This is RSNA Session M8CNMPO Design, Curing Burnout, Optimizing Radiologist Well-Being through Local and National Approaches. I'm Jay Parikh, a professor from the University of Texas A&M Anderson Cancer Center, and I have the privilege of moderating this session. So let's make sure we're on the same page when we talk about burnout and move beyond the colloquial definitions about what burnout is. The World Health Organization has specifically recognized burnout as a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It emphasizes the occupational context. It is something that is work-related. Yes, you could have issues related to other things, physical issues, mental health issues, and so forth. But really, burnout is really specifically talking about occupational stress. The dimensions of burnout have been defined as well by previous work, specifically Dr. Maslach, who talks about the fact that there are three fundamental dimensions to burnout. First of all, there is the emotional exhaustion component, where our colleagues start to feel depleted of being able to carry out physical and emotional abilities for tasks. The depersonalization component, which talks about the cynicism and detachment we start to experience. And then reduced personal accomplishment, which makes us start to feel inadequate and ineffective in what we do. Now, as a mental health advocate, I want to make sure we take a moment to make sure we distinguish burnout versus depression, because I get asked that all the time. I think Dr. Rebecca Brendel, who is president of the American Psychiatric Association, had a good way of distinguishing the two. Because burnout is occupationally related, when you go on PTO and you take time off to do your own thing, you should be able to recover. If you're not able to recharge when you come back to work and you have the negativity beyond the workplace, that may be something that maybe needs to be looked at, something to think about. So in the literature, multiple studies were carried out that have shown, in multiple subspecialties, the actual prevalence of burnout. These are challenging studies to do and have been done now. And I want to point out that all six of these were done by independent collaborators of independent cohorts and submitted for independent review by peer-reviewed journals, meaning the higher standard of publication. And the range is anywhere from 50% to 80% in these theories. Now the actual discussion of burnout has transitioned to an international one. And I want to commend our colleagues in Germany who recently published this study, Dr. Bastian and colleagues, where they show that 76.7% of radiologists were identified to be burned out across Germany. The prevalence was significantly associated with increased workload, reduced sleep quality, suboptimal working conditions, reduced job satisfaction, and negative interplay between work, family, life, and health. And almost 42% of respondents noticed facing daily time pressures. Similarly, a study in JACR was published that looked at burnout across Korea. And what they found in this study, Dr. Koo and colleagues, was 71.6% in academic radiology and 56.3% in private practice reported having experiences of burnout with a highly significant difference. Again, some of the common themes of greater imaging workload, educational requirements, and administrative burdens contributed to Korean academic radiologists' dissatisfaction of burnout risk compared to private practice. So why do we even want to bring up burnout at this juncture? What does it matter? Well, there are significantly adverse outcomes which have been repeatedly associated with physician burnout. The first dimension is that related to what we are supposed to be doing mostly, which is taking care of our patients. Burnout has been shown in peer-reviewed literature repeatedly to be associated with lower quality care outcomes, medical errors, increased recovery times from procedures, and lower patient satisfaction scores. The second dimension is that of our health systems. There is lower productivity of health systems because of physician burnout, increased turnover not just of physicians but their teams, reduced access for patients with burnout, and increased costs. In terms of the physicians themselves, there are also health issues associated with physicians. Burnout has been linked now with substance abuse, depression, suicides, and poor self-care of physicians in multiple studies. But we've heard for now almost the better part of the decade in some of the studies that have been generated about the prevalence of burnout. And now we have more data about the associations of burnout with adverse outcomes. The real question and the point of this session is how do we shift the narrative now from moving from burnout to brilliance? And I wanted to bring this series of studies that were carried out by this very productive group at the Mayo Clinic, where they have done repeatedly the same analysis on four separate times. And I want to emphasize all four were carried out in the pre-COVID era, where they looked at the actual prevalence of burnout amongst all physicians and compared them to radiologists as a specialty. When we look at this consecutively, all four times radiology was higher than the rest of physicians at the mean. But also equally important is we can see that there is fluctuation of the actual prevalence of burnout over time. So it's not a stagnant fixed entity. It is something that can be changed. And so we're going to be looking at opportunities for us to be able to do that. And we are very blessed today to have an all-star panel to help actually help us understand things that we can do to try and use the strategies to address burnout and improve the burnout our physicians are