How Radiology Leaders Can Address Burnout.

The 2018 Annual Workforce Survey conducted by the ACR Commission on Human Resources demonstrated that, although the majority of radiology practice leaders acknowledge radiologist burnout as a significant problem, only about one in five leaders responded that their practices were either extremely or very effective at addressing physician burnout. Moving forward, leaders will be increasingly held accountable and expected to describe to their teams their reasons for not addressing burnout. In this article, common misperceptions that may contribute to radiology practice leaders not addressing burnout are described, followed by outlining practical skills that leaders should develop to effectively address burnout.

Initial Impact of COVID-19 on Radiology Practices: An ACR/RBMA Survey.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic affected radiology practices in many ways. The aim of this survey was to estimate declines in imaging volumes and financial impact across different practice settings during April 2020. METHODS: The survey, comprising 48 questions, was conducted among members of the ACR and the Radiology Business Management Association during May 2020. Survey questions focused on practice demographics, volumes, financials, personnel and staff adjustments, and anticipation of recovery. RESULTS: During April 2020, nearly all radiology practices reported substantial (56.4%-63.7%) declines in imaging volumes, with outpatient imaging volumes most severely affected. Mean gross charges declined by 50.1% to 54.8% and collections declined by 46.4% to 53.9%. Percentage reductions did not correlate with practice size. The majority of respondents believed that volumes would recover but not entirely (62%-88%) and anticipated a short-term recovery, with a surge likely in the short term due to postponement of elective imaging (52%-64%). About 16% of respondents reported that radiologists in their practices tested positive for COVID-19. More than half (52.3%) reported that availability of personal protective equipment had become an issue or was inadequate. A majority (62.3%) reported that their practices had existing remote reading or teleradiology capabilities in place before the pandemic, and 22.3% developed such capabilities in response to the pandemic. CONCLUSIONS: Radiology practices across different settings experienced substantial declines in imaging volumes and collections during the initial wave of the COVID-19 pandemic in April 2020. Most are actively engaged in both short- and long-term operational adjustments.

Characteristics of Radiologists' Clinical Practice Patterns by Career Stage.

PURPOSE: To assess characteristics of radiologists' clinical practice patterns by career stage. METHODS: Radiologists' 2016 billed services were extracted from the Medicare Physician and Other Supplier Public Use File. Billed clinical work was weighted using work relative value units. Medical school graduation years were obtained from Medicare Physician Compare. Practice patterns were summarized by decades after residency. RESULTS: Among 28,463 included radiologists, 32.7% were ≤10 years postresidency, 29.3% 11-20 years, 25.0% 21-30 years, 10.5% 31-40 years, 2.4% 41-50 years, 0.1% ≥51 years. Billed clinical work (normalized to a mean of 1.00 among all radiologists) ranged 0.92-1.07 from 1 to 40 years, decreasing to 0.64 for 41-50 years and 0.43 for ≥51 years. Computed tomography represented 34.7%-38.6% of billed clinical work from 1 to 30 years, decreasing slightly to 31.5% for 31-40 years. Magnetic resonance imaging represented 13.9%-14.3% from 1 to 30 years, decreasing slightly to 11.2% for 31-40 years. Ultrasonography represented 6.2%-11.6% across career stages. Nuclear medicine increased steadily from 1.7% for ≤10 years to 7.0% for 41-50 years. Mammography represented 9.9%-12.9% from 1 to 50 years. Radiography/fluoroscopy represented 15.1%-29.8% from 1 to 50 years, but 65.9% for ≥51 years. CONCLUSION: The national radiologist workforce declines abruptly by more than half approximately 30 years after residency. Radiologists still working at 31-40 years, however, contribute similar billed clinical work, both overall and across modalities, as earlier career radiologists. Strategies to retain later-career radiologists in the workforce could help the specialty meet growing clinical demands, mitigate burnout in earlier career colleagues, and expand robust patient access to both basic and advanced imaging services.

Radiology Practice Consolidation: Fewer but Bigger Groups Over Time.

PURPOSE: The aim of this study was to assess recent trends in US radiology practice consolidation. METHODS: Radiologist practice characteristics were obtained from the Medicare Physician Compare database for 2014 and 2018. Radiologists were classified on the basis of their largest identifiable practice affiliations. Single-specialty radiology practices were identified using practice names. Temporal trends in practice sizes were assessed. RESULTS: At the individual radiologist level from 2014 to 2018, the fraction of all radiologists in groups with 1 or 2 members declined from 3.2% to 2.1%, 3 to 9 members from 10.2% to 6.7%, 10 to 24 members from 18.2% to 14.1%, 25 to 49 members from 16.6% to 15.1%, and 50 to 99 members from 13.3% to 11.5%. In contrast, the fraction in groups with 100 to 499 members increased from 15.7% to 21.8% and with ≥500 members from 22.9% to 28.7%. At the practice level, the fraction of all radiologists' practices with 1 or 2 members decreased from 26.9% to 22.8%, whereas the fraction with 100 to 499 members increased from 7.6% to 10.2% and with ≥500 members from 2.5% to 4.1%. Similar shifts were present for single-specialty radiology practices and all geographic regions nationally. The 30,492 radiologists identified in 2014 were affiliated with 4,908 group practices, including 2,812 single-specialty practices. In comparison, the 32,096 radiologists identified in 2018 were affiliated with 4,193 group practices (a 14.6% decline), including 2,216 single-specialty practices (a 21.2% decline). CONCLUSIONS: In very recent years, the US radiologist workforce has consolidated, leading to increased practice sizes and a substantial decline in the number of distinct practices, disproportionately affecting single-specialty radiology practices. The impact of this consolidation on cost, quality, and patient access merits further attention.

