Burnout, Professional Fulfillment, Intention to Leave, and Sleep-Related Impairment Among Faculty Radiologists in the United States: An Epidemiologic Study

Abstract

Objective

To examine the prevalence of burnout in faculty radiologists in the United States and to explore the relationship between burnout and professional fulfillment (PF), intention to leave (ITL), and sleep-related impairment by gender.

Methods

This cross-sectional study was conducted through a voluntary anonymous, electronic survey of radiologists at 11 academic medical institutions participating in the Physician Wellness Academic Consortium between January 2017 and September 2018. Faculty radiologists who completed the survey were included in the study. The survey contained the validated professional fulfillment index and National Institute of Health Patient Reported Outcomes Measurement Information System sleep-related impairment scale. Demographics of participants only included gender to protect anonymity. Sample t tests and χ² exact tests were used for analysis with significance level set at P < .05.

Results

In all, 456 faculty radiologists (171 women) answered the survey. The overall prevalence of burnout was 37.4%, PF was 35.6%, ITL was 33.3%, and sleep-related impairment was 45.3%. Burnout was higher in female versus male respondents (44% versus 31%, P < .05), and PF and ITL were lower (30% versus 42%, P < .05, 26% versus 38%, P < .05, respectively). When faculty were stratified into burned out versus not burned out, PF was significantly lower in those with burnout (12% versus 52%, P < .05), and ITL and sleep-related impairment was higher (51% versus 24%, P < .05 and 75% versus 30%, P < .05, respectively).

Discussion

Higher burnout was associated with reports of greater ITL and sleep-related impairment and lower PF. Female radiologists experience more burnout but less ITL than their male counterparts.

Introduction

Burnout is an increasingly common occupational hazard for physicians. The World Health Organization defines burnout as a syndrome of chronic occupational stress that has not been well managed, characterized by emotional exhaustion, depersonalization, and lack of personal accomplishment as described in the Maslach Burnout Inventory [1]. Burnout rates have been shown to vary by specialty, although the drivers of this variability are not well described. Radiology is often considered one of the medical specialties offering better quality of life [2, 3, 4], and radiology’s reputation for reduced work-life conflict would suggest that burnout scores might be relatively lower for radiologists than for other physicians. Yet, available data do not support this conclusion. The 2020 Medscape National Physician Burnout and Suicide Report revealed that 46% of radiologists are burned out compared with 42% of physicians overall [5]. Similarly, Shanafelt et al reported that 45% of US radiologists met criteria for burnout using a binary measure [6]. In other reports, 71% of academic radiologists reported at least one symptom of burnout, and 29% reported three symptoms [7]. By subspecialty, the rates of radiologists reporting at least one symptom range from 60% (neuro-interventionalists) [8] to 81% (musculoskeletal radiologists) [9]. Within this range, the rates were 61% to 66% of pediatric radiologists [10], 71.9% of interventional radiologists (88% were faculty) [11], and 78.4% of breast imaging radiologists [12]. Radiology leadership is not exempt; approximately 38% of radiology chairs have reported one symptom of burnout, and 5% have reported all three symptoms [13].

Although the incidence of burnout in radiologists has been well described, the association between burnout and professional fulfillment (PF), intent to leave (ITL), and sleep-related impairment has not been previously studied among radiology faculty. In addition, prior studies measured burnout using the Maslach Burnout Inventory, which does not consider the positive inverts of distress, such as happiness or meaningfulness, self-worth or self-efficacy, and satisfaction at work. These important constructs can be measured, together with burnout, with the validated Professional Fulfillment Index (PFI) [14].

In this study, we report measures of overall wellness of radiology faculty across the United States using the PFI and the National Institute of Health Patient Reported Outcomes Measurement Information System (PROMIS) sleep-related impairment scale to identify potential targets for improvement to promote wellness [15, 16, 17]. We hypothesized that, although radiology continues to be considered a lifestyle-favorable specialty, burnout continues to exist in radiology and that ITL and sleep-related impairment are positively related to burnout rate and PF is negatively related. Therefore, our objective is to examine the prevalence of burnout in faculty radiologists in the United States and to explore the relationship between burnout and PF, ITL, and sleep-related impairment by gender.