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.

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.

"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.

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

OBJECTIVE: The objective of this study is to determine the major stressors affecting practicing breast radiologists. METHODS: All members of the Society of Breast Imaging within the United States received an email invitation to complete an anonymous survey evaluating stressors that may contribute to physician burnout. Stressors evaluated included pace at work, work-life balance, care of dependents, job security, financial strain, decreasing reimbursement, new regulations, delivering bad news, fear of getting sued, and dealing with difficult patients, radiologists, and administrators. RESULTS: The overall response rate was 13.5% (312/2308). For those who opened the email, response rate was 24.6% (312/1269). The most prevalent stressors reported were working too fast (222/312, 71.2%), balancing demands of work with personal life (209/312, 70.0%), fear of getting sued (164/312, 52.6%), and dealing with difficult administrators (156/312, 50%). Prevalence of stress related to new regulation requirements, job security, financial strain, decreased reimbursement, dependent care, call, delivering bad news, and dealing with difficult patients, difficult referrers, and difficult radiologists were present in fewer than 50% of respondents. CONCLUSION: The most prevalent sources of stress in breast imaging radiologists relate to working too fast and balancing demands of work with time needed for personal life.

Utility of Supplemental Training to Improve Radiologist Performance in Breast Cancer Screening: A Literature Review.

PURPOSE: The authors evaluate whether supplemental training for radiologists improves their breast screening performance and how this is measured. METHODS: A systematic search was conducted in PubMed on August 3, 2017. Articles were included if they described supplemental training for radiologists reading mammograms to improve their breast screening performance and at least one outcome measure was reported. Study quality was assessed using the Medical Education Research Study Quality Instrument. RESULTS: Of 2,199 identified articles, 18 were included, of which 17 showed improvement on at least one of the outcome measures, for at least one training activity or subgroup. Two measurement approaches were found. For the first approach, measuring performance on test sets, sensitivity, and specificity were the most reported outcomes (8 of 11 studies). Recall rate is the most reported outcome (6 of 7 studies) for the second approach, which measures performance in actual screening practice. The studies were mainly of moderate quality (Medical Education Research Study Quality Instrument score 11.7 ± 1.7), caused by small sample sizes and the lack of a control group. CONCLUSIONS: Supplemental training helps radiologists improve their screening performance, despite the mainly moderate quality of the studies. There is a need for better designed studies. Future studies should focus on performance in actual screening practice and should look for methods to isolate the training effect. If test sets are used, focus should be on knowledge about correlation between performance on test sets and actual screening practice.

Influences of Radiology Trainees on Screening Mammography Interpretation.

PURPOSE: Participation of radiology trainees in screening mammographic interpretation is a critical component of radiology residency and fellowship training. The aim of this study was to investigate and quantify the effects of trainee involvement on screening mammographic interpretation and diagnostic outcomes. METHODS: Screening mammograms interpreted at an academic medical center by six dedicated breast imagers over a three-year period were identified, with cases interpreted by an attending radiologist alone or in conjunction with a trainee. Trainees included radiology residents, breast imaging fellows, and fellows from other radiology subspecialties during breast imaging rotations. Trainee participation, patient variables, results of diagnostic evaluations, and pathology were recorded. RESULTS: A total of 47,914 mammograms from 34,867 patients were included, with an overall recall rate for attending radiologists reading alone of 14.7% compared with 18.0% when involving a trainee (P < .0001). Overall cancer detection rate for attending radiologists reading alone was 5.7 per 1,000 compared with 5.2 per 1,000 when reading with a trainee (P = .517). When reading with a trainee, dense breasts represented a greater portion of recalls (P = .0001), and more frequently, greater than one abnormality was described in the breast (P = .013). Detection of ductal carcinoma in situ versus invasive carcinoma or invasive cancer type was not significantly different. The mean size of cancers in patients recalled by attending radiologists alone was smaller, and nodal involvement was less frequent, though not statistically significantly. CONCLUSIONS: These results demonstrate a significant overall increase in recall rate when interpreting screening mammograms with radiology trainees, with no change in cancer detection rate. Radiology faculty members should be aware of this potentiality and mitigate tendencies toward greater false positives.