What Causes the Most Stress in Breast Radiology Practice? A Survey of Members of the Society of Breast Imaging

Patient Communication Innovations in Breast Imaging

Effective patient communication is paramount in breast radiology, where standardized reporting and patient-centered care practices have long been established. This communication profoundly affects patient experience, well-being, and adherence to medical advice. Breast radiologists play a pivotal role in conveying diagnostic findings and addressing patient concerns, particularly in the context of cancer diagnoses. Technological advances in radiology reporting, patient access to electronic medical records, and the demand for immediate information access have reshaped radiologists' communication practices. Innovative approaches, including image-rich reports, visual timelines, and video radiology reports, have been used in various institutions to enhance patient comprehension and engagement.

Practical Strategies to Retain Radiologists

Since the great resignation associated with the coronavirus disease 2019 pandemic, radiology practices are now challenged with maintaining adequate radiology staffing requirements to cope with increasing clinical workload requirements. The authors describe practical strategies for radiology practice leaders to retain radiologists in the current challenging job market, while mitigating their burnout.

Patient Characteristics Impact Performance of AI Algorithm in Interpreting Negative Screening Digital Breast Tomosynthesis Studies

Background Artificial intelligence (AI) is increasingly used to manage radiologists' workloads. The impact of patient characteristics on AI performance has not been well studied. Purpose To understand the impact of patient characteristics (race and ethnicity, age, and breast density) on the performance of an AI algorithm interpreting negative screening digital breast tomosynthesis (DBT) examinations. Materials and Methods This retrospective cohort study identified negative screening DBT examinations from an academic institution from January 1, 2016, to December 31, 2019. All examinations had 2 years of follow-up without a diagnosis of atypia or breast malignancy and were therefore considered true negatives. A subset of unique patients was randomly selected to provide a broad distribution of race and ethnicity. DBT studies in this final cohort were interpreted by a U.S. Food and Drug Administration-approved AI algorithm, which generated case scores (malignancy certainty) and risk scores (1-year subsequent malignancy risk) for each mammogram. Positive examinations were classified based on vendor-provided thresholds for both scores. Multivariable logistic regression was used to understand relationships between the scores and patient characteristics. Results A total of 4855 patients (median age, 54 years [IQR, 46-63 years]) were included: 27% (1316 of 4855) White, 26% (1261 of 4855) Black, 28% (1351 of 4855) Asian, and 19% (927 of 4855) Hispanic patients. False-positive case scores were significantly more likely in Black patients (odds ratio [OR] = 1.5 [95% CI: 1.2, 1.8]) and less likely in Asian patients (OR = 0.7 [95% CI: 0.5, 0.9]) compared with White patients, and more likely in older patients (71-80 years; OR = 1.9 [95% CI: 1.5, 2.5]) and less likely in younger patients (41-50 years; OR = 0.6 [95% CI: 0.5, 0.7]) compared with patients aged 51-60 years. False-positive risk scores were more likely in Black patients (OR = 1.5 [95% CI: 1.0, 2.0]), patients aged 61-70 years (OR = 3.5 [95% CI: 2.4, 5.1]), and patients with extremely dense breasts (OR = 2.8 [95% CI: 1.3, 5.8]) compared with White patients, patients aged 51-60 years, and patients with fatty density breasts, respectively. Conclusion Patient characteristics influenced the case and risk scores of a Food and Drug Administration-approved AI algorithm analyzing negative screening DBT examinations. © RSNA, 2024.

Factors Contributing to Disproportionate Burnout in Women Breast Imaging Radiologists: A Review

Physician burnout continues to increase in prevalence and disproportionately affects women physicians. Breast imaging is a woman-dominated subspeciality, and therefore, worsening burnout among women physicians may have significant repercussions on the future of the breast imaging profession. Systemic and organizational factors have been shown to be the greatest contributors to burnout beyond individual factors. Based on the Mayo Model, we review the evidence regarding the 7 major organizational contributors to physician burnout and their potential disproportionate impacts on women breast radiologists. The major organizational factors discussed are work-life integration, control and flexibility, workload and job demands, efficiency and resources, finding meaning in work, social support and community at work, and organizational culture and values. We also propose potential strategies for institutions and practices to mitigate burnout in women breast imaging radiologists. Many of these strategies could also benefit men breast imaging radiologists, who are at risk for burnout as well.

