On behalf of the RS&A, welcome and thank you for joining us for today's webinar, Healing Radiology Strategies to Overcome Burnout. This webinar is one of the many ways that RS&A supports radiologists at every stage of their careers by offering educational resources and tools to increase knowledge and foster innovation. Before we start, I would like to take a few moments to go over a few brief housekeeping items. After the panel discussion, there will be time dedicated to answering your questions. We want this to be engaging and interactive. For this reason, we have asked participants to submit questions in advance as if they were writing a Dear Abby, or in this case, Dear Radi, letter so that we can address those questions publicly from different perspectives. Please also share your questions or your own burnout challenges by typing into the question box, and we will respond during the live Q&A portion of this webinar. And know that we will read your questions as anonymous unless you want your name included, in which case, please include your name in the chat box. You can also interact with speakers and other participants by messaging using the chat box. After attending today's webinar, be sure to click the link in the resources panel to complete the survey to receive credit for your participation. This webinar offers 1.0 AMA Category 1 credit CMEs. Disclosure statement. Accreditation and designation statement. Arson a disclaimer. Okay, let's get started. I would like to start by introducing ourselves. Dr. Sievert, please introduce yourself. Good afternoon. Thank you so much for the invitation to participate in this panel today. My name is Bettina Sievert. I am the Executive Vice Chair and Vice Chair of Quality and Safety in Radiology at Beth Israel Deaconess Medical Center in Boston. I am an Associate Professor of Radiology and Training at the University of Boston. I am also the Vice Chair of the RSNA Quality Improvement Committee. And at the hospital, I am Co-Director of the Wellness Committee for the Physician Organization and also the Director of the Departmental Wellness Committee. I'm very interested in wellness, particularly in the meaning of work and how the search for meaning can contribute to wellness. Thank you very much. Thank you, Dr. Sievert. We were supposed to have three people on the panel today, and you will notice there are two faces here. Regardless, I would still like to introduce Dr. Nicole Rastari. She was integral in the development and planning of this webinar over the past several months. And due to a family emergency, Dr. Rastari is not able to participate live with us today. I will be reading a statement from her at the conclusion of our webinar today. Dr. Rastari is an Associate Professor of Radiology at the University of Colorado. She's a chest radiologist. She's a writer, a coach, and a poet. Thank you, Dr. Rastari, for your contributions. And finally, I am Dr. Jennifer Kemp. I'm a Private Practice Radiologist in Denver, Colorado, with Diversified Radiology, where I am the Chair of Quality for Diversified. I'm also the Chair of the RSNA Public Information Committee and a member of the American College of Radiology PFCC Commission. So let's get started. Learning objectives for today include analyze real-life burnout conundrums to gain practical insight, addressing specific challenges, and fostering resilience. Foster a sense of community and engagement among radiology professionals, creating a space for open dialogue and shared experiences regarding burnout and its solutions. Develop an action plan tailored to unique clinical circumstances, incorporating practical techniques and approaches to mitigate burnout and enhance personal resilience. So we've been talking about burnout for several years now, and just in case anyone needs a reminder of what burnout may feel like in a busy reading room these days, I want to start with this video reminder. And this is credits to Dr. Rastari. Oh, this is easier. Yeah, we can handle this okay. So I think that we've all felt this, otherwise we probably would not be participating in this webinar. It gives a funny and lighthearted look at how we might feel in the reading room, although most of us don't feel it's a laughing matter. So we, I think we know what burnout feels like without necessarily knowing the formal definitions of burnout, which include Christina Maslach first described the entity of burnout as being systematic erosion of the soul. And that definition certainly speaks to my soul. The clinical triad of burnout includes emotional exhaustion, detached response to others and decreased sense of meaning. Medscape did a research study in 2023, where they surveyed physicians asking about burnout. The study found that 53% of physicians report feeling burned out. And for radiologists, that's higher than average. It's actually 56% of radiologists report feeling burned out. And of those 56% of radiologists, 44% of those say that burnout has a strong or severe impact on their lives. In addition, showing the significance of burnout, the surgeon general, Dr. Vivek Murthy, has six priorities in his office to support public health. And one of those six is burnout among healthcare workers, saying specifically, our health depends on the well-being of our healthcare workforce. So taking care of ourselves is also taking care of our patients. This is an important problem, clearly. So moving along, we're