Radiologist Burnout According to Surveyed Radiology Practice Leaders.

Overall, 55% of surveyed radiology practice leaders reported that burnout was a very significant problem, and 22% reported that burnout was a significant problem. Burnout did not vary by geographical region but did vary by practice size. Overall, 71% of respondents reported stress from workplace factors, and 36% reported stress from personal or social factors very significantly affected radiologist employee wellness; both sets of factors varied by geographical region, practice size, and practice type. Only 19% of practice leader respondents reported mechanisms to assess burnout, which varied by region and practice type.

2018 ACR Commission on Human Resources Workforce Survey.

PURPOSE: The ACR Commission on Human Resources conducts an annual workforce survey to determine the makeup of the radiology workforce and to identify potential plans for hiring new staff in an attempt to better understand our profession. METHODS: The Practice of Radiology Environment Database group leaders were asked to complete an electronic survey regarding the makeup of their present workforce by subspecialty as well as the numbers and types of subspecialists hired in 2017 and the numbers and types of subspecialists expected to be hired in 2018 and 2019. They were also asked about midlevel practitioner employment. RESULTS: Twenty-three percent of practice leaders (367) represente 10,179 radiologists, 30% of all practicing radiologists in the United States, responded to the survey. The number of radiology groups represented in this survey decreased from 1,811 in the 2017 survey to 1,588 groups in the 2018 survey. The current makeup of radiology workforce remains similar to 2016 and 2017. The workforce distribution by practice type and radiologists' ages has been relatively stable since 2012. Practice leaders report they plan to hire between 1,393 to 1,808 radiologists in 2018 (similar to 2017 reported hires between 1,434 to 1,861) with the greatest number of hires to be in breast imaging, neuroradiology, and interventional radiology. The study represented 549 midlevel practitioners and 693 medical physicists. CONCLUSION: The 2018 ACR workforce survey continues to show a positive picture and outlook for those seeking jobs as practicing radiologists in 2018.

A Road Map to Foster Wellness and Engagement in Our Workplace-A Report of the 2018 Summer Intersociety Meeting.

The 2018 radiology Intersociety Committee reviewed the current state of stress and burnout in our workplaces and identified approaches for fostering engagement, wellness, and job satisfaction. In addition to emphasizing the importance of personal wellness (the fourth aim of health care), the major focus of the meeting was to identify strategies and themes to mitigate the frequency, manifestations, and impact of stress. Strategies include reducing the stigma of burnout, minimizing isolation through community building and fostering connectivity, utilizing data and benchmarking to guide effectiveness of improvement efforts, resourcing and training "wellness" committees, acknowledging value contributions of team members, and improving efficiency in the workplace. Four themes were identified to prioritize organizational efforts: (1) collecting, analyzing, and benchmarking data; (2) developing effective leadership; (3) building high-functioning teams; and (4) amplifying our voice to increase our influence.

The Late-Career Radiologist: Options and Opportunities.

More than 25% of the present radiology workforce, or nearly 8300 radiologists, are actively practicing late-career radiologists. While these individuals could decide to retire from active practice, their continued presence in the workforce helps to maintain adequate and appropriate patient imaging services. To ensure their continued participation, issues important to all late-career radiologists need to be appreciated, discussed, and addressed. These issues include call-duty requirements, compensation, physical and cognitive health, and organized phase-out programs. The gamut of these issues is addressed in this review article. ©RSNA, 2018.

The Road to Wellness: Engagement Strategies to Help Radiologists Achieve Joy at Work.

Physician wellness is recognized as a critical component of enhancing the quality of health care. An epidemic of symptoms related to stress and burnout among medical professionals, including radiologists, in the workplace is threatening not only health care providers at a personal level but also the entire health care system. In this review, the authors highlight recognized stressors in the contemporary radiology workplace and offer practical suggestions for mitigating burnout, improving professional engagement, and promoting wellness. Thematic goals to focus on include fostering an integrated and harmonious community at work, diminishing workplace detractors, creating opportunities to cultivate positive attitudes and intellect, and implementing effective leadership practices. ©RSNA, 2018.

Comparison of Utilization of the Family and Medical Leave Act in Radiology Practices Between 2015 and 2016.