experiencing. Our first speaker I'm delighted to introduce is Dr. Dorothy Sippo. Dr. Sippo is a board-certified radiologist with subspecialty training in breast imaging. She's an associate professor of radiology at Columbia University, Irving Medical Center, and an attending radiologist at New York Presbyterian Hospital. Dr. Sippo also serves simultaneously as vice chair of informatics for the department over radiology, overseeing the implementation of artificial intelligence tools into the department's clinical workflows. She has a particular focus on creating tools that help radiologists learn continuously from patient outcomes. She has applied informatics methods to develop and implement automatic feedback systems for breast imaging radiologists. Today, Dr. Sippo will present the topic Informatic Solutions to Improve Workflow and Help Radiologists Burnout. And on a personal note, Dr. Sippo, I really wanted to thank you on behalf of the RS&A Program Committee for pinch-hitting at the last minute for our initial speaker that was scheduled. Thank you so much. Thank you. Good afternoon. The content that I'm going to be presenting today was prepared by a friend and colleague, Dr. Stacey O'Connor, who unexpectedly cannot present, but she's the one who prepared the slides and supported me in this presentation today. So when we think about combating burnout, we're going to be looking at two broad topics, using informatics to improve efficiency and optimize workflow, as well as supporting meaning and purpose. We're going to start with workstation design and with how we get onto the workstation, being able to use single sign-on. We use multiple applications, and ideally, we should be putting a username and password in once. Similarly, contact sharing is very helpful between our various applications, so we're not having to pull up the patient repeatedly. And then we can think about the ergonomics of our workstations, starting with input devices, having backlit keyboards, ergonomic mice, and headsets. If we improve the environment, this can improve efficiency and a sense of well-being. Once we get into the packs, we can try to optimize display protocols and shortcuts. With display protocols, we're looking to reduce the time involved in organizing and linking series and make sure that comparisons can be readily found. Shortcuts are keystrokes and or mouse clicks or combinations thereof for frequently performed tasks such as window and leveling. And when these are optimized, the actual definitions of what are the shortcuts should be made clear to the radiologist. There can be signage or a little mouse pad with that information, so the radiologist can easily use this information. When used appropriately, shortcuts can reduce the amount of time spent mousing or clicking on keystrokes. When we think about these types of optimizations, they can be done at the site level, so everyone is sharing the same display protocols, or they can be personalized in specific use cases. Additionally, they can be general, sort of throughout the department, or specific. So for example, as a breast imager, my gaming mouse has shortcuts to specific tools such as toggling between 2D and 3D mammography that other radiologists wouldn't necessarily need. Digging in a little bit further to the mouse, radiologists prefer using gaming mice. They have more buttons than the conventional two or three buttons that can be mapped to a number of functions. Additionally, the keyboard can be mapped to macro-enabled buttons, or an additional input device or keypad can be used. Another level of efficiency can be gained with scripting or macros. So if it's a 10-step process with a conventional keyboard and mouse, you can add a gaming mouse or an additional input device and cut that to five clicks, but you can get it down to one with a script. So for example, AutoHotKey is relatively easy to learn, does not require administrative privileges, although you do need to be able to access a file on the workstation. So if it's too tightly locked down, that might be an issue. But you can sort of have these one-click commands. A common application here is in controlling the dictation software. Instead of pushing buttons on the dictaphone, it can all be on the keyboard or mouse, and this enables you to either have your dictaphone in your headset or on a stand. There's a lot of information we need to access, policies, protocols, phone numbers, the paging directory, common references. Sometimes the on-call schedule is in two different sites, and maybe a little microservice can pull them together. Creating an effective landing page so that a radiologist can quickly access this information is time-saving and stress-relieving. We communicate with a lot of people within our own teams, the reading room coordinator, technologist, nurse, as well as the referring providers. And this is an example of a chat tool where the patient context and the exam context is automatically pulled in, so you're not having to copy it in. Additionally, using a phone tree or a call center can help reduce interruptions. One study found a 35 percent reduction in interruptions with a voicemail and custom call redirection system being put in place. We can benefit from asynchronous communication tools. I'll frequently use the electronic health record to message the referring provider and then wait for a chat message back, as opposed to having to track them down on the telephone or have them interrupt me with a phone call. Protocoling can be quite time-consuming. It can take up a minimum of about 6 percent of radiologist's time. Standing orders or standing protocols take the exam type or a combination of the exam type and the indication and use that to determine that a radiologist doesn't have to look at that