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.