Erik K. Paulson
2023-24 ARRS President
Over the last few years, we in radiology have faced incredible and unprecedented challenges in our day-to-day work, and this is true regardless of our specific work environments. Why? The pandemic, which has touched everyone, has had a profound impact on the workplace in general. It has changed how we work, approach work, and shaped our opinions of work. And it is not just the pandemic—it’s other phenomena: political polarization, social unrest, changes in home life and education, remote work. The pandemic and its effects led to a great resignation, and as a result, many of our sites are now understaffed. One in five doctors plan to leave their current practice in two years; two in five nurses plan to leave their practice in two years; one in three doctors expect to work less next year.
Health care workers have far greater demands now than in the pre-pandemic times. The delivery of health care has changed dramatically and quickly over the last few years. There is unprecedented “consumerism” in medicine now with a mandate to improve and rethink patient access, to provide more and better mental health services to our populations, and to have transparent pricing.
In radiology, whether you work in a large or small private practice, remotely by yourself, an academic department in a medical center, or part of a mega radiology practice, there has been a palpable shortage of radiologists. This shortage is fueled by a trend toward exclusive subspecialization with declining numbers of radiologists who can handle general work, ever-increasing expectations for service to our patients, referring doctors, hospitals, and health care systems. We have been stretched thinner. There is a desire by radiologists to have more flexible work hours or, simply stated, to work less hours overall compared to years past. There is a concern about what role artificial intelligence and machine learning will play; will we be displaced? Reimbursement has been decreasing relative to inflation and compared with other specialties. As a result of these realities and others, there is clear evidence of burnout among radiologists, similar to health care workers in other specialties. On top of that, sometimes, we find that the leaders in our organizations may be distant, or too corporate, or suffer from “toxic positivity,” which may be worse than “toxic negativity.”
There has been a steady headwind for years, but it now feels like a gale force wind. And a lot of this feels out of our control. So, goodness, how do we manage all of this?
Hold on, let’s take a breath. One strategy that we can embrace and control is to develop a culture of teams within our workplaces. In fact, I have titled this series “The Teamwork Imperative” because we must establish teamwork as a core value within the radiology workforce. I believe that if we foster a culture of teams, we can mitigate and shield ourselves from some of these headwinds.
Obviously, I’m not the first to suggest the importance of teams. It’s all over the blogs and press and our literature. In last year’s presidential address, Dr. Gary Whitman alluded to the importance of a culture of resiliency and teamwork . I will also shout out to the 2021 president of our society, Dr. Jonathan Kruskal. Dr. Kruskal, along with colleagues and ARRS staff, launched RadTeams.org—an open-access website that helps radiologists establish, grow, and sustain high-functioning radiology teams, along with other aspects of imaging wellness and wellbeing . Check it out. And you have to revisit the exciting ARRS Radiology Wellness Summit from the Annual Meeting that addressed, among many things, the importance of teams [3, 4].
Let me be clear. Here, when I say teams, I am specifically not referring to the “macro teams” that many of us find ourselves in. For example, at Duke Health, it is said that the 30,000-plus employees are my “teammates.” That very well may be true. But no, I am referring to your local and focal team. I am referring to the individuals that you rely on daily or weekly to deliver your work product. It’s the folks you huddle with. And the teams develop where you huddle. If you are in training, I am referring to your team of co-residents, your chief residents, maybe your program director or program coordinator who you lean on. If you are in a private practice, I am referring to those that you share physical space with, or perhaps switch call with, or the individuals you show difficult cases to, or the referring docs you have developed close relationships with, and who rely on you to deliver care. In an academic environment like mine, it might be the members of your subspecialty division. If done well, the division pulls together as a team to deliver care, service, teaching, and research.
Those divisions that have a culture of team are far more effective than those who are unable to act as a team. If you are lucky enough to have these local and focal teams (and these often form and evolve organically), many challenges at work open up and become more manageable and attainable. The clouds begin to lift. Specifically, your deliverables, whatever they may be, are far more easily and effectively achieved if you have your team and approach your work from the perspective of that team.
Work becomes more efficient and fulfilling and, frankly, more fun. The work becomes more manageable, with more aspects under your control. You become more engaged. And that then becomes an antidote to burnout. Teams, therefore, contribute to retention.
Coaches discuss this all the time. Just as Dr. Whitman was fond of quoting UCLA basketball coach John Wooden in his InPractice columns [5, 6], I’ll borrow here from Mike Krzyzewski, the legendary Duke basketball coach. “Coach K” famously talked about the five keys to an effective team and likened the keys to the fingers on a hand. Each finger is individual and can stand alone, but when the fingers come together into a fist, the fist proves to be much stronger than the sum of the individual fingers.
Communication, trust, responsibility, caring, productivity—my next installments of “The Teamwork Imperative” will discuss all five of these fingers and more, so please do stay tuned!
- Whitman GJ. Resilience in Radiology. ARRS InPractice website. ARRSInPractice.org/resilience-in-radiology. Published May 13, 2022. Accessed July 26, 2023
- ARRS RadTeams website. About page. RadTeams.org/About. Accessed July 26, 2023
- Kruskal J, Azour L, Goldin J. Introducing the ARRS Radiology Wellness Summit in Hawaii—Time to Get Serious! ARRS InPractice website. ARRSInPractice.org/radiology-wellness-summit-arrs-2023-hawaii. Published August 1, 2022. Accessed July 26, 2023
- Kruskal J, Azour L, Goldin J. A Lighthouse for Radiology Wellness. ARRS InPractice website. ARRSInPractice.org/a-lighthouse-for-radiologists. Published November 14, 2022. Accessed July 26, 2023
- Whitman GJ. Be a Primary Radiologist. ARRS InPractice website. ARRSInPractice.org/primary-radiologist. Published August 5, 2022. Accessed July 26, 2023
- Whitman GJ. Repairing the World. ARRS InPractice website. ARRSInPractice.org/repairing-the-world. Published November 4, 2022. Accessed July 26, 2023