protocol. The protocol can automatically be protocoled using logic and sent to the technologist. And this can cut down, you know, how much the radiologist has to protocol. It can be applied to 34 percent of CTs or 24 percent of MRs in one instance with a very low error rate. When a technologist is taking a protocol that was done in an automated fashion, there needs to be close communication between the tech and the radiologist, because if they have a question, they need to be able to reach out quickly. Also, hyperspecific exam orders or order questions can be used so the referring provider gives all the information to automatically protocol that study. It's not just a CT of the abdomen and pelvis, but the pancreas protocol is specifically needed and the ordering provider indicates that with their ordering process. This just shows a tool to help facilitate communication between the tech and radiologist. The tech can flag a protocol that needs radiologist review. And if you actually go back and look at all of those flagged protocols, you can see, oh, maybe there's a break in our logic. Maybe we need to add logic so that the tech doesn't have to keep going back to the radiologist and ask a question. Once the radiologist gets to the point of protocoling, you can actually take the protocoling page and default in the most common selection. So instead of having to click every single time, the radiologist just has to adjust the default when appropriate. Also, make the relevant information readily visible to the radiologist. In those pertinent positives, the patient is pregnant, the patient is too young for particular contrast, have that up at the top or in the area where the radiologist is selecting that part of the protocol. We're going to shift to work list and basically case assignment optimization. So it's possible to prioritize reading order in a semi-automated way, looking at patient location, ordering priority, and next clinic appointment. When this is done, the number of urgent requests, calls from a referring provider saying, please read this first, reduces. Actually in this instance, reduced up to 60%. And this was because the turnaround time for those patients with an immediate appointment or a same-day appointment dropped with appropriate prioritization. So the radiologist wasn't being interrupted to prioritize that case. It was already prioritized by the system. We're going to shift to the reporting experience. So using the exam code and certain patient factors, the appropriate standardized structure template can be dropped into the dictation software automatically. The radiologist doesn't have to pick, this is the template I want. It knows it based on the exam code and some information about the patient. And that relevant information can automatically populate into the report so it doesn't have to be dictated. In some cases, a master template is needed. So for example, if it's a abdominal MRI, and in some cases you're going to report lyrads because special sequencing was done for the liver, and in others you don't need to do that, the template is generic enough that it can report any abdominal MR. But you can select the lyrads component if it's needed. So you have the master template that opens automatically, and then the radiologist selects some additional components as needed. Getting data into the report does not always have to be done by the radiologist. It can be automated by using structured messaging such as DICOM SR or HL7 messaging that brings information from the modality, from the technologist, or even AI results. This decreases errors in the radiologist having to dictate or kind of vocally transcribe as well as the time spent in those types of efforts. When the data isn't in a structured format, you can use sort of scraping tools that'll then pull that data in to the report. One exciting area is automatic impression generation. An early test of this where a large language model was applied to only the finding section found that it was 76% accurate, but with that there was an increase in up to 25% of radiologist throughput. When the AI had access to the findings as well as the exam type, when radiologists scored that generated impression, 92% of those impressions they rated as perfect and the remainder were acceptable. So there's a lot of potential here to reduce the time radiologists spend generating the impression and ensure that they don't miss a finding in that body of the report that should be included in the impression. We do have to be thoughtful about trainees in this workflow. They should be generating their own impressions earlier in their training and know how to judge whether an impression is high quality or not when it's generated automatically. Workflow optimization programs can also be created. One example was the get rid of stupid stuff or gross approach where they collected examples of things that could be optimized and then categorized whether or not to move forward. In the just do it category, an example was automatically being logged out of workstations that were in outpatient settings or home workstations and increasing the time to auto log out. Another initiative was the click buster initiative to reduce alert firings and associated clicks. That was geared toward the ordering provider, but by simplifying their process it led to less headaches for the radiologist downstream. Here's an example of reducing clicks for an advisory relating to a contrast allergy. Rather than just having a box pop up that says the patient has a contrast allergy, this can be optimized to give details of the allergy, make it easy for the order to be canceled or make it easy for the referring provider to order the premedication that's necessary. This prevents a phone call to radiology or prevents an incorrect