ready for our Dear Abby slash bratty questions. Again, we asked participants to submit their burnout conundrums. And those questions we chose from those questions, we chose those with the most commonality to present today. Dr. Siever will be answering for more of a systems perspective, whereas I will be facing the questions more from a personal perspective. This is question one. Dear ratty, I remember the days in the reading room before PACS when we would all be together in the same room hanging phones and reading the newspaper between exams. We had our red wax pencils and calipers. Who would have known at the time that those would be the glory days? I know that every rat struggles with volume now and it will not be getting better. It will not be getting any better in our appreciable future given the worldwide shortage of radiologists, the aging population, and continued reliance on imaging for diagnosis. Many of us now have an RVU counter as part of our workflow to make sure we are reading fast enough. I simply can't read any faster or any more RVUs in a day. I am at my breaking point. What can I do? So we'll start with Dr. Sievert. Yeah, thank you very much and thank you for this question. It's an excellent question. It is on everybody's mind these days. The workload is much higher than one can safely perform and in fact this is the most common cause of moral distress among radiologists today as was shown in a recently published national survey. And the reason is really a mismatch in terms of the shortage of radiologists that's ongoing right now and the large number of examinations that are ordered. And one contributor is also, as we're all aware, the over-utilization of imaging. About 30% of imaging is thought to represent waste in form of unnecessary examinations. So to address this problem of the mismatch and high RVU for the individual radiologists, we really need very large societal solutions. So the inter-society conference met last year and decided with delegates from the 36 radiology societies in the United States what some action items could be. So increase in the number of radiologists to increase the number of trainees to potentially involve private practices in training of residents through a so-called spoke wheel model that's already being used in medical physics. Or we could look at it in terms of trying to decrease the number of studies that the individual radiologists read. So decreased waste would be a large goal that we would have to work on with other specialties that are sending us these imaging requests. Also to establish radiology as a consult specialty where other specialties ask us for advice, what is the best imaging study for this patient? And we would end up maybe doing only one study instead of several. We could also involve advanced practitioners and sonography practitioners in our workflow, which would decrease physician time. You could focus on reading cross-sectional studies. And I know that in some countries that's already being done with plane from radiography no longer being interpreted by radiologists. If we want to think about moonlighting with our existing workforce, we can certainly do that. But it's helpful if that's flexible with everybody having workstations at home these days or most people. It's possible to make that very flexible so that radiologists can read studies whenever they have time to do that and not being locked into a full shift for an evening, but maybe just reading two or five studies a night if that's possible and works with family time at the end of the day. And then also to improve efficiency through workflow reorganizations. There are several AI tools available that we could implement. Some departments have worked with reading assistants that have been very helpful in terms of decreasing the interruptions that radiologists experience and thereby made the radiologists workflow much more efficient. Thank you, Dr. Sievert. This really speaks to me, especially your point about making radiology as more of a consultation specialty. I think this really addresses burnout from many different aspects. So not only would it decrease the number of studies read by radiologists potentially, but it gives us a sense of meaning and purpose. It also connects us with our fellow clinicians, which also is an antidote to burnout. And no radiologist likes reading a study that brings no value. We want to do things that are valuable for our patients. So that definitely speaks to me. Thank you. I'll be looking this again at more of an individual perspective. So what can an individual do? And I think I want to point out in the beginning that I'm not saying this is not a systemic problem. It is a systemic problem. But if we as individuals can make changes that make us better adept at dealing with burnout while our systems are getting better, then we will all be healthier. So I want to start with this quote from Victor Frommgel, who's an Austrian neurologist and psychiatrist and a Holocaust survivor who says, between stimulus and response, there is a space. And that space is our power to choose our response. And our response lies our growth and freedom. So in this scenario, I would say our stimulus is our views. And it's your choice what your response is going to be when you look at this huge work list. Next, I want to focus on work and a book published by a physician named Pooja Lakshman, who's doing work on what she terms real