Physician Work-Personal Intersection: A Scoping Review of Terms, Definitions, and Measures

PURPOSE

A substantial body of evidence describes the multidimensional relationship between the intersection of physicians' work and personal lives and health care quality and costs, workforce sustainability, and workplace safety culture. However, there is no clear consensus on the terms, definitions, or measures used in physician work-personal intersection (WPI) research. In this scoping review, the authors aimed to describe the terms and definitions used by researchers to describe physician WPI, summarize the measurement tools used, and formulate a conceptual model of WPI that can inform future research.

METHOD

The authors searched PubMed, CINAHL, Scopus, and Web of Science for studies that investigated U.S. practicing physicians' WPI and measured WPI as an outcome from January 1990 to March 2022. The authors applied thematic analysis to all WPI terms, definitions, and survey questions or prompts in the included studies to create a conceptual model of physician WPI.

RESULTS

Ultimately, 102 studies were included in the final analysis. The most commonly used WPI terms were work-life balance, work-life integration, and work-home or work-life conflict(s). There was no consistency in the definition of any terms across studies. There was heterogeneity in the way WPI was measured, and only 8 (7.8%) studies used a validated measurement tool. The authors identified 6 key driver domains of WPI: work and personal demands; colleague and institutional support and resources; personal identity, roles, health, and values; work schedule and flexibility; partner and family support; and personal and professional strategies.

CONCLUSIONS

The authors found significant variability in the terms, definitions, and measures used to study physician WPI. They offer a conceptual model of the WPI construct that can be used to more consistently study physician WPI in the future. Future work should further investigate the validity of this model and generate consensus around WPI terms, definitions, and measures.

Should I Stay, or Should I Go? Early Phase Instrument Development of Workforce Movement-A Pilot Study with Breast Radiologists

OBJECTIVE

The goal of this study was to develop a psychometrically valid survey on workplace satisfaction and examine predictors of workforce movement among breast radiologists.

METHODS

Actively practicing members of the Society of Breast Imaging were invited to complete a survey on workplace satisfaction. Radiologists also indicated whether they had recently left their practice or were thinking of leaving their practice.

RESULTS

In total, 228 breast radiologists provided valid responses (8.7% response rate); 45% were thinking of leaving or had left their practice. Factor analysis yielded five factors, and discriminant function analysis found six main aspects associated with workforce movement in breast radiologists: (1) not enough work-life balance; (2) salary too low; (3) not feeling valued; (4) wanting a different challenge and/or more growth opportunity; (5) safety concerns; and (6) not feeling respected by physician leadership.

CONCLUSIONS

Pending further validation in larger and different cohorts, the survey created here can be administered by radiology practices to predict when breast radiologists are vulnerable to quitting. Atlhough this measure was designed for breast radiologists specifically, it could be adapted for other subspecialties.

A pre-post study of stressors and burnout affecting breast radiologists before and during the COVID-19 pandemic

Rationale and objective

To compare burnout and stressors of breast radiologists prior to and during the COVID-19 pandemic.

Materials and methods

Members of the Society of Breast Imaging were emailed an IRB-approved survey in January 2021 during the COVID-19 pandemic. Survey included questions from the Maslach Burnout Inventory and specific stressors including work pace, work-life balance, care of dependents, and financial strain. Data were compared to previous surveys prior to the pandemic.

Results

The response rate was 25% (261/1061) for those who opened the email. Of the respondents, 74% (194/261) were female, 82% (214/261) were white, 73% (191/261) were full time, 71% (185/261) were fellowship trained, 41% (106/261) had more than 20 years of experience, and 30% (79/261) were in academic practice.Respondents in 2021 reported frequent levels of depersonalization (2.2) and emotional exhaustion (3.4) while reporting frequent levels of personal accomplishment (5.3), a protective factor. These values were nearly identical before the pandemic in 2020: (2.2, 3.5, 5.3, respectively, p = .9). Respondents rated practicing faster than they would like as the highest stressor; however, 5 of the 6 stressors improved after the pandemic onset (p < .05). Conversely, participants perceived these stresses had gotten slightly worse since the pandemic (p < .01). Almost 50% of respondents reported they were considering leaving their practice; the most common reason was work/life balance.

