Rethink Imaging

EP 12 • February 6, 2025

Addressing Burnout and Enhancing Radiologist Health with Elizabeth Krupinski

Featured Guest

Elizabeth Krupinski, PhD

Professor and Vice Chair for Research, Department of Radiology and Imaging Sciences, Emory University •

Listen Now25 min

Also on:

Let's Talk

Beyond dose

Ask us what your imaging data can actually show you.

Start a Conversation

Share This Episode

Subscribe to Rethink Imaging

In Part 2 of his conversation with Dr. Elizabeth Krupinski, host Chris St. John turns from the psychology of radiologist errors to the problem that sits underneath many of them: burnout. Dr. Krupinski, Professor and Vice Chair for Research in the Department of Radiology and Imaging Sciences at Emory University, explains how the volume of images radiologists now read, along with the growing complexity of cases, creates a cognitive load that wears people down over time. She draws a clear line between ordinary fatigue and burnout, which she describes as a chronic condition that a nap or a stretch of time off cannot fix on its own.

The conversation moves from diagnosis to response. Dr. Krupinski walks through the warning signs of burnout, including increased irritability and a shrinking tolerance for frustration, and makes the case for a culture change in how departments set expectations for radiologists. She also talks about the newer generation of radiologists, who treat psychological wellbeing as a professional priority rather than an afterthought, and about where AI could take real work off the reading list. For imaging leaders, this episode is a practical look at protecting performance and patient care by protecting the people doing the reading.

Host

Chris St. John

•

Featured Guest

Elizabeth Krupinski, PhD

Professor and Vice Chair for Research, Department of Radiology and Imaging Sciences, Emory University •

Watch the Episode

Key Takeaways

Image volume is a primary driver of burnout. Advances in imaging technology mean radiologists read far more images per case, and each one demands a precise decision that adds to cognitive load.
Burnout is a chronic condition, a step beyond fatigue. Time off or a good night’s sleep does not resolve it, and it needs sustained attention rather than quick fixes.
The warning signs are behavioral before they are clinical: increased irritability and a reduced ability to deal with frustration. Catching them early gives departments a chance to intervene.
Real progress requires a culture change in what is expected of radiologists, not just individual coping strategies. Supportive work environments are a systemic responsibility.
The newer generation of radiologists insists that psychological wellbeing matters as much as output, and AI has a role to play in taking workload pressure off readers.

Full Transcript

[00:00:00] Christ St John: You are extremely eloquent in this format, and I just, I’m

[00:00:04] Elizabeth Krupinski: Cool, thank you. I’m

[00:00:04] Christ St John: really having a good time, thank you. Oh, nice, yay! Okay, uh, so, next up, uh, I’m gonna read a second introduction for you, and we’ll just keep on going.

[00:00:14] Okay.

[00:00:15] Christ St John: Cool. Yep. So, uh, today, totally a different day on Frame by Frame, Rethink Imaging.

[00:00:22] Christ St John: We are continuing our conversation with Dr. Elizabeth Karpinski, a pioneering expert in the psychology of medical imaging. In the second part of our discussion, we will dive into into the important issue of radiologist burnout and its psychological underpinnings. As a researcher focused on human factors, medical decision making, and performance, Dr.

[00:00:42] Christ St John: Krupinski has a deep understanding of how cognitive load and stress impact radiologists ability to perform at their best. In this segment, Dr. Krupinski will share her insights in what we can do to reduce burnout. In what we can do to reduce burnout, improve radiologist health, and ultimately create a more supportive work [00:01:00] environment to enhance both individual performance and patient care.

[00:01:03] Christ St John: Welcome back, Dr. Krupinski.

[00:01:05] Thank you.

[00:01:08] Christ St John: And so, you know, we’ve been talking high scale about Mistakes on a psychological level, but like to really start to dig into burnout. It is a significant issue in many healthcare professions, um, including radiology, but from a psychological perspective, what are the main factors that are just contributing to burnout in radiologists?