self-care. And she's differentiating real self-care from what she calls faux self-care, being things like taking a bubble bath or having a glass of wine, meaning like a quick fix. And saying that real self-care is things that you can work on internally that are long-term. And those four things that she is recommending is boundaries, self-compassion, aligning values, and assertion of power. So in this case, we're talking at RVU, talking about RVU burden. I want to talk about how you might apply these four principles. So boundaries. You have three potential scenarios. One is to read all the RVUs. Two is not to read them. And three is to negotiate. Or if you are not sure, give yourself some space to think of what the best answer is. Self-compassion. That's kind of that voice that's always talking to yourself. So with me, that voice is often saying little things like, you're not fast enough. You're the slowest radiologist in the group. Different radiologists don't like working with you because you're not fast enough. Change that voice in your head to something more self-compassionate. Talk to yourself like you might talk to a friend. And maybe change that language in your brain to something like, you know what? You're doing the best you can do. You're doing the best for your patients. And this is great. And your fellow radiologists enjoy having you as a partner. Third, aligning your values when you're faced with this RVU burden. If your value is being the fastest reader in your group, great. There's no judgment there. That's fabulous. Then go for it. If your value is taking time and slowing down, then accept that and honor that value that you hold. Assertion of power, I think, is very important in burnout. And I think this is where at least this is the one that's most meaningful to me. What can I do about this burden personally? And different options might be going to creating a committee in your group to look at getting rid of some contracts so you have fewer RVUs. Maybe hiring more radiologists and decreasing your pay. Maybe hiring an overnight service. So I think actively participating in ways to reduce this burden would be helpful. Okay. We are to our next question. Question two, dear Ratty. I'm an academic radiologist. I went into academics because I love teaching our budding radiologists who are the future of our profession. My academic center touts that one of its missions is teaching, but who has time to teach? There are simply too many cases to feel like I can take time to teach the residents in the management I can take time to teach the residents in the manner they deserve and still leave at a reasonable time to have dinner with my family. Then I'm in a vicious cycle of guilt. How do I step away from this rat race of cases to give time to the residents without falling behind on the list? This never-ending dilemma can quickly put out my fire for radiology and leaves me with a burned out, smoldering attitude. Thank you for this question that so many of us feel. This is really looking at work-life balance. And I want to look at this again through these four principles of boundaries, self-compassion, values, and power. So this radiologist has a choice. They can stay and continue to teach the residents, or they can go home and have dinner with their family. And either is a reasonable choice. So realize that it's your choice of what you want to do. Talk to yourself with compassion. Try to stop that negative chatter in your brain that might be saying something like, this resident doesn't think I'm doing a good job teaching, or that the voice in your head that's saying, my husband is going to be so angry with me for not getting home in time for dinner. And change that voice to a way that you might talk to a friend saying, you're doing the best you can. The resident is struggling with these same scenarios. Your family understands and they love you. Look at your values. What are your values? Is your value work above all? Or is your value family? For me personally, mine was work. It really was. So I'm not judging that in any way. I'm now an empty nester. And I missed a lot of time at home with my family. That was my value. I do have some regrets over that, but I was holding true to my values at the time. And then assertion of power. Again, try to actively change your scenario if it's not working for you. Maybe you could create a work from home program. Maybe you could create a committee that develops alternative schedules, having different start times so that sometimes you're you always make it home from for dinner and maybe you start earlier on those days. Or from the other perspective, maybe hire somebody to cook dinner for your family. So those are a few different ways that you can assert power. Dr. Siever. Yeah, looking at this from a departmental or, you know, again, societal perspective, the fulfilling the teaching commitment as an academic institution, that is very important. It's a big part of the tripartite mission, but it does require time. And because of the additional RVUs that everybody has to take care of, it is increasingly difficult to do both the clinical workload and the teaching component at the same time. And thinking about some possible solution, I've heard that some departments, academic departments have started to create dedicated teaching track positions that do not have a research obligation. Many of our residents are interested in clinical work