order from being entered that then has to be addressed later by a radiologist. This is an example of it's required to identify where the study was interpreted for billing purposes and one institution had the radiologist dictating that into their report and then having that pulled from the report text. By working with IT and the interface team, it was possible to obtain this data in the background and have it sent to billing without the radiologist dictation being part of that workflow. So the new report stripped down and made it much simpler what the header had to be for the report and met the billing requirements. Finally, I'm going to talk a little bit about how radiologists can be fulfilled and engaged in education. So this is actually a project that I did previously providing automatic feedback to breast imagers. So for every screening mammogram they recalled when the patient came back for additional imaging or had a biopsy, it provided that outcome information back to the radiologist so that they could learn from it. Almost 70 percent of the available feedback was reviewed and putting this program in place was associated with improved performance in terms of screening mammography performance metrics like abnormal interpretation rate and positive predictive value. So there's really the potential for the radiologist to find out what happened to their patient and learn from it. And these types of tools, this is all informatics. It's data that exists already for patient care. But if we package it in a way that is consumable by the radiologist, it allows them to learn. This is another example. Similarly, it's a RADPATH correlation tool. This was for abdominal imaging. And it focused on discordant cases, so when the radiology report didn't match what the ultimate pathology was. Review of 234 cases showed that 70 percent of discordances would have been missed without this automated tool. Five percent required further radiologist action. Nearly 40 percent were noted to probably or definitely influence future interpretations. And more than half were added to a teaching file. So this reduces the burden of creating your teaching file. This automated system is flagging those cases that are of particular interest. When we engage with trainees, to give trainees feedback about a discordance between their initial preliminary report and the final report, sometimes a page like this is used. You go to a webpage and you enter the case and what was the key discrepancy. But this process can be automated using a large language model that looks at the two reports, flags the discrepancy, and actually also will grade the severity of it. So the burden comes off the radiologist to have to do this flagging. They can actually look at those more severe cases and pick a topic to discuss with the trainee. The trainee can focus on high-yield feedback and essentially reduces burden to both the attending and trainee in this process. So in conclusion, there are many opportunities for workflow optimization and also to tap into meaning and purpose using these types of informatics approaches. There have been a lot of examples, and I'd invite you to reflect about which of these tools might be best applied in your environment. Thank you. Thank you, Dr. Sipot. Our next speaker will be Dr. Frank Lexa. Dr. Lexa is an academic neuroradiologist at the University of Pittsburgh, where he is a professor and vice chair for faculty affairs. At Pitt, he also works in several capacities for UPMC International. Dr. Lexa has authored over 170 peer-reviewed papers and has given over 2,000 academic invited educational business and ground rounds lectures. He is currently the chief medical officer of the Radiology Leadership Institute at the ACR, as well as chair of the RLI board. He recently served in 2022 and 2023 as vice president of the American College of Radiology. Today, Dr. Lexa will present the topic, Leadership Approaches to Improve Radiologist Burnout. Dr. Lexa. All right. I want to thank Dr. Preek for inviting me to come and to speak to you today, and thank you to all of you for coming. I'm really honored to be part of this panel. And I've been given the job of sort of talking about something that people may want to start throwing things at me about, but that's okay. At my age, you've already had people throw things at me before, so we're going to be talking about why leaders and leadership are sometimes the cause of this, and that's the part that I hope gets your attention, but that they can also be part of the solution. But I even have some ideas about that that may be a bit controversial. But I would have to say that probably the biggest strategic challenge we face in the U.S. I know we have people from around the world here today, is our growing shortage of radiologists and the amount of work that is just skyrocketing around the world. I was just thinking that I first talked at RSNA 32 years ago, and at that time, a head CT in the U.S. was about 37 images. And today, I typically read 400 to 500 images for every head CT, and the government pays me half as much thank you for the same work. So that's kind of where we're going. So this is a very important strategic challenge that we're going to talk about and how we can do better in terms of building things that will help radiologists, as you just heard about, but also some things that I think have to be part of the solution as well. I want you to understand the impact of leadership on wellness and burnout in the workplace. Leaders can destroy radiologists or they can help them. Just that simple. I'll talk about some simple but stupid approaches versus more robust answers to the challenges. How to develop a strategy or strategies to address these issues that will otherwise challenge your physical and mental