[00:01:32] Uh, you know, I, I think it’s one, a matter of just the volume of images. And that is, um, one within a given. case. So, for example, C. T. And M. R. I. Have evolved from, you know, 16 slices to a kajillion slices to be right, be honest. And, you know, to get through, um, you know, a single M. R. I. Or C. T. Can sometimes take, [00: 02:00] depending on the person, the complications in the patients, the number of things to find the history.

[00:02:05] I mean, 45 minutes to an hour to get through one case. And then you’ve got 10 more that you’ve got to get through that day and it’s like, you know, wow, that’s a lot of images to get through and cases. Or if you’re on, say, you know, chest or mammography, okay, it’s not CT, it’s not MRI. Um, but now I’ve got hundreds of cases to get through and, you know, compounded, you know, where are all these images coming from?

[00:02:30] Well, we’re having an increasingly aging population. Uh, imaging is the first line. Let’s find out what’s going on. Get an image. So there’s a lot of images both on the outpatient side on the inpatient side and it’s not decreasing and it is one of the main things I think it’s just the sheer volume and to some extent the the the you know it’s it’s it’s you know it’s don’t look a gift horse in the mouth but we’ve created all this great [00: 03:00] technology um that’s more sophisticated that can hopefully find more things.

[00:03:05] And so, all right, well, let’s do it. And so now, we’re, we’re, we’re, we’re using all these imaging technologies. We’re, we’re sending all these images and expecting the world from our radiologists. Uh, so to some extent, you know, we’ve created the problem that, We’re in right now, um, because of the advances in technology and what it can do, but it, it hasn’t made, uh, you know, it doesn’t make the lesions just pop right out at you.

[00:03:38] Right. You’ve still got to search. You’ve still got to find them. You’ve still got to, you know, make decisions that are best for the patient. You’ve still got to make, classify the lesions and everything else. And so it’s, it’s literally, it’s, it’s the volume as well as. The, the nature of the decisions that are being rendered, you know, the [00: 04:00] radiologist task has changed over the years, um, from just pure diagnostic, find the lesion, tell me what it is and where it is, and okay, providers will do the rest to a much more prognostic and theranostic type of a decision making process.

[00:04:17] Um, and that, that is changing the cognitive load as well.

[00:04:21] Christ St John: Right. So, and it’s, it’s, it’s like, it’s like when you, It’s like being at work for me, right? So like I can send an email, I can have a phone call, I can text, I can send a slack, I can, you know, have a zoom call. And then all this like, yes, I have all these lovely technologies that are slightly more specifically for slightly different things.

[00:04:41] Christ St John: But then at the end of the day, I need to tell my coworker, hey, I sent you this document. Oh, where did I send that? And I have to like go through all of these things and all of a sudden all this very helpful technology is not really making me my most efficient self.

[00:04:56] Yeah.

[00:04:58] Christ St John: Yeah. I can, uh, I can [00:05:00] absolutely empathize with that.

[00:05:03] Christ St John: Um, and so are there, are, forgive me if this, if this question doesn’t, uh, come out right, but like, What aspects of cognitive load need to be balanced to prevent burnout while maintaining a high diagnostic accuracy?

[00:05:23] Uh, you know, that’s an interesting question, and I’m not sure you can really

[00:05:30] Christ St John: Right. You know, kind

[00:05:31] of measure that and say, Okay, you know, keep constant load under 50 percent and you’re going to be fine.

[00:05:36] Right, of course. It would be nice if we could. That would solve a lot of the problems in the world. You know, and I think it’s not just, um, You know, it’s a multifactorial problem. You know, it’s not just the volume of images. It’s not just how complicated these cases are and so on. It’s, you know, it’s also, you know, sort of the expectations of the health care system.

[00:05:59] Um, you know, [00: 06:00] when do the other providers, what turnaround times do they expect? What are the consequences of missing things or over calling? Uh, you know, what are just, you know, So many other issues that go into burnout and so on. And I think to some extent, you know, you can’t just blame it on cognitive load.

[00:06:19] I mean, that’s there, but, you know, people can deal with cognitive load. There’s so many ways to deal with that and, you know, adjust your schedules. I think to some extent, we as a society have to figure out, um, Um, what acceptable turnaround times? For example, um, how many cases can one expect a radiologist to read in an hour?