Conclusion

Burnout in breast radiologists remains frequent but unchanged during the COVID-19 pandemic. While participants perceived that some stressors were worse during the pandemic, there was slight improvement in most stressors between the pre-pandemic and pandemic cohorts.

How breast radiologists can deal with the disruptive technologist

Physician burnout continues to be a challenge in addressing radiologist wellness. The stressors contributing to breast radiologist burnout are distinctive due to the unique work environments of a breast center. The intimate nature of a subspecialized team of radiologist(s) and technologists at an imaging center may result in interpersonal challenges such as a disruptive technologist. It is important to address the stressors to mitigate the increasing burnout affecting breast radiologists. This article raises awareness among radiologists and administrators and provides strategies to breast centers and breast radiologists for guidance on dealing with a disruptive technologist.

Leveraging Society Membership for Career Development

A breast radiologist who is early in their career will be faced with many opportunities that can be both challenging and rewarding. It is helpful to be aware of the resources available in the breast imaging field. Specialty society membership provides opportunities for personal and professional growth. Connections and relationships can be made with other breast radiologists at differing career stages, presenting opportunities to develop mentor-mentee relationships with experienced members and peer-to-peer relationships with colleagues who may have similar professional experiences. The resources available through society membership can assist in career development and help navigate academic and private practice settings.

Mammography Information Systems: A Survey of Breast Imaging Radiologist Satisfaction and Perspectives

OBJECTIVE

To assess use of mammography information systems (MISs) and explore features associated with breast imaging radiologist satisfaction.

METHODS

A 22-question survey regarding MISs was distributed electronically to the Society of Breast Imaging membership between February 16, 2022 and June 28, 2022. Differences in responses between respondents satisfied and dissatisfied with their MIS were analyzed using Pearson chi-squared test, Fisher exact test, and multivariate logistic regression.

RESULTS

The response rate was 11.4% (228/2007). Most respondents used a commercial MIS (195/228, 85.5%). Most used were Epic (47/228, 21%), MagView (47/228, 21%), and PenRad (37/228, 16%). Only 4.4% (10/228) reported that patient tracking was not integrated with results reporting. The majority (129/226, 57%) reported satisfaction with their MIS. Satisfaction correlated (P < 0.05) with features such as picture archiving and communication system integration, structured reporting, access to physician outcomes metrics, and ability to query data. Less commonly reported features such as non-English language options and recognition of laterality and patient mismatch errors also correlated with satisfaction. Lack of these features correlated with dissatisfaction (P < 0.05). Satisfaction also correlated with adequate training (P < 0.001) and technology support (P < 0.001). On multivariate analysis, longer time using the current MIS was independently associated with satisfaction.

CONCLUSION

Most respondents used a commercial MIS and were satisfied with their system. Satisfied users reported several helpful MIS features and adequate training and support. The survey results could help MIS companies when designing new products and inform radiologists and administrators when considering a new MIS.

Burnout Among Breast Radiologists: How Can We Restore Fulfillment?

Physician burnout is increasing in prevalence and has negative implications for the quality of patient care and the health and wellbeing of physicians. Surveys before the COVID-19 pandemic showed high rates of burnout among breast radiologists, and the COVID-19 pandemic has further increased stress. This article summarizes strategies to combat burnout, including improving individual resilience by increasing mindfulness about handling stress, making goals, and noting personal accomplishments. However, more effective change is likely to occur when there is change at both a personal and an organizational level, which includes identifying the stakeholders in a workplace and determining what changes must occur to increase joy and decrease rates of burnout. Despite the increasing rates of burnout, breast radiologists report high rates of personal career satisfaction. Self-reflection and positive steps to increase joy at work are important in maintaining career fulfillment in these challenging times.

Prevalence of Burnout of Radiologists in Private Practice

PURPOSE

The aim of this study was to evaluate the prevalence and demographic factors associated with both burnout and fulfillment of private practice radiologists within the largest coalition of independent wholly physician-owned diagnostic radiology practices within the United States.

