Among the concerns with which U.S. healthcare is presently reckoning, the phenomenon of physician burnout may or may not be one of the more overblown. Either way, recent survey research has shown growing numbers of doctors feel they’re essentially working in a chronic state of stress-induced exhaustion. Radiologists are no exception. What are the causes of and cures for burnout within medical imaging?

The matter came front and center for half a day at the American College of Radiology’s 2017 Radiology Leadership Institute (RLI) Summit, held Sept. 7 to 10 at Babson College in Wellesley, Mass.

One small-group breakout discussion involving 25 to 30 attendees began with the dispelling of two common fallacies misinforming some efforts to curb burnout. Session facilitator Cheri Canon, MD, stated that there can be no true separation of work life from home life—and that the widely pursued “work-life balance” is not, in fact, achievable.

“There’s never a balance,” said Canon, who works as radiology chair at the University of Alabama at Birmingham and serves on the RLI board. “You spend more time with people you work with than you do with your spouses or your children, so there is no balance. There is integration, and that’s what we strive for.”

Canon then invited participants to weigh in with ways to identify, head off or otherwise beat back burnout.

Unhelpful overreaction?

James Brink, MD, radiology chief at Massachusetts General Hospital and chair of the ACR’s board of chancellors, expressed skepticism over the high numbers of physicians self-reporting burnout. He said Mass General’s most recent internal physician survey, which uses the well-established Maslach burnout inventory, revealed the burnout-affected rate had risen to nearly 50 percent.

“The Maslach scale says that if you’re exhausted more than once a month or cynical more than once a week, you qualify as burned out,” Brink said. “But what job isn’t exhaustive at least once a month? Personally, I believe a little cynicism is a good thing. It’s a coping mechanism. So my question is, are we overdoing it on the burnout panic? To say that one of every two physicians is burned out seems a little extreme to me.”

One participant conceded the point while pointing to “harder statistics, things like suicide rates,” as evidence of how severe the problem can become. “I agree that the definition of burnout has expanded,” he said, “but I hope the expansion doesn’t jeopardize us really critically looking at this.”

This prompted Canon to take a quick poll: How many people in the room worked for an institution that suffered a physician suicide over the past couple of years? Five or six hands went up.

“So something is going on,” Canon said, adding that an earlier breakout group had about the same high ratio of suicide-touched attendees. “But is there some mass hysteria around it that is making it seem bigger than it is? If so, is that going to prevent us from doing something about it?”

Lunch as burnout barometer

Canon introduced a theme she would come back to repeatedly during the session: the sense of a loss of control that’s so common among burned-out physicians. She mentioned a radiologist whose group lets members take a half-hour lunch break—as long as they work an additional half hour at the end of the day.

“They’re shamed into not eating lunch,” Canon said. “That gets right to the theme of the loss of control.”

The good news is that, in this and similar scenarios, the key to effectively countering burnout is simple in concept, albeit sometimes difficult to practice: Devote a substantial portion of your weekly hours to work you’re genuinely passionate about.

“Let’s say your passion is helping treat men who have prostate cancer,” Canon said. “If you can do that for 20 percent of your time over the course of your work week, you will find it’s one of the best ways to mitigate against burnout.”

Canon pointed out that the literature has shown that 20 percent is, in fact, something of a cutoff point. Spend more time than that on your passion, and there’ll be no corresponding increase in your sense of work fulfillment or protection against burnout.

Brink added that the opposite of burnout is joy. “Many of the things we are talking about involve different ways to promote joy in the workplace,” he said. “But those ways are going to be different for different people, whether it be finding your passion in teaching or administration or certain disease conditions.”

Creative coping 101

Other suggestions raised by the group included setting realistic expectations for trainees and new hires, along with identifying and avoiding isolation—a state to which radiologists are particularly prone.

Jane Clayton, MD, an independent breast specialist who practices in Louisiana, said she’s made a good habit out of maintaining contact with fellow health workers. “When I get tired of being at my workstation, I’ll drop in on the nurse,” Clayton said. “If she looks busy, I say hello but just keep walking. It’s just a very simple way of changing your state of mind.”

Clayton also demonstrated several simple exercises that can be done standing right next to the radiology workstation. “If you’re stuck in a chair and your workflow is such that you are not even able to take a lunch break,” she said, “you can just stand there, exercise in place—and hope the surgeons don’t come in at that moment.”

Samir Parikh, MD, of Henry Ford Health in Michigan said he listens to music and watches comedic films. Presumably he meant at home and after work. “Very soft music really gives me a release,” he said. “Sometimes I watch Tom and Jerry. For me, that’s a great release. I also like Charlie Chaplin. He goes through a lot of problems. In many cases, what he is going through is a lot worse than what you are going through as a radiologist at work.”

Small steps, big gains

The levity was well-timed, but the potential seriousness of the concern at hand wasn’t lost on attendees.

William Thorwarth, Jr., MD, chief executive officer of the ACR, spoke about the need to build personal resilience. “How do you develop coping skills for those inevitable times when you are going to be stressed out?” he said. “I think there is no substitute for offering professional [wellness] assistance to the members of your practice. There are professionals out there who can guide groups.”

Thorwarth added that ACR recently availed itself of such services and found the program “hugely well received. It was not a major expense for the organization. We had a professional come in and present a number of proven ways” to better cope with stress on the job.

Canon underscored that the research has borne out that “even small changes have incremental improvements that are measurable in mitigating against burnout. Even though you may not solve the whole problem, any steps you take will make an improvement.”