OBJECTIVE: The objective of our study was to assess utilization of the Family and Medical Leave Act (FMLA) in radiology practices in 2016 and compare with 2015 utilization. MATERIALS AND METHODS: The Practice of Radiology Environment Database was used to identify practice leaders, and these leaders were asked to complete the annual American College of Radiology Commission on Human Resources workforce survey. The 2017 survey, which asked about 2016 experiences, again included questions about the number of radiologists in each practice who took FMLA, reasons why, and how absences were covered. RESULTS: Twenty-six percent (477/1811) of practice leaders responded to the survey. Of these respondents, 73% (346/477) answered FMLA questions, and 23% (80/346) of those answered affirmatively that a radiologist in their practice had taken FMLA leave in 2016 (previously 15% in 2015; p = 0.15). The reasons for FMLA leave included taking care of a newborn or adopted child (57%, previously 49%; p = 0.26), personal serious health condition (35%, previously 42%; p = 0.31), caring for an immediate family member (8%, unchanged), and engaging in active military duty (< 1%, unchanged). Although more women (72%) than men (32%) took FMLA leave for the first reason (p < 0.01), more men (63%) than women (18%) took FMLA leave for the second (p < 0.01), and there was no significant difference between women (10%) and men (5%) taking leave to care for an immediate family member (p = 0.18). Most practices (80%) again made no workforce changes to cover absences due to FMLA leave (previously 82%). CONCLUSION: Utilization of FMLA leave in radiology practices in 2016 was similar to that in 2015 and represents the beginning of longitudinal accrual of data on this important topic for both male and female radiologists.

Musculoskeletal Injuries Affecting Radiologists According to the 2017 ACR Human Resources Commission Workforce Survey.

Practice leaders surveyed in the 2017 ACR Human Resources Commission workforce survey reported that 25% of the radiologists or radiation oncologists they supervised had neck pain, 32% had low back pain, and 16% were dealing with a repetitive stress injury. The prevalence rates of these musculoskeletal ailments among radiologists and radiation oncologists were consistent with those reported in the literature in other populations. However, these prevalence rates may be underestimated because practice leaders, not the radiologists themselves, were surveyed, and the leaders may not be aware of all injuries.

The 2017 ACR Commission on Human Resources Workforce Survey.

PURPOSE: The ACR Commission on Human Resources conducts an annual workforce survey to determine the makeup of the radiology workforce and to identify potential plans for hiring new staff in an attempt to understand our profession better. METHODS: The Practice of Radiology Environment Database group leaders were asked to complete an electronic survey regarding the makeup of their present workforce by subspecialty, as well as the numbers and types of subspecialists hired in 2016 and the numbers and types of subspecialists expected to be hired in 2017 and 2020. They were also asked about midlevel practitioners. RESULTS: Twenty-six percent of practice leaders (477) representing 11,056 radiologists, 33% of all practicing radiologists in the United States, responded to the survey. The workforce distribution by practice type and radiologists' ages has been relatively stable since 2012. Six percent of the practicing workforce is over the age of 65 years. Sixteen percent of radiologists work part-time, and 21.5% of radiologists are female. The survey results indicate that 1,569 to 2,037 radiologists were hired in 2016. In 2017, 1,826 to 2,370 new job opportunities are anticipated, a 14.1% increase compared with 2016. For 2017, the subspecialists most recruited will be neuroradiologists, general interventionalists, after-hours radiologists, and body imagers. Approximately 2,156 midlevel practitioners are presently working and supervised by radiologists. CONCLUSIONS: The 2017 ACR workforce study shows an optimistic picture and outlook for those seeking jobs as practicing radiologists in 2017. For practice leaders, the market will be much more competitive than it has been in past years.

Work-Related Injuries of Radiologists and Possible Ergonomic Solutions: Recommendations From the ACR Commission on Human Resources.

Increasingly, radiologists' workplaces revolve around PACS and digital imaging. Use of these technologies can lead to repetitive strain injuries, many of which can be exacerbated by specific features of a radiology practice environment. Ergonomic approaches, such as proper reading room structure, lighting, temperature, noise, and equipment setup, can help decrease the frequency and severity of repetitive strain injuries and improve radiologist productivity. However, ergonomic approaches are complex, include all aspects of the radiology practice environment, and are best implemented along with proper training of the practicing radiologists. The ergonomic approaches considered most important by members of the ACR Commission on Human Resources are presented in this report, and this information may serve as an aid in departmental planning.

Potential Radiation-Related Effects on Radiologists.

OBJECTIVE: The risk of injury associated with long-term occupational exposure to ionizing radiation is low for radiologists. The purpose of this article is to systematically review and inform radiologists about radiation-related effects to which they are potentially susceptible. CONCLUSION: Formal education and training on radiation safety and management, careful attention to good radiation protection habits, and continued emphasis on radiation management and the as low as reasonably achievable principle are recommended for all radiologists.