METHODS

The study cohort included practicing radiologists within the largest coalition of wholly radiologist-owned, independently practicing diagnostic radiology groups within the United States. Practicing radiologists within all 31 radiology private practices within the organization were electronically mailed a web link to a confidential institutional review board-approved survey in August and September 2021. The survey included validated questions from the Stanford Professional Fulfillment Index, individual and practice demographics, and self-care. Radiologists were classified as being burned out and professionally fulfilled on the basis of established cutoffs from the Professional Fulfillment Index.

RESULTS

The overall response rate was 20.6% (254 of 1,235). The overall rate of radiologist burnout was 46% (Cronbach's α = 0.92), and professional fulfillment was 26.7% (Cronbach's α = 0.91). The inverse association between professional fulfillment and burnout was highly significant (r = -0.66, P < .0001) on the basis of average scores. Radiologists who took call (evenings, overnight, and weekends) were statistically most likely to be burned out. Older radiologists were less likely to experience burnout. Factors statistically significantly associated with professional fulfillment were eating nutritious meals and exercising at least four times per week. No statistically significant association was seen between either burnout or fulfillment with gender, ethnicity, practice geography, or practice size.

CONCLUSIONS

In the largest coalition of independent wholly physician-owned diagnostic radiology practices across the United States, about one-half of radiologists were burned out, and just over one-quarter were professionally fulfilled. Taking call was significantly associated with radiologist burnout. Self-care habits were associated with professional fulfillment.

Work-Life Experience of Academic Radiologists: Food for Thought

RATIONALE AND OBJECTIVES

Work-life experience of physicians is a driver of work engagement vs. burnout. We aimed to determine individual and institutional factors affecting work-life experience of the clinical faculty at a large tertiary care academic medical center.

MATERIALS AND METHODS

The Department of Radiology clinical faculty (n = 62) were surveyed electronically in October 2022. Twenty-three questions, consisting of multiple choice, Yes/No, and Likert scale ratings were administered to obtain demographic information and data for life outside of work, life at work, and work-life integration for the prior 12 months. Work engagements in terms of clinical, research, administrative, and education; work practices including engagement in extra work and remote work; life responsibilities; and utilization of work-life balance strategies were analyzed for percentages and differences in seniority levels and genders. Ratings of faculty work engagement and life integration strategies were assessed utilizing a 1-5 Likert scale. Descriptive statistics were utilized to report mean, standard deviation, median, Q1 and Q3 for continuous measurements, while count and percentage for categories measurements. Comparisons between seniority and gender categories were conducted using independent t-test or Wilcoxon rank sum test depending on data normality assessed through histogram analysis. Chi-square test was used to make comparisons for categorical data. When encountered with small cell (category with <5 count), Fisher's exact test was used for 2 × 2 table analysis and Freeman-Halton test was used for comparisons with more than two categories. SAS 9.4 was used for the data analysis.

RESULTS

Twenty-eight faculty (M:F = 17:11) responded to the survey (survey response rate 45%). The vast majority of faculty reported working extra hours, with 40% working at least 10 hours extra per week. Total of 42.9% reported performing clinical work in the extra hours worked. Total 70.4% of faculty had caregiver responsibilities and 64.3% reported other individual stresses (e.g., financial, family/social, health-related), which required consistent demand of time and effort. A total of 35.7% of faculty reported not being able to balance competing life and work demands. A total of 21.4% respondents reported not utilizing any individual healthy lifestyle choices on a consistent basis over the prior 12 months. Protected time off work and remote work were perceived as effective strategies to provide adequate work-life balance; however, remote work engagement was relatively minor and 35.7% bought back vacation. Total 53.6% respondents reported a level 4 (out of 5) rating for work being meaningful and being positively engaged in their work.

CONCLUSION

Institutions should invest in providing the infrastructure for physician work-life balance and in facilitating healthy lifestyle choices for physicians.

Coaching: A Strategy for Breast Radiologists' Professional Development

The continually increasing demands placed on physicians have led to high levels of burnout, and breast radiologists are no exception. Professional coaching is a means to guide and support the radiologist through a process of positive thinking, stress reduction, goal setting, mental growth, work-life balance, and behavioral change. Professional coaching may be effective in preparation for leadership roles or in response to workplace issues or conflict. The radiologist, with the help of a coach, establishes goals, expands perception and mindset, and collaboratively may find ways to resolve issues by taking new and different approaches. This article discusses why radiologists should seek out a certified coach and what a coach can offer radiologists during these trying times, as well as outlining the coaching process. Coaching has proven useful in addressing professional growth, workplace issues, and physician burnout. At the conclusion of the article, the readers will be able to discern whether coaching can support a better quality of life for them.