[00:06:48] And of what type of exam? You know, is it acceptable to say two M. R. I. S. In an hour? Is that acceptable? Acceptable cognitive load and number of images, or is it [00: 07:00] five? And, you know, I, I, I think that, you know, we don’t want to set mandates and limits and things like that. I really don’t think we want to say

[00:07:07] Christ St John: it’s counterproductive, right.

[00:07:08] Christ St John: Cause all of a sudden, if I was supposed to look at two MRIs in an hour, and then I keep, I’ve been thinking about football for 25 minutes, like,

[00:07:16] no, exactly. It, you know, I don’t think we want anybody regulating, but you know, to some extent that there’s got to be. An awareness of what’s going on. Um, and I don’t think that the other providers or the health care systems truly understand what radiologists do, to be perfectly honest.

[00:07:37] Um, and the complicated tasks that radiologists do and what, you know, what their regular workday looks like. Um, and I, I, I think it’s been that way for years. You know, a lot of other specialties in health care. The CEOs and stuff already. It’s just a service, you know, and unfortunately they treat it that way and [00: 08:00] it shouldn’t be.

[00:08:01] Um, and I think that’s to some extent where we have to make some of the changes around the expectations. And once we started to change that and get people to recognize what some of these problems are and what the radiologists are facing, that’s going to change the culture. And I think that has to change more than anything else.

[00:08:23] Christ St John: Right. Yeah. All we have to do is just a real quick cultural and societal shift, which normally pretty, pretty quick turnaround on those. I’m, I’ve

[00:08:31] heard. You know, and also, you know, just, we have to, uh, you know, it’s healthcare in general. There, there’s huge healthcare provider shortages, uh, in, in the United States around the world.

[00:08:44] And I think we have to really fundamentally change, um, how we get providers and the types of providers and what they can do. Um, you know, we’re, we’re very much MD focused, but there are other [00: 09:00] providers that could potentially do things. The role of APPs is increasing in radiology in many ways and in, in healthcare in general.

[00:09:09] Um, but we need to rely on our, our, our nurses, our APPs, our MDs. You know, we have the whole spectrum of healthcare providers and perhaps figure out different ways. of doing some of the tasks that have to be done and bringing in different levels and types of expertise to either help with triage or help with the volume or help with some of the annoying tasks that a radiologist shouldn’t have to do.

[00:09:38] Um, you know, have somebody else deal with the interruptions, have somebody else deal, uh, you know, with questions from the technologists about, you know, uh, you know, quality or exam types or protocols or something. So I, you know, it’s, yeah, it’s, it’s It’s something that’s going to take time, um, but I think that it’s something that’s going to be critically important if we’re going to [00: 10:00] maintain the levels of health care that we’re going to provide.

[00:10:02] To, to our patients over the years. It, it’s gotta change.

[00:10:06] Christ St John: Yeah, absolutely. I mean, I, you know, I used to experience decision fatigue running a restaurant and like throwing weddings, you know, like there, there would be some Saturday nights where I was just like, someone asked me a question about what to do and I’m like, I, I don’t like, I don’t do something.

[00:10:25] Christ St John: Please just do something. I dunno anymore.

[00:10:29] Exactly. You can’t, you can’t even process the question. I mean, and, and literally it’s not, you know, and people may think, oh, you’re just kidding. You know, if you just thought about it, but you literally can’t even get past that point to, to, it’s like, I can’t deal with it.

[00:10:44] And unfortunately, you know, what burnout, true burnout is really about. I mean, it’s, it’s not. you know, oh, I’m tired or I’m fatigued. Burnout is a very different phenomena. Um, you know, and it’s it’s actually being looked at, you know, [00: 11:00] by psychologists and by psychiatrists as, you know, something that that truly is beyond, you know, just being tired, just being fatigued or being frustrated or something that it’s it’s a it’s a chronic condition, and it’s something that really requires attention.

