiologists learning experience for the use case in Australia.
Daniel Arnold
Thank you so much. So the topic for today is how to grow your practice when it is impossible to recruit and retain. Every group in the world is having a radiologists shortage and we think education can play a real role. Oftentimes, there’s a challenge where 98% of people are specialized, they come in, they maybe just finished an MSK Fellowship and they want to practice 100% MSK and their practice actually needs them to be able to read beyond just MSK. Maybe they need them to read spines or some advanced body or provide call coverage.
So we provide tailored pathways for them to do on the job training. What we’ve developed with I-MED is called the Junior Consultant Program. Can you tell me a little bit about that?
Dr. Catherine Jones
Thanks, Daniel. So this is something we came up with in conjunction with Daniel and the team at Medality about five years ago. We realized very early on that there was a competition in private and public practice in Australia for the residents as they finish training.
There’s a finite number of residents that come through and of course we all want to, bring them over and have them join our groups. One of the things as a resident, no matter how well you’ve been trained or whether you’ve done a fellowship or not, there’s always a level of concern and anxiety taking the next step into becoming a staff radiologist, or as we would call it, becoming a consultant radiologist.
In order to ease those anxieties, we’ve said, “Why don’t you join our team? We’re going to provide you the opportunity to join our Junior Consultant Program.” Essentially what that means is we have up to ten places every year across our network. The radiologist joins having just finished training and they spend about half the time doing general clinical practice, usually in a large clinical environment where there’s at least one or two radiologists available to be there to support them. And half the time they do a Fellowship Program. Most of the time, the radiologists finish their residency and they feel a little bit undercooked on MRI and so this is a perfect synergy with Medality being able to tap into their amazing MRI resources not only to do some didactic teaching, but also to allow our newly trained residents to do some virtual fellowships throughout the year.
The other really important part of all of this, and I can’t stress this enough, is that they know what to expect at the start of the year. Usually it’s a 12 month program and we offer them not only the online mentorship, but we schedule frequent events throughout the year, some of which are online with the team at Medality, but also one on one mentorship throughout the year with our own team in Australia.
So we bring on a variety of consultants. Some of them are dedicated MRI specialists and some of them like me, I’m a Cardiothoracic Imager, but I do a lot of MRI. I give them more of a day to day, mentorship and sponsorship. So it’s really important to cover all of the bases…it’s about recruiting, it’s about making our more junior consultants feel supported, as well as providing them with a really high quality educational product.
Daniel Arnold
Thanks, Catherine and a few elements of this program to highlight. We have a broad range of fellowships and so we can personalize it to the junior consultants interest. Some might want to go deep into MSK and Neuro, others might want to go into Advanced Body or Breast and so they can pick and choose and develop multiple specialties in a period of time to reduce their burnout because they get to practice across a wide range of their interests as well as become really versatile members of the reading team. If they’re doing all the same thing every day, we know, that leads to less happy and less fulfilled radiologists.
In addition, it’s extremely data driven. You can see a chart here on the slide where we can track each junior consultant’s performance across misrates, accuracy, time it takes to read cases, make sure that they’re seeing enough volume and competent before they get set loose into an area so that I-MED knows they can provide extremely high quality of care.
We’ve been talking more and more with groups in the U.S. looking at whether this model might be achievable. At a recent conference I was at with about 30 presidents of private practices, I asked “how many of you are willing to hire right out of residency and no longer require a fellowship”? And over half of the hands were raised and I’m confident that that was not the case five years ago when we started this program and I-MED paved the way.
But one of the things that they really struggle with is there’s quite a bit of administrative burden to pull off this program at scale and that’s where we come in with our team. We handle all of the administrative work so that the clinicians aren’t dealing with additional burden in order to drive this program forward and have successful outcomes from it.
One other key point is it’s great for these fellows to be able to come in and start earning a real income one year earlier and great for the program to have additional capacity. One thing that through this partnership and five years of building, we’ve now released a brand new product called a Fellowship Certificate Program, which is built on the years of experience running these programs. These mini fellowships include over 25 cases. They baseline not just your accuracy, but also your speed.
“How long does it take you to read Knee MRI? How long does it take you to read a Prostate MRI?” Are you improving as you work through those cases? Based on your performance, we recommend the right modules that are high efficiency modules, 2 to 4 minute videos that you can work through at the workstation, but you can also do it on your phone or your iPad.