Patient-centered Care and Integrated Practice Units: Embracing the Breast Care Continuum

Patient-centered care is a health care approach optimized for the needs of the patient. As patients have sought more autonomy in recent years, this model has been more frequently adopted. Breast radiologists aspiring to advance patient-centered care should seek greater ownership of the breast diagnostic imaging and intervention workflows, helping their patients navigate the complex breast care landscape with patients' preferences taken into account. Applying this approach to breast radiology will increase patient satisfaction and compliance while also limiting wasted health care dollars, unnecessary diagnostic delays, and overall confusion. Herein, the benefits of patient-centered breast radiology are discussed, and numerous suggestions and case examples are provided to help readers reshape their practice toward the priorities of their patients.

"Managing Up": Cultivating Relationships With Practice Leaders

"Managing up" for the radiologist means developing and cultivating work relationships to benefit high-level stakeholders and the institution at large, and to maximize one's own effectiveness. Today's breast radiologists are responsible for more than image interpretation and image-guided interventions. Radiologists' roles and responsibilities have evolved to include clinical initiatives, staff development, quality improvement, and administrative tasks where management skills are needed. To be successful in these roles, developing skills to manage up will allow radiologists to be more effective team members. In this article, we discuss tactics to start developing strategies for managing up, including how to understand practice leaders and create meaningful relationships; explain various work style personalities and how to navigate them; describe how to understand oneself, including strengths and weaknesses; and, finally, provide tips on how to begin to cultivate managing up skills.

Managing Challenging Patient Interactions in Breast Imaging

Managing challenging patient interactions can be a daily stressor for breast imaging radiologists, leading to burnout. This article offers communication and behavioral practices for radiologists that help reduce radiologists' stress during these encounters. Patient scenarios viewed as difficult can vary among radiologists. Radiologists' awareness of their own physical, mental, and emotional states, along with skillful communications, can be cultivated to navigate these interactions and enhance resiliency. Understanding underlying causes of patients' emotional reactions, denial, and anger helps foster empathy and compassion during discussions. When exposed to extremely disruptive, angry, or racially abusive patients, having pre-existing institutional policies to address these behaviors helps direct appropriate responses and guide subsequent actions. These extreme behaviors may catch breast imaging radiologists off guard yet have potentially significant consequences. Rehearsing scripted responses before encounters can help breast imaging radiologists maintain composure in the moment, responding in a calm, nonjudgmental manner, and most effectively contributing to service recovery. However, when challenging patient encounters do trigger difficult emotions in breast imaging radiologists, debriefing with colleagues afterwards and naming the emotion can help the radiologists process their feelings to regain focus for performing clinical duties.

Peer learning in breast imaging

With the increasing focus on quality and safety in medicine, radiology practices are increasingly transitioning from traditional score-based peer review to peer learning. Participation in a peer learning program can increase learning, practice improvement, and cultivation of interpersonal relationships in a non-punitive environment. As breast imaging errors are the most cited in medical malpractice cases, learning and attention to and reduction of these errors in breast imaging are especially important. We describe the strengths of a peer learning program, implementation process in a breast imaging program, challenges to overcome, and strategies to support success.

Relationship Building as a Strategy for Managing Referring Clinicians

The strength of a radiology practice depends on the strong relationships radiologists develop with referring clinicians. Solid relationships with referring clinicians can contribute to a satisfying work environment, and ultimately excellent patient care. There are several different ways that a radiologist can help improve relationships with clinicians. As a start, this includes a radiologist strengthening one's emotional intelligence. Also, identifying the personality traits of others is key to successful interactions. Conflicts in the workplace are inevitable, and effective negotiation is helpful in building relationships with clinicians. Interacting with the referring clinicians is also key to a successful relationship. This includes all in-person communication, participating in tumor boards, community outreach events, and social functions outside of work. This article presents several tips to improve and manage relationships with referring clinicians.