[00:11:18] You can’t just pick yourself up, you know, You know, from burnout, you know, okay, go take a nap, maybe, you know, take, take some time off and, you know, you can get refreshed burnout is, is it’s a step beyond that. And it’s really a true phenomena. And, you know, if, if we’re getting it, if we’re creating a, you know, court whole cohort of physicians that are experiencing burnout, you know, just look at the suicide rates in the healthcare profession.

[00:11:47] And a lot of that increasingly is, is due to, to burnout and, and to a lot of the other factors, um, that are affecting the healthcare system in general.

[00:11:57] Christ St John: Yeah, absolutely. I mean, I, I, [00:12:00] I did true, like, I, I truly believe I experienced like real, true burnout, uh, a few years ago when I, when I actually decided to, to upend my entire career and stop because I was burnt out.

[00:12:11] Christ St John: Um, but like. In, in like, you know, it’s not particularly sustainable to just be like, Oh, your lifelong career and you’ve burned out. Why don’t you just drop everything and walk away forever? Like, especially in this field where it’s like, yeah, we need these bodies. We need these people. How do we take care of them in a way that we can start to prevent this before it happens?

[00:12:36] Exactly. Exactly. And there, there are efforts that are going into that. Um, you know, but again, it’s a, it’s a cultural shift.

[00:12:45] Christ St John: Um, so just like psycho, I mean, this, this is going to seem like an entirely obvious question probably, but like from a psychological standpoint, how is burnout impacting a radiologist’s ability to interpret [00:13:00] images effectively?

[00:13:01] Christ St John: Um,

[00:13:02] yeah, I mean, I, I think it, it does. Um, you know, I think what it could lead to is, um, you know, uncertainty. Okay. And, um, you know, you’re, you’re, you’re so burnt out and that there’s so much volume, um, and that you, you just, like you said, you become paralyzed. And, you know, you don’t want to become paralyzed when you’re rendering these types of decisions.

[00:13:25] And I think to some extent that, that’s potentially what burnout can do. Um, I think it takes, you know, the, the cognitive load, you know, we talked about that last time. Cognitive load is probably the same, but when you’re at the point of burnout, the load is the same, but the way you deal with that load is, is just absolutely changed dramatically and you can’t deal with that load.

[00:13:49] And, you know, you, you, you potentially either. You know, there’s two ways to react. Well, probably three ways. There’s multiple ways. I guess one way to react is, okay, I’m going to slow down. [00: 14:00] Okay, I’m going to concentrate. I’m going to do this. Okay, but then the pressures build because you’ve got somebody saying, you can’t slow down.

[00:14:06] You’ve got to keep reading images. Okay, I’ll read faster. Okay, let me read faster. Let me get through these. Okay, but if I read faster, maybe I’m going to make more mistakes. I can’t read more mistakes. I’m going to get in trouble. I’m going to get sued. That’s not an alternative either. I mean, everybody kind of has their optimal speed and it’s going to differ for everybody.

[00:14:25] So, you know, figuring all that out, uh, it’s, it’s, uh, it’s very difficult.

[00:14:32] Christ St John: Yeah, absolutely. I mean, and like the, the, Like the domino effect, uh, leading to the patient, uh, is, is honestly kind of terrifying to some degree if I’m going to be totally transparent about it, right? Like the downstream effects on patient care of a radiologist experiencing burnout and just like the whisper down the lane of things that may or may not get missed until you end up at the patient is, you know, I’m sure [00:15:00] most people would Not sit with that particularly well.

[00:15:04] No, I mean, you don’t want a pilot who’s burnt out either. No, you know, I mean, yeah, I mean, you know, think about it. I mean, there’s every every profession you said, you know, the restaurant business I was in the restaurant business. Yeah, I mean you Experience burnout and it can it affects all sorts of things and everybody in every profession can experience it You know teachers experience it all the time, you know social workers special at everybody everybody in the health care profession I’m sure at some point in time has felt that way Florida with, you know, is this burnout or am I just tired?

[00:15:33] Or, you know, should I just tire and just give it up? But when, you know, people are thinking it, you know, they, they’d been, you know, you go through medical school, you go through residency, you go through fellowship and you know, you’ve been in practice say for five years and you’re experiencing burnout and you’re thinking of retiring.

