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Tembelis M, Patlas MN, Katz DS, Revzin MV. The Second Mountain: Climbing the Challenges of Midcareer Radiology. J Am Coll Radiol 2024; 21:827-835. [PMID: 37844656 DOI: 10.1016/j.jacr.2023.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/14/2023] [Accepted: 08/25/2023] [Indexed: 10/18/2023]
Abstract
A radiologist's career can be divided into the early, middle, and late phases. The midcareer phase is a particularly difficult period and has the highest rate of burnout among radiologists. Often throughout the early phase of a radiologist's career, during residency, fellowship, and while a junior faculty member, there is an abundance of support to help in personal and professional growth, but this support often wanes as radiologists gain seniority. Unfortunately, this often leaves midcareer radiologists feeling forgotten, or "invisible." This lack of support can lead to burnout, decreased job satisfaction, and premature departure from the workforce. The purpose of this review is to bring to light the challenges, such as higher rates of burnout and career stagnation, in addition to the lack of emphasis placed on midcareer mentorship, sponsorship, and career development programs, facing radiologists while climbing the "second mountain" of their career, as well as to provide potential individual and institutional interventions to combat these challenges. In addition, emphasis will be placed on the difficulties experienced by midcareer female radiologists, whose challenges are particularly problematic and to our knowledge have received little attention in the imaging literature to date.
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Affiliation(s)
- Miltiadis Tembelis
- Medical Student Liaison, Department of Radiology, New York University Langone-Long Island, Mineola, New York; and Executive Committee, Long Island Radiology Society.
| | - Michael N Patlas
- Professor and Chair, Department of Medical Imaging, University of Toronto, Ontario, Canada
| | - Douglas S Katz
- Professor of Radiology and Vice Chair for Research, Department of Radiology, New York University Langone-Long Island, Mineola, New York; and Co-Director, Emergency Radiology Course, ACR Education Center
| | - Margarita V Revzin
- Associate Professor of Diagnostic Radiology, Emergency Radiology Fellowship Program Director, and Educational Director Emergency Radiology, Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Chair, Economics Committee, Subcommittee on Ultrasound
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Making the Financial Case for Surgical Resident Well-being: A Scoping Review. Ann Surg 2023; 277:397-404. [PMID: 36124776 DOI: 10.1097/sla.0000000000005719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To conduct a scoping review of literature on financial implications of surgical resident well-being. BACKGROUND Surgeon well-being affects clinical outcomes, patient experience, and health care economics. However, our understanding of the relationship between surgical resident well-being and organizational finances is limited. METHODS Authors searched PubMed, Web of Science, and Embase with no date or language restrictions. Searches of the gray literature included hand references of articles selected for data extraction and reviewing conference abstracts from Embase. Two reviewers screened articles for eligibility based on title and abstract then reviewed eligible articles in their entirety. Data were extracted and analyzed using conventional content analysis. RESULTS Twenty-five articles were included, 5 (20%) published between 2003 and 2010, 12 (48%) between 2011 and 2018, and 8 (32%) between 2019 and 2021. One (4%) had an aim directly related to the research question, but financial implications were not considered from the institutional perspective. All others explored factors impacting well-being or workplace sequelae of well-being, but the economics of these elements were not the primary focus. Analysis of content surrounding financial considerations of resident well-being revealed 5 categories; however, no articles provided a comprehensive business case for investing in resident well-being from the institutional perspective. CONCLUSIONS Although the number of publications identified through the present scoping review is relatively small, the emergence of publications referencing economic issues associated with surgical resident well-being may suggest a growing recognition of this area's importance. This scoping review highlights a gap in the literature, which should be addressed to drive the system-level change needed to improve surgical resident well-being.