health. One of the advantages of living this long and working this long is that I've seen people make really good decisions and really bad decisions, and it's sad when somebody literally gets sick from their work. And as you just heard from Dr. Parikh, this is a very serious issue. Burnout is real, and it can hurt you, and in some cases, it can even kill you. So this is a very serious issue. If you're a burnout denier, you're probably not in the room. But it is real. Maybe there's another room where the people who think the world is flat, people who think that the U.S. Navy has trillion-watt lasers that can move hurricanes around or other nonsense like that. This is real. And if nothing else, think about what he said the next time you're at work, because your brother and sister radiologists are burning out, and you want to take care of each other just like we said we would take care of patients. I also am going to encourage you to build a personal plan, because I think it's too important to rely on leaders to do this for you. We'll talk about that a little bit, and also contributing to trying to improve the welfare of diagnostic radiology, as the people on this panel are doing. This is from the paper that Dr. Parikh referenced. This is from work I did with Jim Chen. He's a professor at UCSD, and we were doing the first study that anybody had done, a neuroradiologist in the States, and we were really looking at workflow and what we call work-work imbalance. You're reading so many cases that you don't have time to teach, you don't have time to mentor, you don't have time to do research or any of that other academic stuff that we're supposed to be doing. And I said, let's just throw some questions on, because I bet we're going to find out stuff that's so shocking they won't let us do another survey. So we put these in, and not surprisingly, we found that a lot of people are getting burned out. And more importantly, they're getting burned out rapidly. This is just a five-year observation period, and it was getting worse rapidly. The paper was successful. The ASNR did let us do another one. They've actually let us do a third one. But we were invited to submit this to the European Journal of Radiology, which we did, and they said, well, you have to make it global. And I said, I looked around and said, that's easy, because as you just heard from Dr. Parikh, this is a global problem. And in fact, I had to call them up and say, can you give us some more words? Because we don't have enough words to cover the globe. There are just too many places where people are reporting these problems. So this is my challenge to you. And I'll just read the highlighted part of this quote, because it's the people who think that they can change the world are the ones who do. And that's what I really, you are the people who can change this if you want to, and can contribute to building a better world. Anybody know whose quote this is? I heard it. I heard somebody whisper it. Yeah, it's Steve Jobs, not my favorite of the two Steves. The other one makes an appearance later in the talk. Now, if you ask the ACR, this is what they came up with. These are all nice things to do. They sound great. But as you all know, we are under more and more pressure to do more. We have places where you have to do involuntary extra call. You have to do involuntary reads of other things, because we're just running out of radiologists. And all these sound good. And please, you can look this up. It's a nice white paper. But certainly, the question is not, should we do these things? It's how do we do them? How do we get to this point? Now, there's some obvious answers, in my humble opinion, for what we need to do with burnout, which is read fewer cases per hour. There was an interesting convergence about a year ago where Max Wintermark, who many of you probably know his name, he's originally, I think, from Switzerland. And he works in Texas now. He put out an article in Neuroradiology talking about why we should keep it to four cases an hour if we're teaching in an academic place. And interestingly, that same year, the Japanese Association of Radiology said the same thing about body cases and neuro cases. It should be four cases an hour. If anybody in this room will pay me a decent wage to read four cases an hour with your trainees, I'm available, because there isn't a place in the US where I think this is possible. You want to work at the level of your training. And one of the things that was very cool about some of the tools we just saw is that it helps you to work at the level of your training, as opposed to me spending 20 minutes trying to find somebody who knows where they can find this patient with a subdural and help them. And that's really kind of below my level of training. At least somebody with less training can do that. And then to be really controversial, if you look at the aviation industry in the United States, when they instituted duty hours, limits on sleep deprivation, et cetera, there were no more accidental crashes of planes in the US. There were still some crashes, but those were done on purpose, and you know all about those. But there were no more accidental crashes for years. Taking breaks, avoiding isolation at work. I know there's some people who are on the spectrum in our profession who would rather be by themselves, but I think most of us do much better if we are part of a team, ideally in person or virtually now. And there's some really bad ideas, and not bad ideas, but kind of silly ideas. The first time I got interested in burnout, I went to the HR person at Penn and said, you know, some of the people are burning out. What should we do? And her answer was, well, instead of going out for lunch, you should come at noon to the green area