This all comes together into a Mastery Scorecard. So I can see as an individual that I’m developing competencies, but then also as an administrator, I can understand where your strengths and weaknesses are.
Dr. Catherine Jones
And not only does that really reassure the resident or in this case the fellow, because they’re no longer residents, it reassures them that they’re getting enough coverage across all of the findings.
So, for example, I was one of the mentors on the MRI Knee program last year, and I had fellows that would say, “but I could report 100 MRI’s and never see any of these particular findings because they’re quite uncommon.”
And that’s where having the mini fellowships is ideal because all of those pathologies are covered. It’s an enriched learning environment. So every case that you look at has been designed to challenge the resident in a further and additional way. I like to call it the inverse Netflix effect. Here’s a case you’re not going to like because you’re going to have to learn something else. Which is what I want if I’ve got a limited amount of time to devote to learning.
We’re all time poor and that’s the same for me as the supervisor as well. When I see my fellows in the clinic with me and we do a readout session, I need to know that when they come to me and they’ve looked at those cases, because they’ve already done the online teaching material and then they’ve done the mini fellowship, that when they come to me and we talk through these cases, I’m not starting from scratch.
I don’t have the time to start from scratch and that’s really where the Medality product has led to not only the fellows being able to do this at their own pace at a time that suits them, but it’s allowed me to have the maximum effect, being able to take them that little bit further for how they actually interact with these cases in the in the clinical real world environment.
Well, the other thing that I would say is that since we started this program about five years ago, we’ve gone from quite a narrow offering, which is what we needed at the time to a really comprehensive offering of many fellowships. And I’m at the point now where I might actually do a few the next year because I’ve been so busy doing cardiothoracic the last five years I’d like to go back and do another MSK one. So Dan, we’ll be having a chat after this.
Daniel Arnold
And that’s a great segue to broadening how we work with groups. So this junior consultant program is one way which is around onboarding and hiring, but this spans across the radiologists through their entire life cycle within a practice. One of the things that we really enable groups is on practice expansion.
Everyone’s facing rising volumes in Cardiac CT, Nuclear Medicine, Pet CT, Pediatrics. Yet if you’re a 20 person group or even if you’re a 300 person group, chances are you can’t hire in those specialty areas and you’re going to have to look within your group to find readers that can work with them. And so, for example, we’re working with one large 300 person practice that needs ten more prostate readers.
We actually run a 360 degree survey of all of their clinicians to identify people who are interested in learning Prostate MR but don’t have the requisite skills. We enroll them in the fellowship and then we enable them to grow their practice. It’s something that the radiologists love because now they can learn a new skill, potentially one that reimburses better than maybe the volume that they’re currently reading and the practice is finally able to have a little more breadth of coverage.
Dr. Catherine Jones
I think the prostate MRI is a great example. In Australia, we suddenly had reimbursement approved about four or five years ago and so we suddenly not only had radiologists who were keen to upskill in that area anyway, but now we had a really good business case to have more patients coming through for that scan.
So we were able to identify the key areas of interest for us. And because the offering is so comprehensive from Medality, we just itemize them in order of priority and started working our way through. Another great example is Breast Imaging. Again, it can be difficult to find good quality online breast resources and it’s a very time intensive process to do that within your own clinic or to send somebody away to do an observership somewhere else.
This is another great opportunity to be able to provide that sort of in-house upskilling as a combination of the didactic teaching, the videos, the self assessment, the mini fellowships, and then being supported by your in-house radiologists who are experts in that field.
Daniel Arnold
The final thing I’ll say is, we’ve been growing really fast and I think one of the reasons for that is our focus on the product. This online educational experience is unlike anything else on the market. It’s fun, it’s easy to use, and we listen very closely to our customers and constantly innovate on the product and that’s why we’re happy to announce we just passed a 125th client, three times where we were this time at RSNA last year, as a testament to how much our radiologists, our end users love and enjoy working with it.
Dr. Catherine Jones
I think I can safely say that if for some reason…in fact we had a survey that went out across our 450 radiologists last year at I-MED asking: “Which of the following educational resources would you like us to retain? Which of the following would you like us to think about?” And it almost across the board, came back saying, “I don’t care what you do, but just don’t get rid of Medality” because honestly, it’s all in one place. It’s easy to access, it’s very user friendly and you’re able to download all of your certificates at the end of the year to say that you’ve had some CME. So it really ticks all of our boxes.
Daniel Arnold
Thank you. Thanks, Catherine. Thank you so much.