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Kim J, Kim J, Shen E, Yoon JD. Sustaining the Intrinsic Motivations of the "Good Physician": A Content Analysis of Medical Students' and Physicians' Responses from Two National Surveys. South Med J 2022; 115:727-733. [PMID: 36191907 DOI: 10.14423/smj.0000000000001450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Physician motivation has been described as the reason, purpose, and force that drives people to pursue their work, and motivating factors include those that are intrinsic or extrinsic to the work. Social forces may contribute to motivational disparities between medical school and actual practice. METHODS A secondary data analysis of two national surveys (medical students and practicing physicians from various specialties) was conducted. Content analysis was performed on open-ended survey items that elicited students' and physicians' responses to meaningful experiences in medicine. RESULTS In the medical student sample, four themes were identified as factors intrinsic to medicine: role models, clinical experiences, patient interactions, and peer interactions. In total, intrinsic factors comprised 86.5% (193/208) of coded responses. In the practicing physician sample, five themes were identified as factors intrinsic to medicine: difficult patient interactions, conflict with colleagues or staff, meaningful patient interactions, involvement in medical education-research-academia, and medicine as a calling/mission. In total, intrinsic factors comprised 24.0% (140/582) of coded responses. CONCLUSIONS Our findings suggest that the reality of social forces in medicine threatens the ability of practicing physicians to derive meaning from their work, although students and physicians still report intrinsic motivation from establishing meaningful relationships. Further research is needed to explore what strategies enable physicians to wisely navigate the dynamic interactions of intrinsic and extrinsic motivators over various stages of their careers. These strategies could include encouraging reflective spaces in physicians' workplaces that have a specific focus on sustaining intrinsic motivation in medicine.
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Affiliation(s)
- Jenny Kim
- From the University of Texas Southwestern at Dallas, Dallas, the College at the University of Chicago, Chicago, Illinois and the Department of Medicine, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
| | - Jae Kim
- From the University of Texas Southwestern at Dallas, Dallas, the College at the University of Chicago, Chicago, Illinois and the Department of Medicine, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
| | - Elizabeth Shen
- From the University of Texas Southwestern at Dallas, Dallas, the College at the University of Chicago, Chicago, Illinois and the Department of Medicine, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
| | - John D Yoon
- From the University of Texas Southwestern at Dallas, Dallas, the College at the University of Chicago, Chicago, Illinois and the Department of Medicine, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
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Greenberg AL, Tenzing N, Ghadimi TR, Tilahun MN, Berler MH, Lebares CC. Well-Being Intervention in General Surgery: Multicenter Study of Program Director and Resident Perspectives. J Am Coll Surg 2022; 235:217-224. [PMID: 35839396 DOI: 10.1097/xcs.0000000000000250] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Physician well-being is critical for optimal care, but rates of psychological distress among surgical trainees are rising. Although numerous efforts have been made, the perceived efficacy of well-being interventions is not well understood. STUDY DESIGN This qualitative thematic study included online questionnaires to Program Directors (PDs) and residents at 16 ACGME-accredited General Surgery residency programs. PDs reported active well-being interventions for surgical residents or those under consideration at their institutions. Residents shared perspectives of available well-being interventions through open-ended responses. Conventional content analysis was used to analyze responses. RESULTS Fifteen PDs, or their proxies (94% response rate), responded. Responses revealed that a majority of available well-being interventions are focused on changing the individual experience rather than the underlying workplace. PD decision-making around well-being interventions is often not based on objective data. Three hundred residents (34% response rate) responded. Of available interventions, those that increase control (eg advanced and flexible scheduling), increase support (eg mentorship), and decrease demand (eg work hour limits) were consistently identified as beneficial, but interventions perceived to increase demand (eg held during unprotected time) were consistently identified as not beneficial. Group social activities, cognitive skills training, and well-being committees were variably seen as beneficial (increasing support) or not (increasing demand). CONCLUSIONS Our findings underscore the prevalence of individual-based well-being interventions and the paucity of system-level changes. This may explain, in part, the persistence of distress among residents despite abundant effort, highlighting the imperative for system-level transformation.
