Category: Radiologists

Moral Distress in Radiology

Posted on by Brian Casey

The rising volume of medical imaging studies isn’t just a data point. It’s causing moral distress among radiologists and is a major systemic cause of the specialty’s burnout epidemic. 

Radiology’s problem with burnout is no secret, with a recent analysis disclosing that 54% of all radiologists identify as burned out. Studies have found that a cause of burnout can be moral distress, defined within healthcare as when a clinician knows the right course of action for a patient, but is prevented from taking it due to systemic factors.

In a March 22 study in American Journal of Roentgenology, researchers describe findings from a survey of 93 radiologists on their feelings of moral distress in different clinical scenarios and the impact it had on their careers. In short:

  • 98% reported some degree of moral distress
  • 48% thought the COVID-19 pandemic influenced their moral distress
  • 28% considered leaving their jobs
  • 18% actually did leave a job

Several factors contribute to moral distress in radiology: 

  • Case volumes that are higher than can be read safely
  • Higher case volumes that prevent resident teaching
  • A lack of action and support among administration

These latter issues lead to burnout in specific ways, the authors wrote. Institutional constraints to providing high-quality care can prompt physicians to spend more time at work. Error rates can also grow during shifts with high study volumes or that last longer than 10 hours. And orders for unnecessary imaging exams can be seen as disregard for professional expertise. 

The Takeaway

This study rips the Band-Aid off the burnout problem in radiology, pointing out that inexorably rising imaging volumes rather than bad bosses or lazy colleagues are a root cause, one that’s been exacerbated by the COVID-19 pandemic.  

A further implication is that no amount of “self-care” – often prescribed as a solution for burnout – will cure the problem in the long run as long as radiologists will have ever-growing worklists to return to after their sabbaticals and motivational staff meetings. The researchers recommended “urgent action” to address the issue.

The Radiologist Skill Gap

Posted on by Jake Fishman

A new Stanford study revealed that diagnostic variations are largely due to differences in radiologist skill levels (not work styles/preferences, etc.), suggesting that physician skill gaps might represent a major source of healthcare waste, and warning that efforts to standardize care could lead to even worse results. 

The researchers analyzed 4.67M CXR interpretations from patients with suspected pneumonia, finding that radiologist skill level accounted for 39% of variations in positive diagnoses (both true & false) and 78% of variations in missed diagnoses. Those variations had a major impact on patient care:

  • Reassigning a patient from a radiologist in the 10th to 90th percentile for positive diagnostic rates would increase their probability of receiving a positive diagnosis from 8.9% to 12.3%.
  • Reassigning a patient from a radiologist in the 10th to 90th percentile for missed diagnosis rates would increase their probability of receiving a false negative from 0.2% to 1.8%.

Perhaps counterintuitively, they found that the radiologists who were more likely to diagnose patients with pneumonia were also more likely to submit false negative diagnoses, suggesting that less skilled radiologists are responsible for an outsized share of unnecessary, delayed, and inconsistent care.

Skill can be hard to define, but the researchers found that the “most skilled radiologists” were generally older and more experienced, wrote shorter reports, and spent more time on each report.

The researchers weren’t specifically trying to understand radiologist skill variations with this study, and their main takeaway is that we might have to change our assumptions about how to fix the U.S. healthcare system:

  • Healthcare inefficiency might have more to do with physician performance, and less to do with other commonly cited issues (e.g. misaligned payor/provider incentives) 
  • Relying on standardized approaches to equalize patient care and address cost variations might actually lead to worse care and higher costs

The Takeaway

Most readers probably aren’t surprised to hear that some radiologists are way more accurate than others, and that diagnostic skill increases with age/experience. However, this study gives new evidence supporting the value of quality improvement efforts, and could make it easier to demonstrate how radiology products/processes that reduce variability but don’t generate revenue (like AI…) might deliver clearer ROI than some might think.

Get every issue of The Imaging Wire, delivered right to your inbox.

You might also like..

Select All

You're signed up!

It's great to have you as a reader. Check your inbox for a welcome email.

-- The Imaging Wire team

You're all set!