and in teaching, but not that interested in the research component necessarily. So it would be nice to engage people in that discussion and potentially have a larger pool of faculty available if people are interested in that. Also, with the increasing RVUs for experienced faculty, that may be a consideration to stop working entirely. So we would need to keep everybody involved to think about stay interviews, to find out what people value about their work and how we can support them and make that happen. Particularly, we open to flexible work options. Most departments already have some hybrid portion of the workforce such that some people work in the hospital, others remotely from home with various divisions of time. We also have to be more open to staff requesting part-time positions and make that possible. Another thought would be to decrease the administrative burden that comes also with an academic program by employing administrative personnel that can help with those in terms of administering the residency program and other administrative burdens. And also to improve mentorship and sponsorship that we provide for the faculty such that they can experience the joy of a successful academic career. Thank you, Dr. Siever. I really like your idea of a stay interview. I know in my practice, we do exit interviews. And often during those exit interviews, we find out that's the first that we've heard that the person had an issue or a concern. And then we're saying, oh my gosh, had we known, we might have changed this or this or this. And maybe you could have stayed. But at that point, it's often too late. So if we start to address some of these concerns before that person starts looking for another job, we're much better off to keep them on staff. So thank you for that. Moving to question number three, I think. Dear Ratty, I am in a private practice radiology group. And over time, our group is becoming more corporatized. I often feel like we are no longer equal partners in running the group. I know that many of my fellow partners feel similarly. What advice would you give group leadership to assure that their partners in the practice feel like they still have the opportunity to impact the direction of the group? Thank you for that question. Dr. Siedert. Yeah, again, this is an excellent question, because leadership can actually contribute to staff burnout and also be a big part of curing staff burnout. So we have to discuss how leadership can be particularly helpful here. So it is critical that leadership first of all, acknowledges that staff is having these experiences of burnout and that it is a real problem. What staff experience oftentimes is loss of control over their work environment, a lack of understanding, meaning they feel completely disconnected from, they feel that their leaders are disconnected from the front lines, don't know what the experience is like, in the trenches, so to speak. And that creates feelings of isolation and feeling of lack of support and abandonment. And in order to solve this problem, a leadership style that has recently become more talked about is this philosophical style of servant leadership. This was initially This was initially described in the 1970s by Robert Greenleaf. And it is a style of leadership where the leader itself, it is their goal to serve their employees. And it is very different from traditional leadership, where the leader is dedicated to put all their effort into the improvement of the institution or the success of the company, and not focus on the employees themselves. Now, what would that look like? So leadership in this scenario of burnout, so what the leader would want to show is that there's deep listening ongoing with the staff. So staff meetings that are dedicated to the staff experience and to the exchange of information, what it feels like to be a radiologist every day in front of the workstation, that is important for the chairman to know. Similarly, the chairman has to make a commitment to improving the staff experience to learn about the problems, dedicate time to solve these problems that are brought forward, and then report back on progress on how these problems are solved or lack thereof. Sometimes problems are not that easy to solve, it takes a long time. So to be in close communication with the staff to be very transparent about the ongoing efforts and what progress has been made is very helpful. And then lastly, is to show appreciation for everybody's contribution. And if we look at appreciation, the lack of appreciation itself is actually the second leading cause of burnout and stress. And some studies have shown that about 79% resign because of lack of appreciation. And it is because appreciation is actually not that easy to do. And many of us have appreciation programs in our departments, and about 75% of departments have that, such as an employee of the month or a spot bonus that's given to staff who've done something great for a patient. But that is actually not that helpful. First of all, not many staff are reached by that. It's really very few people that are directly addressed here. And it's really only affecting positively about 20% of the staff. However, if one would move to appreciation practice, which is in the moment thank you or excellent job when something great that somebody has contributed to is witnessed, then this is much more effective. Up to 70% see this as a real recognition