in front of the hospital and do yoga with us. And I said, we haven't gone out to lunch in five years. It's not a possibility. But these are all good ideas, and the only thing I would say about this is if you're going to get a pet, don't get that one. She's actually mine. She has many great qualities, but she is not a stress reducer. So does leadership matter? So let's get to the heart of this. We assume that our leaders are going to fix these problems for us. I'm here to tell you that I hope that's true. If your leader has fixed this problem, I want to come to work for her or him. I'm not here to find a job, but I just want to be emphatic about this, because many places are not getting this right. It also depends on whether or not you have a leader or you have a manager. Sometimes people have titles, but they're really managers. Leaders take risks, and leaders are willing to stand up for what's right for their people, and we don't always get those kinds of people into these positions. So that's going to be part of the question here. And again, they can be the cause of work-work imbalance and burnout, and that certainly there's a drift here where every year if you're doing more and more work, eventually you do less and less academic stuff. If you're in academics, if you're in private practice, you may have less time to run your practice, and then sooner or later somebody else owns you and somebody else is running your practice for you. And I strongly believe that radiologists should lead themselves, because I don't think there's anybody else who knows what it's like to be one of us at 3 in the morning having to do a tough procedure or to make a tough call. Now, how do we succeed? Well, I think we need personal strategies. In addition to departmental level, group level, and national strategies for sustainability and radiology, I think we need all of the above. But again, I'm going to encourage you to take care of yourself in case your leaders don't. I also tell young people, and I spend a lot of my time in the Radiology Leadership Institute working with young people. It's been one of the shifts that I've made during my 10 years of tenure there. You know what? If you look around and nobody's doing this, this is a leadership opportunity. And many of the people who are doing this in some of the countries where I work, particularly in the States, many of them are on the younger side, because I think they see the problems, they understand that if you want somebody to work 30 or 35 years, we need to rethink how we're working. And it's part of—this thing at the bottom is something that—I don't remember saying this, but a friend of mine in Sacramento said I said this in a meeting like this. It happens sometimes. Things just come off the cuff. And I really think that leadership at times is too important to be left just to the leaders. So how do we do this? Well, you start by thinking about the goals and outcomes that you want. So this is a radiology couple. They're kind of late in life. They've had a good 30 or 35 years. And you look at them, they look like they're healthy. They look like they're in a good relationship. They've got—you know, they're touching each other. They're smiling. They're sitting close to each other on the, you know, whatever it is, a sofa or love seat. I don't know anything about interior design. My wife can attest to that. But it looks like they've got decent stuff. So they've, you know, made some money and they've spent it well. And they're happy and healthy. That's what you want to be at the end of your 30 or 35-year career. And you know, it's important that we think about that time horizon. Because if we're going to do this strategically, we want to plan for that. I wouldn't be able to sleep at night myself if I thought I was training somebody, putting them through taking call with me, having to sit next to me and have me grill them about cranial nerves and skull base and all that kind of stuff, if I thought that they weren't going to be around in 10 years or 15 years. That's not fair to them. And in comparison, if you are in a, you know, private equity-owned investment, they're really trying to work on a four-year time horizon. Or worse, you've got a hospital executive who's coming up for a performance review. And in 90 days, you cannot possibly build value. Instead, you just cut costs. And that's what hospital executives like to do when they're up for performance reviews. So we have to rethink the time horizon. The strategies, obviously, you should have started yesterday. Like the adage, the best time to, you know, plant a tree was 10, 20 years ago. But, you know, start today. When I talk to young people about choosing jobs, I say, look around. Does this practice or department care about wellness? Are they building the kinds of things you just heard about? Or are they just telling the radiologists, just work harder, and yeah, the PACS isn't any good, and the EMR isn't any good, but tough. Just do the best you can. But look for mentors. Look for allies. Look for role models. You want to be like the two physicians on the left. They're kind of happy. They're relaxing. They're able to ski. They're able to ski at altitudes, so they're probably pretty healthy. The guy on the right already has metabolic syndrome. He's exhausted. He's missing that met that's over there in the corner. And he's not doing good for himself or for his patients. And ask the questions. Does your program, hospital practice, or department have a wellness committee, and is it any good? If not, you want to start one. There was an interesting article in the Wall Street Journal several years ago about the whole idea of doing yoga. And people actually wrote and called it a moral hazard. You design a terrible job, and then you blame