Medality, the leading practice development platform for radiologists and imaging organizations and the American Association for Women in Radiology (AAWR), an organization focused on leadership advancement, education, support, and empowerment of women in radiology of all career levels and practice types, announced during RSNA 2023, their collaboration on several initiatives in their shared commitment to advancing & supporting women in radiology and transforming the way radiologists learn and thrive.
In 2024, Medality will further enrich the educational offerings on the platform and continue to showcase the expertise of AAWR members through it’s Noon Conference, a weekly free, live educational webinar that connects the global radiology community. These live lectures are accessible for all, and are an opportunity to learn alongside top radiologists from around the world.
“The AAWR could not be more thrilled to continue our partnership with Medality as we work together to promote women and allies not just in the United States, but around the world when it comes to sharing their expertise and diverse educational content,” said Dr. Amy Patel, AAWR’s President.
Since the launch of the partnership, Medality has amplified AAWR members on the Medality Practice Development Platform by featuring them as speakers and educators through a variety of educational offerings such as: Noon Conference, Mastery Courses, and the Radiology Report Podcast. These AAWR members join notable women in radiology such as Dr. Rachel Brem, Dr. Lacey McIntosh, Dr. Robyn Roth, Dr. Erin Gomez, Dr. Soonmee Cha, Dr. Jenny Bencardino, Dr. Petra Lewis, Dr. Suzie Bash, Dr. Emily Conant, Dr. Laura Avery, Dr. Ella A. Kazerooni, Dr. Pam Schaefer, and more!
“I am thrilled to continue our partnership with the AAWR to advance women in radiology and transform the way radiologists learn and thrive,” shared Daniel Arnold, CEO and Co-Founder of Medality. “I created Medality to connect the international radiology community and to give every radiologist the opportunity to learn from the best educators in the world. Our continued partnership with the AAWR gives their educators access to this international platform so they can expand their diverse voices, continue to teach and inspire the next generation of radiologists.”
To learn more about how you can join the AAWR or Medality’s practice development platform, please reach out to support@medality.com.
About AAWR
The American Association for Women in Radiology AAWR is a professional organization for women radiologists that was founded in 1981 to provide a forum for issues unique to women in radiology, radiation oncology, and related professions. The association sponsors programs that promote opportunities for women, as well as facilitates networking among members and other professionals. AAWR’s goal is to provide mentorship opportunities for the next generation of women radiologists, as well meet the diverse and changing needs of its members.
Learn more at aawr.org.
About Medality
Medality is the leading practice development platform for radiologists and medical imaging organizations. Medality helps tens of thousands of radiologists from over 100 countries upskill in high-growth, advanced imaging areas with case-based microlearning video courses and integrated cases designed to simulate clinical practice from anywhere, anytime. Imaging organizations use Medality to improve diagnostic and reporting quality, reduce turnaround times, and expand their breadth of practice quickly in the areas they need it most.
Medality’s case-based education is accredited under MRI Online by the Accreditation Council for Continuing Medical Education (ACCME) and totals more than 700 AMA PRA Category 1 Credits™ across its platform. Learners can also earn SA-CME credits that meet the American Board of Radiology requirement for MOC as well as credits for MQSA, SCCT, NASCI, state licensure requirements and more. Courses are developed in partnership with hundreds of top academic faculty, such as Dr. David Yousem, Dr. Stephen Pomeranz, Dr. Petra Lewis, Dr. Don Resnick, Dr. Rachel Brem, Dr. Suresh Mukherji, Dr. Stefan Zimmerman, and Dr. Lacey McIntosh.
Learn more at www.medality.com.
As a practice leader, it is important to ensure that your radiologists are up-to-date with the latest industry developments and certification requirements. Continuing medical education (CME) is an essential component of maintaining and improving the knowledge, skills, and performance of healthcare providers. Managing and tracking CME hours can be a complex and time-consuming process, particularly when you are responsible for overseeing a large team of radiologists.
Medality is a Practice Development Platform that offers a one-stop-shop for CME for radiologists. With our platform, you can create CME pathways for your radiologists and enroll them in affordable training courses based on their necessary certifications and state requirements. This makes it easy for you to manage your team’s CME certification process and ensures that your radiologists are always up-to-date with the latest industry developments.
Medality’s flexible practice development platform includes more than 100 courses, 4,000 bite-sized microlearning videos, & over 4,000 integrated, scrollable cases designed to simulate a workstation.