of their efforts. So in the moment, a quick thank you and recognition is much better. And interestingly, this does not actually have to come from a manager or leader. But if peers provide this type of appreciation, it's equally meaningful and something very important for us to know about that we can actually support each other in giving each other appreciation. And then maybe just one more word on how to do that very well. You may be familiar with work that was done by Gary Chapman in 1992 on the five love languages. He then later expanded that work. This was done in 2012, together with Paul White on the five languages of appreciation in the workplace. And all the things that I mentioned earlier about the leadership behavior will show up here again. So words of affirmation, a thank you, an email to a to an employee, maybe CC to their manager that they did a great job. Thank you notes, that would be very much appreciated. Quality time, what's meant by that in the setting is this extra time of the leader to meet with the staff and hear what their issues are, and dedicate time to solving those issues. Receiving gifts, little tokens of appreciation, are also very welcome. Acts of service, again, the leader spending time with staff and solving their problems, doing work for making the life of the employees easier falls in that category. And the last one, physical touch, not that much used in a workplace. But you know, some people appreciate a high five or fist bump in the right moment. And that's another tool we could consider. Now, if you want to find out how people would like to be appreciated, because it's different for every person. If we listen to how they express appreciation for their coworkers, that is most likely the way that they would like to be appreciated themselves. So something to look out for when we talk to staff and our coworkers. Thank you, Dr. Seidert. That's excellent discussion. I want to look at leadership, again, with the same principles. And for the leaders that are on our call, this would be my advice to you. Boundaries, let your staff and our fellow partners have some boundaries, meaning don't have too rigid of rules. And I'm not saying that you just let everyone create their own job description, but give people a little bit of wiggle room, a little bit of autonomy. And then like Dr. Seidert was saying, compassion. And this, I think, is the most important, is listening to your staff, listening to your faculty. If they say that they're feeling a problem, validate that problem, whether you agree with it or not. It's real to that person. Create psychological safety for people who are talking to you and sharing their problems with you. And know that a problem shared is a problem halved. Allowing someone to share their problem with you may be half the battle and could do a lot of good in just allowing them to speak. I think stifling people's voices is sure to flame the fires of burnout. For values, realize that not all faculty or fellow partners share the same values that you do. And this is something that I struggle with personally when I get to thinking work should be above all and everyone needs to have these same values that I have, is to realize, no, that's not true. Different things are valuable to different people and learn to respect that. Power. Allow faculty and your fellow partners to feel like they have some say. Not, again, not to direct everything in their job description or in their day-to-day role, but some autonomy over their days. And that will help eliminate or decrease burnout. Again, flexibility in schedules. Cultivating connection. Allowing staff to participate and create their own societal changes that Dr. Siebert has been talking about. Okay. Question number four. Dear Ratty, I am experiencing that the radiologist trainees and junior faculty often lack curiosity to learn and explore new ideas. There's also lack of deep connection, purpose, with the specialty. It's being treated as a shift that pays the bills. When you combine this with staffing shortages and high examination costs, burnout emerges as a symptom. Finally, we need to be honest that radiologists are commoditizing their own specialty for more money. Thank you for that excellent question, Dr. Siebert. Yeah, thank you for this question. I think it is a really good question because what we're seeing I think it is a really good question because what we're seeing is that there is a different emphasis, I want to say, on work-life balance in the different generation. And that is something that we have to talk about. I think there's not enough dialogue about what is, you know, how different generations feel about it and how we are going to come together on that. So work-life balance is something that is a focus of current radiology trainees. And that is in part due to, I think, because we have made that a priority for future generations. And I'm saying this in the best possible way. It's something that certainly our generation did not have at all. And we have lamented that. And we've wanted a different type of environment for the generations that come after us. So that is certainly something that is a good development, that people are more focused on work-life balance. And it is something that probably, and I'm including myself in that, you know, as somebody from an older generation that can learn from that more. And it is very important, particularly if we're looking