Hot Topic! Has PACS Ignited an Epidemic of Burnout?

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 - Burnout

Nearly half of U.S. physicians responding to a survey about burnout reported at least one symptom of burnout, researchers reported in a study published online August 20, 2012, in Archives of Internal Medicine. The researchers reported that radiologists face a slightly higher than average rate of burnout, a finding that doesn’t surprise many radiologists.

Peter S. Moskowitz, MD, founder and executive director of the Center for Personal & Professional Renewal and clinical professor of radiology, emeritus at Stanford University School of Medicine in Stanford, Calif., led workshops focused on burnout and avoidance at RSNA in 2011 and 2012. He played to a sold-out house of radiologists from around the world, illustrating the international scope of the problem and a stark contrast to the mid-1990s, when Moskowitz first started researching physician burnout. At that time, research on burnout was nearly nonexistent.

Today, more radiologists are succumbing to the physicians’ plague with potentially dire effects on patients and practice. Error and malpractice rates are suspected to be higher for burned out physicians, says Richard B. Gunderman, MD, PhD, vice chairman of radiology at Indiana University School of Medicine in Indianapolis. The current epidemic of medical errors in the U.S. is connected to the epidemic of physician burnout, adds Moskowitz. Turnover is likely higher among burned out physicians, and a toxic doctor can infect an entire practice. On the plus side, researchers are diving into the problem and leaders are acknowledging its existence, which mitigates some of the stigma associated with burnout.

The cure for burnout may be as complex as its causes and consists of an array of fixes from reading room design to technology to mentoring and therapy.

Diagnosis: Burnout

Burnout, explains Moskowitz, is a syndrome characterized by somatic, psychological and interpersonal symptoms. Radiologists in the early stages of burnout may report exhaustion, insomnia, fatigue, headaches, gastrointestinal disturbances and shortness of breath. If not addressed, the symptoms can progress to anxiety, depression, irritability, negative thinking, cynicism, and social withdrawal. “All of this often leads to pervasive anger and irritability that keeps others off balance,” says Moskowitz.

The radiology reading rooms at Rhode Island Hospital in Providence, R.I., have been redesigned as open spaces to facilitate interaction and communication among radiologists, which reduces the sense of isolation that can spark burnout.

Compounding the problem is physicians’ reluctance to admit vulnerability and ask for help. Thus, physicians often present in advanced stages of burnout and on the verge of emotional and physical bankruptcy, says Moskowitz.

Burnout can be an individual problem or departmental disease. At Rhode Island Hospital in Providence, R.I., John Cronan, MD, chief of the department of diagnostic imaging, like many of his colleagues across the world, observed a change in the departmental disposition after PACS implementation.

The reading room, which had been a hub of activity and social interaction, had become dull and gloomy. Radiologists dreaded the isolation and lack of connection. 

In fact, the Brown reading room of yesteryear could have been the reading room at just about any radiology department in the world. While many departments have invested in ergonomic chairs and other tools to minimize stress on the body, few have focused on de-stressing the mind, observes Allison Tillack, MA, a student in the MD/PhD program at the University of California-San Francisco. Cubicles and sound barriers are the norm and effectively increase isolation.

The PACS problem

Cronan characterizes the advent of PACS as a double-edged sword. PACS enabled radiologists to become hyper-efficient reading machines. But they paid a price. At Brown, Cronan estimates radiologists’ reading room interactions with physicians dropped from 500 to 600 per day in the early 1980s to a mere trickle by the mid-‘90s.

“It takes a toll on physicians if they don’t see the people who depend on them, whose lives they impact—referring physicians, patients. You can begin to wonder if your work is having the kind of impact you hoped it would,” explains Gunderman. That also can negatively impact referrals.

Radiologists are not immune to the drivers that increase all physicians’ risk for burnout. These include changing reimbursement models, which likely mean continued downward