Our case-based education is accredited under MRI Online by the Accreditation Council for Continuing Medical Education (ACCME) and totals more than 600 AMA PRA Category 1 Credits™ across the platform.
Courses are developed in partnership with hundreds of top academic faculty, such as:
Learners can earn unlimited CME & SA-CME credits across 135+ courses to meet their CME and certification requirements. Medality helps to fulfill:
Medality offers a wide range of CME courses, covering a variety of radiology subspecialties and modalities. Our courses and fellowships are designed to be engaging and interactive, allowing your radiologists to learn at their own pace and on their own schedule.
With Medality, you can say goodbye to spreadsheets and chasing your radiologists to complete or collect their certifications. Our platform offers completion tracking, so you can easily monitor your team’s progress and ensure that everyone is on track. You can also integrate our platform with credentialing software, making it even easier to manage your team’s certifications and licenses.
Learn how Medality can help you streamline the CME process for your radiologists.
If ever there was a case to be made for the importance of quality and patient care in radiology it is this one statistic: the real-time error rate in daily radiology practice is 3 to 5 percent, representing 40 million diagnostic errors annually worldwide.1 To make matters worse, the retrospective error rate in radiologic examinations is approximately 30 percent.2 In an environment where physicians are increasingly reliant on imaging for patient diagnosis and care plans, quality and patient care hang in the balance.
The good news is that diagnostic errors are preventable events, root causes can be readily identified, and real time solutions can be hardwired into department protocols and staff training.
However, administration must have the will, departments must have the budget, and staff must be engaged. Quality must be priority number one for every radiology department – and every radiologist.
As physicians and payers require more imaging to support diagnoses, radiologists are experiencing a steep workload with reduced support staff, rising quality expectations, and in some organizations, antiquated technology. This is increasing stress levels and burnout rates in radiologists, exacerbating an already risky environment with errors that occur all too frequently.
Medical errors and misreads can take different forms in radiology, including:
Several factors contribute to the occurrence of medical errors and misreads in radiology. Burnout, for example, can result in fatigue and decreased focus, leading to misreads or errors. Radiologists who specialize in a particular subspecialty or modality may not have enough exposure to other specialties, leading to potential errors when interpreting unfamiliar images. Additionally, staff members may be under pressure to read a high volume of imaging studies quickly, leading to errors or misreads.
Another contributing factor to misreads in radiology is the increasing demand for imaging studies. “The demand for imaging is outpacing what we’re doing on the training side,” said Dr. Vahid Yaghmai, professor and chair of radiological sciences at the University of California, Irvine. “The number of radiologists in the workforce is not growing as fast as the population and the demand for imaging.”3
There are not enough radiologists available to read these studies, and even if there are, they may not have the appropriate training in other subspecialties or modalities to handle the volume of imaging adequately. This situation can result in more misreads or errors due to the radiologist’s lack of experience.
Given the myriad issues resulting in misreads and errors, how can patient care be improved? The answer is a methodical approach that assesses and addresses each issue proactively, combined with an action plan for immediate assessment of issues in real time.
Here’s how to address the issues raised above:
The bottom line is that everyone in an institution bears the responsibility of protecting and improving patient care. When it comes to the radiology department, their specific efforts must be supported by quality and risk, finance and administration. Just as “no man is an island”, no department functions completely alone.
Radiology must have robust support in order to deliver highly accurate interpretations and improved reporting quality. That means:
It could be said that every patient diagnosis begins with imaging and the interpretation of those images are the first milestone in the patient care pathway. Therefore, this essential function must be supported with training, trust, and empowered radiologists that feel free to share concerns and seek advanced training. When these tools are placed in the hands of the experts in the department, errors can be addressed, quality will improve, and patient care will be enhanced.
[1] Radiographics https://pubs.rsna.org/doi/10.1148/rg.2018180021
[2] American Journal of Roentgenology https://www.ajronline.org/doi/full/10.2214/AJR.12.10375#:~:text=Every%20radiologist%20worries%20about%20missing%20a%20diagnosis%20or,claims%20against%20radiologists%20are%20related%20to%20diagnostic%20errors
[3] Radiological Society of North America https://www.rsna.org/news/2022/may/Global-Radiologist-Shortage
As a practice leader, it is your responsibility to ensure that your radiologists are meeting their CPD requirements. The Royal Australian and New Zealand College of Radiologists (RANZCR) have recently updated its CPD requirements to promote the continuous learning and development of radiologists, ensuring that they remain up-to-date with the latest advancements and technologies in the field of radiology. The new requirements focus on promoting evidence-based practice and encourage radiologists to reflect on their professional practice and engage in continuous improvement.