at a long career that we want to remain happy with and engage with for a long period of time. Now, if people feel that engagement is an issue, there's a lot of research that's been done. I have included two references here from Gallup, although I must say that this research does not include physicians. So it's not clear how applicable this is to physicians. But they did a lot of surveys with millennials and asked them what they would want from their work environment. And they are looking for the work environment to provide them with or an institution to provide them with purpose and professional development so that they can develop their strengths more in that environment. Also, that any kind of feedback that is given is more done real time, not only an annual review, and that it is very focused on a strength-based approach, where people develop their strengths, rather than being criticized for their shortcomings. And there is research that shows that strength-based approaches are very successful, in fact, more successful than other approaches. So something to think about. Also, they'd like to see their bosses as a coach who helps them develop their career in the future. And they are very much identifying the job as part of their life, as an important part of their life. And that is why they would like to find the very best fit for them going forward that they spend a lot of time on. And because of the issue of purpose, I wanted to just make the connection to meaningful work. So first, in terms of the definition. So purpose is referring to a future-oriented, high-level motivational goal that gives life a direction. And then meaning is the degree to which an experience is personally significant. So how can we develop the meaning in our work? And how can we develop something that's personally significant for us? And three different ways to meaningful work have been described in the literature. And in fact, all of these are able to be found in medicine and radiology, which we're really very lucky to have that. So one is self-actualization or craftsmanship. And that is to develop expertise and specialized skills, which certainly in radiology we have. And from that, we can develop and gain a great deal of personal satisfaction and meaning. And the second one is self-transcendence. And that is making a contribution to the greater good, which in healthcare we are perfectly aligned with that from the beginning by making a contribution to our patients' health, to the training of future generations of radiologists, to developing new knowledge if we are involved in research, or making contributions in administration of a large institution and a large group, and therefore have very meaningful work doing all of these things. And then the last one is connection and belonging. And that is also referred to as the kinship mindset, when we are creating and improving relationships with others. And we have the opportunity to do that in radiology, not only with our colleagues, but also with our patients. And many ways to get into that in radiology these days by setting up consult services, as we talked about, or in interventional procedures, also developing clinics for patients where they can come to discuss results, and many more opportunities to do that. Thank you, Dr. Seidert. And your answer there, what really speaks to me, is purpose. And it made me think of a documentary that I've been watching about blue zones and where people are most likely to live into their hundreds. And one of the cultures that was studied is Okinawa, Japan. And they talk about something called ikigai, meaning your reason for being. And having a reason for being, having a deep sense of purpose is something that helps people live a longer life, and obviously would help them have less burnout. The four pillars of your reason for being, some people would say, are what you love, your passion, what the world needs, your mission, what are you good at, your vocation, and what can you get paid for your profession. So for me, personally, the answer to every one of these is radiology. Radiology, radiology, radiology, radiology. And the more that we can exude that towards everyone that we're with, and towards the fellow trainees, the more that sense of purpose can hopefully be something that is contagious. So as we near our Q&A part of this presentation, I want to read a statement from Dr. Rastari that she wrote for this webinar. And this, I think, nicely summarizes some of what we're talking about today. So Dr. Rastari says, I regret that I will not be able to join you for today's webinar due to a significant illness in my family and want to extend my thanks to the RSNA and my colleagues for their support. I chose to use the word regret intentionally in this context because I don't think an apology is appropriate as the word is laced with implied ownership of fault and, as we have all experienced, cataclysmic health-related events are truly acts of God. Furthermore, physicians have been apologizing for being human for far too long. Rather than putting together an academic presentation on the topic of physician burnout this week, I have been immersed in its consequences, spending my time in the hallowed halls of healthcare as my mom battles a rare and debilitating disease and I, as both daughter and physician, attempt with all of my heart and mind to navigate tumultuous seas. During the past week, I have seen the