people because they don't do enough yoga. That is a moral insult, so you don't want that. So I'm out of time, so I'm going to stop and just talk a little bit about what you should be looking for. Again, leaders should be role models, and they're good or bad. If you have somebody who is a workaholic, who doesn't care, doesn't have a family, that may be a very tough person to have as a leader. You want to set expectations in a practice or a department that are reasonable. You want to act as an advocate within a larger institution. You want somebody who will stand up to the institution and say, no, we're not going to take bad contracts just to make a little bit more on the margin. You want to advocate in the House of Radiology for quality, appropriate compensation, and safety. We are underpaid relative to the work we do. I once said at a meeting like this that someone was complaining about the cost of what a radiologist costs today, and neuroradiologists are overpaid. I said, no, we're not overpaid. You're finally going to have to pay us what we're worth. That divided the room pretty harshly. But if your leaders won't lead, then you should be stepping up yourself, and that's what happens when leadership fails. With that, I'm out of time. That's me with the other Steve who invented the computer that I use. That's Steve Wozniak. Thank you. Thank you, Dr. Alexa, for that wonderful talk. So if it's not hard enough to try and develop wellness and overcome burnout on your own, for yourself, or for your department, imagine taking on the challenge of improving nationally well-being for radiologists. And our next speaker is actually leading that. This is Dr. Tycoon See, and I met Dr. See when I had the privilege of going to Cambridge as a visiting professor. Dr. TCC is a consultant interventional radiologist at Cambridge University Hospitals NHS Foundation Trust, United Kingdom. His clinical interest is in hepatobiliary, oncological, and transplant interventions. He is the co-chair for the Support and Well-Being Group at the Royal College of Radiologists at the United Kingdom. He has organized and delivered talks on well-being-related events nationally. Currently, he is co-leading the launch of the RCR, a Royal College of Radiologists National Well-Being Program. He has had multiple leadership positions in his hospital, national organizations, and the Medicines and Healthcare Products Regulatory Agency. For those of you who aren't familiar, that's equivalent to the FDA here in the United States. And he is currently vice president of the British Institute of Radiology. We were very amazed that he accepted our invitation to fly across the ocean and come and speak with us today. Dr. See will present the topic, A National Approach to Improve Radiologists' Well-Being. Dr. See. Thank you, and thank you, Jay, for the introduction. It's a pleasure to be here. So I'm going to share with you some of the local and regional initiatives that we did back in Cambridge and East of England, and subsequently the formation of the National Group of the Support Well-Being Group in Royal College of Radiologists, and discuss some of the ongoing initiatives and our challenges. So this all started when I was the head of the department back in 2019, when we had a few issues in the department. So I drafted in Dr. Susie Hunt, who is the primary physician by training, but then at that time was committed to professional well-being full-time in our hospital. So Dr. Hunt did a survey in the department, you can see three specialties there, radiology is number three, and you can see all of us who responded show high OB score to a very high score at that particular time. So as a result, we then formed in our department well-being and debrief sessions, reflective debrief sessions on a weekly session for over a month continue to be served. So each time one would talk about the issues or the group issues with Dr. Hunt and her colleagues, and if anybody require individual attention, they can make separate consultation with them. You can see Dr. Hunt is also an excellent baker, and she bake as well. And sometimes her husband also participate, he's sitting on the bottom right there, because he's a sound engineer, he also provide background music for us most of the time. And then hit the COVID, and we converted the face-to-face to virtual debrief session, continue our conversation. And when lockdown was lifted, we have a small group allowed to meet outside the department. We had it in one of the backyards in the hospital campus, and you can see Paul there as they are very enthusiastic, provide the music outdoor, a very good way to enjoy afternoon tea as well. So we continue to meet as a group in the department to highlight what questions we have or what issue we have, organizing various events, including a fund run for the department. In addition, we also extended to the region, for example, taking part in the training day for trainees and also consultants incorporating wellbeing in their agenda. And of course, we're very lucky enough to have Jay with us in Cambridge a couple of years ago to talk about burnout. And we have many other events in the department as well as in the region. In parallel to this, the Royal College of Radiologists always does a workforce census annually. You can see this is from 2019, where shortages of radiologists have been highlighted to impact significantly on patient care. And of course, also on the morale and pressure on the workforce. And the next year, the same workforce stress and concern about burnout and decreased quality of service for the patient. And year in, year out, it's the same thing. Everyone is very highly pushed and only just keep coping and all the clinical directors or head of department will worry about workforce morale, the