These updated guidelines were developed to better align with the requirements of the Medical Board of Australia (MBA), and the Medical Council of New Zealand (MCNZ) and to provide radiologists with a more flexible and personalized approach to professional development. This change brings new opportunities for professional growth, but it also means that radiologists will require guidance and support to navigate the new requirements.
The new CPD program requires radiologists to:
There will also be an additional minimum requirement of activity that needs to be met across the 3 broad categories:
1. Compliance
Radiologists must comply with the new RANZCR CPD requirements, which means that they must complete a certain number of CPD activities each year. Practice leaders must ensure that their radiologists are aware of the updated requirements and are meeting them.
2. Professional Growth
The updated RANZCR CPD program offers radiologists more opportunities for professional growth, including a greater focus on reflective practice and self-directed learning. Practice leaders must help their radiologists to take advantage of these opportunities and provide support for their ongoing development.
3. Improved Patient Care
By meeting the updated RANZCR CPD requirements, radiologists can enhance their knowledge and skills, which will ultimately lead to improved patient care. Practice leaders must recognize the importance of this and encourage their radiologists to embrace the updated program.
4. Competitive Advantage
Practices that have radiologists who are meeting the updated RANZCR CPD requirements will have a competitive advantage in the marketplace. Patients and referring doctors are likely to prefer practices with radiologists who are committed to ongoing professional development.
5. Reputation
A practice’s reputation is closely linked to the reputation of its radiologists. By helping their radiologists to meet the updated RANZCR CPD requirements, practice leaders can enhance their practice’s reputation as a center of excellence in radiology.
Practice leaders have a critical role to play in ensuring that their radiologists meet the updated RANZCR CPD requirements. By providing guidance and support, practice leaders can help their radiologists to embrace the new opportunities for professional growth and ultimately deliver better patient care.
Find the 2023 RANZCR CPD requirements here.
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.
[1] https://www.neimanhpi.org/press-releases/radiologists-job-changes-trends/
[2] https://healthimaging.com/topics/medical-imaging/neuroimaging/burnout-369-radiologists-early-retirement
[3] https://projectionsinc.com/abetterleader/morale-the-number-one-factor-for-employee-retention-and-productivity/
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.
[1] https://vulcanimaging.com/wp-content/uploads/2021/08/Value-of-the-New-General-Radiologist-in-Private-Practice.pdf
[2] 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.[1] 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.[2] 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.[1] 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[1] 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.[1] In fact, 62% of radiologists polled said they would be willing to reduce their pay in exchange for better life-work balance.[2] Dr. Richard Duszak, Chair of Radiology at the University of Mississippi, said that CME accreditation requirements are serious contributors to burnout for radiologists today.[3] 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.[4] 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.[5] In the previously cited Medscape survey, only 44% of men reported feeling burnt out as compared with 65% of women.[6] 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.[7] 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.
[1] https://radiologybusiness.com/topics/healthcare-management/radiologist-salary/dramatic-shift-new-survey-highlights-salaries-and
[2] https://www.neimanhpi.org/press-releases/radiologists-job-changes-trends/#:~:text=Researchers%20found%20that%20over%20the,job%20during%20the%20study%20period.
[3] https://healthimaging.com/topics/medical-imaging/neuroimaging/burnout-369-radiologists-early-retirement
[4] https://www.appliedradiology.com/articles/coping-with-covid-resilience-in-radiology
[5] https://radiologybusiness.com/topics/healthcare-management/leadership/radiologists-burn-out-medscape-radiology-physician
[6] https://radiologybusiness.com/topics/healthcare-management/leadership/radiologists-burn-out-medscape-radiology-physician
[7] https://www.diagnosticimaging.com/view/has-burnout-become-an-epidemic-in-radiology-
[8] Id.
[9] https://www.healthecareers.com/articles/career/millennial-physicians-setting-healthier-work-life-balance
[10] https://dailybulletin.rsna.org/dailybulletin/index.cfm?pg=20mon06
[11] https://radiologybusiness.com/topics/healthcare-management/leadership/radiologists-burn-out-medscape-radiology-physician
[12] https://www.prnewswire.com/news-releases/vrad-selects-vital-worklife-to-support-its-national-remote-workforce-301646288.html
