Current Problems in Diagnostic Radiology 44 (2015) 389–390
Current Problems in Diagnostic Radiology journal homepage: www.cpdrjournal.com
Burnout in Radiology Refky Nicola, DOa, Michael F. McNeeley, MDb, Puneet Bhargava, MDb,n a b
School of Medicine and Dentistry, University of Rochester Medical Center Rochester, NY Department of Radiology, University of Washington School of Medicine, Seattle, WA
Burnout is a psychological syndrome that arises in the setting of prolonged work-related stress. Although its speciﬁc manifestations are highly variable, the core features of burnout include emotional exhaustion, callousness or apathy towards patients or peers, and feelings of personal inadequacy. Burnout can have profound consequences for the affected physician, his or her patients, and the health care system at large. Increased rates of substance abuse, depression, and suicide have been linked to physician burnout, as have medical errors and lapses in patient safety. Disruptive workplace behaviors, such as presenteeism (which is reduced productivity due to physical or emotional dysfunction), absenteeism (which is nonparticipation in work), high employment turnover, and early retirement also have been linked to physician burnout and depression. In this article, we review causes, preventive measures and possible solutions for physician burnout. & 2015 Mosby, Inc. All rights reserved.
My dear, here we must run as fast as we can, just to stay in place. And if you wish to go anywhere, you must run twice as fast as that. —The Queen of Hearts, Alice in Wonderland by Lewis Carroll
How Does Physician Burnout Develop?
multitude of reasons, work can also be a source of considerable stress—physicians are certainly not immune to this stress. In a recent study by Shanafelt et al,14 physicians in general were found to be more likely to express symptoms of burnout than other professionals did, with 45.8% of all physicians reporting at least one symptom of burnout. Under certain circumstances, the aggregation of minor and major workplace stressors can cause signiﬁcant dysphoria, even in the absence of professional catastrophe. It is generally held that physician burnout develops through a complex interplay among oneʼs personality, work conditions, and professional relationships. The most commonly cited factors include an excessive workload; inadequate control over scheduling demands; challenges balancing personal and professional commitments; and a diminished sense of autonomy, purpose, and self-efﬁcacy.15-19 Perceived ﬁnancial scarcity and job insecurity may be contributory.20-22 Commitment to service is the hallmark of our trade. Empathy, equanimity, perfectionism, and indefatigability could be considered our cardinal virtues. Yet, a physician may be predisposed to burnout when his or her work conditions undermine these ideals. Although patient contact can be gratifying, excessive exposure can be exhausting. Long workdays and extensive after-hour responsibilities can disrupt work-life balance and social relationships. Moreover, an ascendant medical bureaucracy, coupled with seemingly inexorable drives toward commoditization, market consolidation, and cost containment, may challenge a physicianʼs sense of professional selfdetermination.
For most people, gainful employment is an essential basis for satisfaction, social status, and self-esteem. However, for a
Are Radiologists Immune to Burnout?
n Reprint requests: Puneet Bhargava, MD, Department of Radiology, University of Washington School of Medicine, 1959 NE Paciﬁc St, Seattle, WA 98195. E-mail address: [email protected]
Despite radiologyʼs branding as a “lifestyle specialty,” traditional assumptions about work-life satisfaction and burnout may not necessarily apply. For instance, emotionally exhausted medical
What is Burnout and Why Does it Matter? Burnout is a psychological syndrome that arises in the setting of prolonged work-related stress. Although its speciﬁc manifestations are highly variable, the core features of burnout include emotional exhaustion, callousness, or apathy toward patients or peers and feelings of personal inadequacy.1 These hallmark symptoms and their workplace origins help to distinguish burnout from other psychiatric conditions such as depression, fatigue, anxiety, and lack of motivation,2 although there may be signiﬁcant overlap. Burnout can have profound consequences for the affected physician, his or her patients, and the health care system at large. Increased rates of substance abuse, depression, and suicide have been linked to physician burnout,3-7 as have medical errors and lapses in patient safety.8,9 Disruptive workplace behaviors such as presenteeism (which is reduced productivity owing to physical or emotional dysfunction), absenteeism (which is nonparticipation in work), high employment turnover, and early retirement also have been linked to physician burnout and depression.10-13
http://dx.doi.org/10.1067/j.cpradiol.2015.04.007 0363-0188/& 2015 Mosby, Inc. All rights reserved.
R. Nicola et al. / Current Problems in Diagnostic Radiology 44 (2015) 389–390
students might self-select for a ﬁeld with relatively scarce patient contact. Similarly, the relatively isolated nature of a radiologistʼs work could exacerbate individual tendencies for social detachment. Conversely, radiologists have traditionally enjoyed above-average ﬁnancial compensation with a relatively favorable work-hour expectation. Regardless, it is clear that radiologists are not immune to burnout. Previous data5,14 have shown that radiologists report burnout more often than other medical specialists do. Radiology trainees20 have shown similar rates of burnout when compared with internal medicine residents.23
Hope for a Cure: Preventive Measures and Possible Solutions Although the complex interplay of workplace stressors likely affects each radiologist idiosyncratically, there appear to be a few broadly applicable remedies for burnout. Maintaining physical ﬁtness is a commonly cited means of staving off burnout. Although this may be challenging for radiologists, given the relatively sedentary nature of the job, certain technological and behavioral interventions could combat this tendency.24,25 There may be signiﬁcant psychological beneﬁt to maintaining prolonged and immersive focus on work that is meaningful and stimulating.26 A state of uninterrupted “ﬂow” may be difﬁcult to manifest in a busy reading room27,28; department leaders should strive to minimize external workﬂow disruptions, while radiologists should remain vigilant against unmuted cellphones, compulsive e-mail checking, and other self-inﬂicted distractions. Sood et al29 recently described a pilot program called the Stress Management and Resiliency Training (SMART) Program, in which 13 radiologists from the Mayo Clinic participated in a 12-week program comprising 90-minute small group sessions, emphasizing stress management and relaxation techniques. At the conclusion of the course, SMART Program enrollees reported lower levels of stress, anxiety, and quality of life when compared with nonparticipating colleagues. In her work Employment and unemployment: a socialepsychological analysis,30 social psychologist Marie Jahoda described several “latent beneﬁts” of gainful employment that include structured time commitments, routine workplace activity, an enhanced social network, a sense of purpose, and augmented social status. These have been shown to have a protective effect on emotional wellness.21,31 Radiology leaders—department chairpersons, practice group leaders, and program directors—are encouraged to leverage the “latent beneﬁts” of employment to promote team wellness. This includes ensuring that time commitments are structured and meaningful, encouraging social interactions among team members and their families, making sure that team members are treated as valued members of the department, and above all else, instilling in them a sense of purpose. Radiologists have to see beyond the worklist to truly feel their worth. Autonomy, mastery, and purpose are healthy intrinsic motivators.32-34 Although autonomy may be an increasingly scarce asset in radiology, there remains no shortage of opportunities for meaningful contribution or mastery of some facet of the ﬁeld. To some degree, the psychological challenges of becoming and being a radiologist are probably unavoidable. To be good at this job, one must work very hard for a very long period. For the individual, it is about embracing that challenge. For the team, it is about identifying and capitalizing on strategies to encourage wellness and success.
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