[00:15:47] It’s like, wait a minute, you haven’t even been practicing for as long as you were training. There is something fundamentally wrong with this. Yeah. No, I think we’ve got to, like I said, you know, we’ve, we’ve got to one, be able to [00: 16:00] recognize it. And acknowledge that it exists, and then say, okay, what are the warning signs?

[00:16:09] So let’s not wait till somebody’s burnt out. What are the warning signs? And maybe we need more, more, you know, study on this and figure out exactly, you know, what some of these warning signs are earlier. you know, but there’s tools out there that we’re using. There’s the mass slack burnout survey and we’re, you know, a lot of departments are using that and finding, you know, giving it periodically to their, their radiologists and residents.

[00:16:33] It’s finding out is somebody at risk. Um, there’s these well being indices that people are using. And so there are ways to assess and try to predict. Okay, this person last month they were, you know, Fine. This month, wait a minute, there’s some little orange or yellow, uh, you know, signals here. Maybe we should, you know, do something.

[00:16:58] Christ St John: I’m, I’m curious. I actually, I [00:17:00] haven’t, I haven’t heard about these, these burnout. Are they there? Are they surveys? Are they tests? Like what, how, how do these, how do they work?

[00:17:07] Um, a lot of them are surveys and they’re, they’re, they validated, um, you know, by, by psychologists who are doing this and they’re not just for radiologists.

[00:17:15] I mean, there, some are specific for healthcare or specifically tuned towards healthcare. Um, and a lot of recognition came out during COVID. Right. To be perfectly honest, that, that health care providers, you know, experience burnout. And we’ve known it for years, even before that, but I think it, it brought to the general public that knowledge.

[00:17:36] But no, these are validated surveys and you go through and you answer a series of questions that, like I said, have been carefully designed and validated, uh, that can, that can, uh, assess, you know, whether somebody is, you know, kind of going down or exhibiting signs of burnout. And, um, you know, it all depends on what you then do with these.

[00:17:58] So, you know, and that that’s where the [00: 18:00] tricky part comes into some extent. So, you know, it’s all well and fine to do the surveys and do them anonymous anonymously and then feed that back to whoever took it. And the survey, you know, You know, you get an email saying, Oh, by the way, you look like, you know, you’re a little more stressed than last month.

[00:18:14] You might want to consider blah, blah, blah, you know, and then it comes back on the person to do something. Do we make these available to division directors, to department chairs, to HR? You know, that’s where you get into, you know, funnier issues and, you know, and, and things that are a little more, um, harder to navigate.

[00:18:36] Uh, you know, Should we make these available? Um, you know, I think pilots go through and they do specific batteries. Um, and I think they go through before they go on flights or periodically, they have to take certain types of, you know, these surveys and tests, not for burnout, but, you know, for alcohol abuse and all sorts of stuff.

[00:18:57] And, you know, are you ready to take this flight? Really? [00: 19:00] Okay, should we do that with radiologists and other physicians before, you know, at the beginning of the day? Are you ready to be, you know, flying in the radiology room today? And, you know, but, but that’s again, something that, you know, we as a society have to figure out where we want to go with all this and, you know, at what level do we monitor and intervene?

[00:19:24] Christ St John: Absolutely. I mean, my, my, my grandmother just lost her license after taking a test to, you know, See if she was still okay to drive and she failed. I love her to death, miserably, you know, she’s she’s mid 90s She shouldn’t have been driving for probably a little while. I hope she doesn’t listen to this.

[00:19:43] Christ St John: Mimi. I love you but Immediately her response after taking the test is oh, well, I shouldn’t have taken that test if I had known I was gonna lose my license[00:20:00]

[00:20:00] Christ St John: In this industry where everyone is so short staffed and there’s already not enough biodies and images are piling up and someone tells you, hey, like, you’re probably pretty burnt out. Why don’t you just let your team get further burnt out while you try and fix like there is no good solution.

[00:20:17] Exactly, exactly.