stress and the burnout. And the same, this is from the year before, and this is from last year. And interestingly, last year, we also identified that the median age of radiologists leaving the profession or retiring for a profession is about 54 years old. So at that time, back in spring 2019, the college had formed a group on stress and burnout, consisting of a number of cross-faculty. Royal College of Radiologists does have clinical oncology and clinical radiology, two joined together under the umbrella of the RCR. We had our first meeting back in May 2019 and discussed various issues. You won't be able to see that. Discussing about the drivers and strategies, and also in terms of the checklist for organization, for the individual, and for the department. And you learned about this before, the driver for stress and burnout, primarily due to work pressure, but it could be also IT related, as we heard before, and the time that we had for our admin, et cetera. And we decided as a group that the potential output for the college must be proactive. We must exude a strong statement of support for the workforce, helping to raise the issues and to develop practical guidelines. In addition, our aim is to prevent and to deuce and to spot burnout. And for that, a series of documentations have been published, and also events and themes have been working on. And also one of our challenge is to apply a well-being champion locally in each hospital for the radiology department, be supported by the College of Radiology. Of course, the RCR also work collaboratively with other stakeholders, for example, with the British Medical Association, in order to proceed more comfortably in what we want to do. Back in 2019 and 20, the college published the annual report for the formation of this new support and well-being working group. So instead of calling it stress and burnout, we call it a support and well-being working group. Our aim is to develop resources on support and well-being. We will focus on prevention to identify the root causes and wider impact of stress and support the members in maintaining well-being and promote a positive working culture. During the launch, we wanted to bring awareness, and of course, went to the social media, arrange a series of talks. At the same time, we also receive insight from memberships. You can see that more than 85% of our members have burned out to a certain degree. And certainly, this is what we heard from before. And this is our current president talking about looking after ourselves during the winter time, because during winter time, the pressure in the healthcare system is quite significant. At the same time, a number of documents, a couple of them, for example, job planning in the UK, we work according to the job plan for each individual consultant, have been published and home reporting, for example. And we also embrace other publications. This is an excellent one from the National Health Service in England on enhancing doctors' working lives, which is pretty comprehensive. One of the things that we're working on is the guidelines on those radiologists who are approaching retirement age. In addition, we also hold a number of events. This is during COVID, the Webminar, SOURCE Round. We also have self-hypnosis for stress management, taking part in the other society, for example, this one in BRESS, and taking part in various Webminar. This is from Silent Webminar. In addition, the college also produced a comprehensive document, Care is Not Just for the Patient, meaning it's also about yourself, discussing our mission, talking about strategies to manage this situation. In this particular document, we also share individual memberships, issues, for example, this particular one with depression, and although not actively suicided, but was hoping to get an accident that will end her life. So essentially, we try to be real, to avoid a stigma. Of course, at the time, we also enriched our IT system for the publication of this group, and we since updated our IT. This is a support wellbeing webpage, which has got a lot of resources in it, including signposting members to other areas that will be able to provide support, and also the events that we run, et cetera. The college also promotes widening participation for those who are disadvantaged, to ensure we are true and true in equality and diversity. We set up the mentoring system, and also reverse mentoring to make it even more effective. A series of other events, for example, as a competition, primarily to highlight the importance of burnout and stress, and looking after wellbeing. And finally, we revived the support and wellbeing working group. We have recruited new memberships to the team, and also, we have also received support in terms of launching the support and wellbeing champion, as I said, it's an individual champion from each hospital radiology department, and they are supposed to work in collaboration with the College of Radiology, as well as in their department and the management team, and Jay has contributed to the term of reference for this. Finally, challenges, obviously, participation from all the hospitals, prioritizations, very competitive, and resources, because these are all volunteers, so they need to be supported, and we need experts to contribute to this. For future, we will continue our work and our initiatives, and we will collaborate with every organization, and then to develop our wellbeing champions with a series of wellbeing programs that we hope to incorporate to the healthcare in the UK. And thank you for everyone that contributed to this. Thank you.

radiologist burnout

workplace stress

emotional exhaustion

informatics solutions

leadership role

well-being champions

professional sustainability

healthcare systems