best of us and I have seen the worst. An interventional neuroradiologist with gentle and expert hands whose groundbreaking techniques and research were equaled only by his kind bedside manner, talking us through complicated procedures as though he had nowhere else in the world to be. I have sighed in relief at the willing smiles and gentle souls of transport technicians whose forest green scrubs punctuated an otherwise whitewashed landscape. I have shed tears of gratitude when a busy nurse gave a timely, simple gift of a packet of salting crackers, the emotional equivalent of fresh-baked bread. In these halls, there are the best of us and there are also the worst. The lifeless, sterile voices of many physicians and resident physicians loudly echoed statistics on burnout in a way that was intimate and heartbreaking. Doctors hardened by the opiate epidemic hesitant to treat intense physical pain with appropriate medication. An attending physician in emergency room managing her patients like a drone pilot, unable or willing to leave her position of command at a computer to deliver imaging results or manage symptoms, let alone lay hands on the sick. I held my tongue when a young trainee opened a phone conversation about my mom's health, not by an introduction of her name, but by a curt request that I not give her cell phone number out to anyone else. I wish I had the words and agency to have told her that the cold tone in her voice only served to amplify our suffering and in the ways that work beyond the mechanics of words, her requests made us feel ashamed and isolated as we searched for answers. I also wish I could have had the good sense in that moment to share with her, as I'm sharing with you now, that I get it. I've walked in her shoes. I have been curt. I've endured sleepless nights. I've read studies at a dizzying pace that participates the fear of making critical medical error, leaving me feeling defensive and immoralized. I get the impulse to protect just one thing that separates the self from the system. I think she should also know that I too have missed nourishing family dinners and tried to fill the emptiness with cafeteria french fries. I wish I would have told her that that being exhausted and fragmented is a consequence of a sick system and that as I am coming to understand burnout from both sides now and so I forgive her as much as I forgive myself. As the epidemic of burnout leaves health care providers feeling robotic, the experience of human suffering for doctors and patients alike is increasingly dehumanized and the capacity for healing and connection diminished. I think in the end we are all at times both the best and the worst of us. I believe that the health care system, with its dependency on speed and focus on profits, robs patients and physicians of that sacred relationship that defines the conversation at the borderlines of life and death. Sometimes all it takes for the fires of truth to illuminate a dark corner of the world is one person telling their story. I wonder what would happen if we all put pen to paper, lips to microphones, hands to canvas and spoke all that we once merely whispered out loud and into the light with love and compassion. Sincerely, Nicole Rustari-Emdi. Thank you Dr. Rustari for your words that so thoughtfully shape the webinar that we presented today and know that our thoughts are with you and your family. Okay, opening it up to Q&A. Again, please write your questions in the chat box and we will start discussing them. Yeah, so we can start with a question that has to do with clinical decision support. The question reads, could you provide an update on what happened to where we are with clinical decision support? This was intended to help providers order appropriate imaging studies and perhaps decrease the number and type of inappropriate examinations ordered and performed, but it is not clear why this has never been employed. It might help address the volume issue to some small degree. Thank you. So, I can start with what I know about this and you may know more. So, clinical decision support was, you know, has been on the horizon for many years and the implementation deadline had moved from, you know, was pushed back every year again until, so January of this year was supposed to be the actual deadline when implementation was going to happen for real. But then it was cancelled last minute with no date given at which it will be, will have to be instituted. So, for now, it is completely off the table and this is very unfortunate. I agree with the radiologist who entered this question because it would help us a lot. There are, the interesting thing about decision support is there is a lot of research that says decision support does not work. However, it was a large study, it was performed at Mount Sinai in New York where they looked at decision support in the entire hospital and they looked at the correlated decision support with patient outcomes and length of stay. And what they found is that the physicians who followed decision support and all the recommendations, it was a very well-designed support system that included all recommendations from societies with how to manage, you know, whichever disease the patient was suffering from. And they found that physicians who followed this algorithm, you know, by the book, that they had a decreased length of stay of the patients and better patient outcomes. However, the