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Affiliation(s)
- Anya L Greenberg
- From the UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
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Du M, Tak HJ, Yoon JD. Association of Intrinsic Motivating Factors and Joy in Practice: A National Physician Survey. South Med J 2021; 114:583-590. [PMID: 34480191 DOI: 10.14423/smj.0000000000001297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In response to the need to identify positive measures that more accurately describe physician wellness, this study seeks to assess the validity of a novel joy in practice measure using validated physician well-being measures and test its association with certain intrinsic and extrinsic motivators. METHODS Secondary data analysis using a nationally representative dataset of 2000 US physicians, fielded October-December 2011. Multivariable logistic models with survey design provided nationally representative individual-level estimates. Primary outcome variables included joy in practice (enthusiasm, fulfillment, and clinical stamina in an after-hours setting). Secondary outcomes were validated measures of physician well-being such as job and life satisfaction and life meaning. Primary explanatory variables were sense of calling, number of personally rewarding hours per day, long-term relationships with patients, and burnout. RESULTS The survey response rate was 64.5% (1289/2000). Physicians who demonstrated joy in practice were most likely to report high life satisfaction (odds ratio [OR] 2.75, 95% confidence interval [CI] 1.52-4.98) and high life meaning (OR 2.62, 95% CI 1.41-4.85). Joy in practice was strongly associated with having a sense of calling (OR 10.8, 95% CI 2.21-52.8) and ≥ 7.5 personally rewarding hours per day (OR 3.75, 95% CI 1.51-9.36); meanwhile, it was negatively associated with burnout (OR 0.26, 95% CI 0.14-0.51). Extrinsic factors such as specialty, practice setting, and annual income were not significantly associated with joy in practice in most regressions. CONCLUSIONS The joy in practice measure shows preliminary promise as a positive marker of well-being, highlighting the need for future interventions that support physicians' intrinsic motivators and foster joy in one's practice.
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Affiliation(s)
- Matthew Du
- From the Pritzker School of Medicine, University of Chicago, Chicago, Illinois, the Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, and the Department of Medicine, Section of Hospital Medicine, and MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago
| | - Hyo Jung Tak
- From the Pritzker School of Medicine, University of Chicago, Chicago, Illinois, the Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, and the Department of Medicine, Section of Hospital Medicine, and MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago
| | - John D Yoon
- From the Pritzker School of Medicine, University of Chicago, Chicago, Illinois, the Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, and the Department of Medicine, Section of Hospital Medicine, and MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago
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Santavicca S, Hughes DR, Fleishon HB, Lexa F, Rubin E, Rosenkrantz AB, Duszak R. Radiologist-Practice Separation: Recent Trends and Characteristics. J Am Coll Radiol 2021; 18:580-589. [PMID: 33197406 DOI: 10.1016/j.jacr.2020.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess recent trends and characteristics in radiologist-practice separation across the United States. METHODS Using the Medicare Physician Compare and Medicare Physician and Other Supplier Public Use File data sets, we linked all radiologists to associated group practices annually between 2014 and 2018 and assessed radiologist-practice separation over a variety of physician and group characteristics. Multivariate logistic regression modeling was used to estimate the likelihood of radiologist-practice separation. RESULTS Of 25,228 unique radiologists associated with 4,381 unique group practices, 41.1% separated from at least one group practice between 2014 and 2018, and annual separation rates increased 38.4% over time (13.8% from 2014 to 2015 to 19.2% from 2017 to 2018). Radiologist-practice separation rates ranged from 57.4% in Utah to 26.3% in Virginia. Separation rates were 42.8% for general radiologists versus 38.2% for subspecialty radiologists. Among subspecialists, separation rates ranged from 43.0% for breast imagers to 33.5% for cardiothoracic radiologists. Early career status (odds ratio [OR] = 1.286) and late (OR = 1.554) career status were both independent positive predictors of radiologist-practice separation (both P < .001). Larger practice size (OR = 0.795), radiology-only (versus multispecialty) group (OR = 0.468), academic (versus nonacademic) practice (OR = 0.709), and abdominal (OR = 0.820), musculoskeletal (OR = 0.659), and neuroradiology (OR = 0.895) subspecialization were independent negative predictors (all P < .05). CONCLUSIONS With over 40% of radiologists separating from at least one practice in recent years, the US radiologist workforce is highly and increasingly mobile. Because reasons for separation (eg, resignation, practice acquisition) cannot be assessed using administrative data, further attention is warranted given the manifold financial, operational, and patient care implications.