problem with the study was that of the entire staff, 6% of staff were following the algorithm. And that is the problem with decision support. I think that we would see in radiology as well. It's really a matter of making it clear to the referring physicians and breaking through ordering patterns is very difficult. There's also a great study by Mike Bruno that looks at, it was actually a survey of referring physicians looking at why they do not use decision support or why they still would like to order a study, even if it's not indicated by decision support. And people admit that it is what they are asking for is asking for certainty beyond what an examination can provide. And that's really what we're up against. And it's a large cultural shift that has to occur. Thank you, Dr. Siderot. Just to comment a little more on that, I have read some of those studies saying that it doesn't work and that people learn how to game the system kind of and say, you know, choose the right indication to get the test that they, what they really want to order. I think, I feel, I personally feel that medicine is getting to be so algorithmic with so many checkboxes that I wish instead of decision support that they would just use the radiologist. So my advice would be to make yourself accessible to ordering clinicians for questions, how on earth can you expect a referring doctor to stay up to date with all the imaging types of exams and what, and what test is best for what patient and what scenario, and that what test is best for what patient could change depending on what type of scanners you have or what, what environment you're in. So that answer is not always going to be the same. So I think making ourselves available to our referring physicians to act again as a consultant is a way to give us meaning and purpose as well as decrease waste from doing inappropriate exams. Yeah, that's an excellent, that's an excellent consideration and I do share that. I feel that in our institution, we have thought about instituting radiology as a consult specialty where people can order radiology consults in the same way that one could order an ID consult. And there are specialties that are very much in support of that. So our hospitalists and our private practitioners very much in favor of getting our advice and they value our advice a lot. So we could certainly make already a good start there and have a lot of impact in that realm. I think. So I'm just seeing another question in the chat here. And the question is, how can AI help decrease some of these issues within radiology? So, I think that AI has so many potential advantages that we are just learning about. And AI certainly can help make radiologists more efficient in helping to quickly prioritize cases that might have a positive finding. AI can maybe help you feel more confident in your read if it's kind of like a second set of eyes. My personal take on AI is I don't want to read any faster than I'm already reading. I don't want to read any more efficiently than I'm already reading. I want to read better than I'm already reading. So I want AI to decrease my burnout by making me feel more secure in my reads. I want it to decrease burnout by making me less concerned about litigation. I want it to decrease my burnout maybe by actually increasing my efficiency, but that allows me to take a lunch break or have a phone conversation with a colleague to decrease my burnout. So those are ways that I think AI could be super helpful. Yeah, I'd like to add to that. I think that in the future, AI could help with taking care of normal examinations. So of course, we would need to develop some comfort level around that as radiologists. But if we can do studies and show that AI can confidently identify normals, that would be a good way of at least decreasing the volume somewhat. And also, the more we then develop comfort with that, I could see that in the future, maybe some benign findings will require still a radiologist overread, but it'll be much quicker. So if there's a normal abdominal CT that just has a few renal cysts, that will be much faster to read in the future. And also a great opportunity for AI is, you know, other than the improving efficiency, is that it can help in the future with report corrections. So right now, we still have communication errors in reports, not only by typos, but by right, left mistakes and other, you know, phrasing errors in reports. So in the future, AI is in the development to take care of those issues for us and to at least alert us. You know, there are reports sometimes saying no gallstones in the finding description of the report, and then it'll say gallstones in the impression. So those types of errors, now there is no way to identify those. So we're coming to a close today. Thank you to those who have joined us. I hope that you had the opportunity to learn some tips that might help you in the future. And please know that you can contact any of us at our email addresses, which will be posted on the RSNA website. I also would like to thank Dr. Sievert again for joining us today, Dr. Ristori for her participation, Kim Cabrake with RSNA, and here is our contact information again. Thanks, everyone, and thank you, RSNA, for the invitation.

radiologist burnout

wellness strategies

RS&A webinar

work-life balance

AI in healthcare

leadership in radiology

clinical decision support

professional purpose

radiology workload