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Affiliation(s)
- Stefan Santavicca
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia.
| | - Danny R Hughes
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia; Professor, School of Economics and Director, Health Economics and Analytics Lab (HEAL) Georgia Institute of Technology, Atlanta, Georgia
| | - Howard B Fleishon
- Chair, ACR Board of Chancellors, American College of Radiology, Reston, Virginia; Associate Professor, Department of Radiology and Medical Imaging, Emory University, Atlanta, Georgia and Chief of Radiology Services, Emory Johns Creek Hospital, Johns Creek, Georgia
| | - Frank Lexa
- Professor and Vice Chair-Faculty Affairs, Department of Radiology, University of Pittsburgh and UPMC International. Chief Medical Officer, The Radiology Leadership Institute and Chair of the Commission on Leadership and Practice Development of the American College of Radiology
| | - Eric Rubin
- Director, CT Division, Southeast Radiology Limited, Ridley Park, Pennsylvania
| | - Andrew B Rosenkrantz
- Professor of Radiology and Urology, Director of Prostate Imaging, Director of Health Policy, and Section Chief of Abdominal Imaging, Department of Radiology, NYU Grossman School of Medicine, and NYU Langone Health, New York, New York
| | - Richard Duszak
- Professor and Vice Chair of Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, and Emory Healthcare, Atlanta, Georgia
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Choi KJ, Tak HJ, Dwyer R, Mousa P, Barreras N, Dawahir W, Christou T, Yoon JD. Moral Controversy and Working with Colleagues with a Shared Ethical/Moral Outlook: A National Survey of US Primary Care Physicians. South Med J 2019; 112:457-461. [PMID: 31375845 DOI: 10.14423/smj.0000000000001003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study assesses physicians' attitudes on the importance of working with colleagues who share the same ethical or moral outlook regarding morally controversial healthcare practices and examines the association of physicians' religious and spiritual characteristics with these attitudes. METHODS We conducted a secondary data analysis of a 2009 national survey that was administered to a stratified random sample of 1504 US primary care physicians (PCPs). In that dataset, physicians were asked: "For you personally, how important is it to work with colleagues who share your ethical/moral outlook regarding morally controversial health care practices?" We examined associations between physicians' religious/spiritual characteristics and their attitudes toward having a shared ethical/moral outlook with colleagues. RESULTS Among eligible respondents, the response rate was 63% (896/1427). Overall, 69% of PCPs indicated that working with colleagues who share their ethical/moral outlook regarding morally controversial healthcare practices was either very important (23%) or somewhat important (46%). Physicians who were more religious were more likely than nonreligious physicians to report that a shared ethical/moral outlook was somewhat/very important to them (P < 0.001 for all measures of religiosity, including religious affiliation, attendance at religious services, intrinsic religiosity, and importance of religion as well as spirituality). Physicians with a high sense of calling were more likely than those with a low sense of calling to report a high importance of having a shared ethical/moral outlook with colleagues regarding morally controversial healthcare practices (multivariate odds ratio 2.5, 95% confidence interval 1.5-4.1). CONCLUSIONS In this national study of PCPs, physicians who identified as religious, spiritual, or having a high sense of calling were found to place a stronger emphasis on the importance of shared ethical/moral outlook with work colleagues regarding morally controversial healthcare practices. Moral controversy in health care may pose a particular challenge for physicians with lower commitments to theological pluralism.
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Affiliation(s)
- Kwang Jin Choi
- From the Department of Medicine, University of Chicago, Chicago, Illinois, the Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, and Mercy Hospital & Medical Center, Chicago, Illinois
| | - Hyo Jung Tak
- From the Department of Medicine, University of Chicago, Chicago, Illinois, the Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, and Mercy Hospital & Medical Center, Chicago, Illinois
| | - Richard Dwyer
- From the Department of Medicine, University of Chicago, Chicago, Illinois, the Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, and Mercy Hospital & Medical Center, Chicago, Illinois
| | - Peter Mousa
- From the Department of Medicine, University of Chicago, Chicago, Illinois, the Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, and Mercy Hospital & Medical Center, Chicago, Illinois
| | - Nicholas Barreras
- From the Department of Medicine, University of Chicago, Chicago, Illinois, the Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, and Mercy Hospital & Medical Center, Chicago, Illinois
| | - Wafa Dawahir
- From the Department of Medicine, University of Chicago, Chicago, Illinois, the Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, and Mercy Hospital & Medical Center, Chicago, Illinois
| | - Theodore Christou
- From the Department of Medicine, University of Chicago, Chicago, Illinois, the Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, and Mercy Hospital & Medical Center, Chicago, Illinois
| | - John D Yoon
- From the Department of Medicine, University of Chicago, Chicago, Illinois, the Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, and Mercy Hospital & Medical Center, Chicago, Illinois
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