[00:20:18] And it kind of goes back when I was talking about before, which is the pipeline. I mean, maybe we need to rethink. You know, how many people, how many medical schools we have, and how many students we admit to medical school. Maybe we need to increase that dramatically. Uh, you know, maybe we need to redefine some of the roles of different health care providers to, to be able to take over some of the duties of, of, of the different providers.

[00:20:41] And I think there’s, there’s ways to address it, um, but it, it really is so ingrained in our society, every society, about what, what’s expected of health care providers. That’s going to take a long, not a long, hopefully not a long time, but it’s going to take time to change.

[00:20:59] Christ St John: [00:21:00] Yeah. And I’m, I, I’m curious. And if you don’t have an answer to this, it’s, it’s totally fine.

[00:21:04] Christ St John: But I’m curious like what are some of the warning signs that a radiologist should be looking for within themselves? And are there strategies that they can use to like mitigate it as they realize that they’re starting to burn themselves out?

[00:21:18] Yeah. I think, you know, some of the things that, that you can look for, um, Are, um, just as a positive.

[00:21:26] Are you seeing my video or does it matter? Uh,

[00:21:29] Christ St John: your video actually just froze on me. But, the audio is still there. I wonder, I’m, I mean, I guess, let me take a look. I think, I think we’ll probably be fine if we have to, I mean, if we, I mean, honestly, the YouTube version of, of this is the thing that we, um, that’s like our smallest pocket.

[00:21:58] Christ St John: Most of almost [00:22:00] everyone exclusively listens to the audio format. Um, yeah, let’s, um, let’s, let’s keep going with it.

[00:22:08] Okay. Yeah. I’m not sure why I’m completely frozen.

[00:22:11] Christ St John: Hmm. Actually. Oh, hang on. We just lost you. Something went wrong.

[00:22:49] Christ St John: Hey, welcome back.

[00:22:51] Elizabeth Krupinski: I think I’m back. Can you hear me?

[00:22:53] Christ St John: I can hear you. I cannot see you anymore. But, um, I’m going to [00:23:00] say to some degree.

[00:23:02] The problem is on.

[00:23:03] Christ St John: So it says you have no camera selected. Um, if you go, if you look on the right, um, under your name, there’s like three little drop downs with arrows. One that’s camera, one that’s mic, and one that is headphones.

[00:23:18] Christ St John: If you drop down where it says no camera, you should be able to select, uh, your computer’s webcam. And if that doesn’t work, we can just keep talking.

[00:23:33] Hmm.

[00:23:40] It says my micro cam is in use by another app. Hmm.

[00:23:44] Christ St John: Hmm.

[00:23:46] That is weird, because I know it’s not.

[00:23:48] Christ St John: Right, this is the app.

[00:23:49] Yeah.

[00:23:53] Christ St John: Well, I

[00:23:54] guess if we’re okay and you’re recording, and you don’t mind not having video.

[00:23:59] Christ St John: I mean, you know, [00:24:00] it’s, it’s, it’s, it’s not perfect, but what I really care about is, is the, is the podcast itself. Um, and we absolutely have enough content to do, like, some little, like, video clips and assets. Um.

[00:24:14] Elizabeth Krupinski: Settings?

[00:24:17] Christ St John: Are you on a, uh, on a, on a Mac or a PC?

[00:24:20] Elizabeth Krupinski: I’m on a PC.

[00:24:21] Christ St John: Oh gosh, then I’m going to be of no help to you.

[00:24:23] Elizabeth Krupinski: Yeah, no.

[00:24:24] I mean, it’s, it’s like

[00:24:27] Christ St John: Hm.

[00:24:28] The problem is I got a new computer on Friday, but I mean Um Hm. And it’s like it’s not allowing me to change or select anything.

[00:24:44] Christ St John: Okay! Oh my god. Yeah, let’s, let’s, let’s just finish up the episodes then.

[00:24:47] Christ St John: I don’t want to eat up your time anyway. And yeah, I’ll just, I’ll, I’ll let our editing team know to just switch to an audio only format for the YouTube for the last few minutes, which is, which will be no big [00:25:00] deal. Um,

[00:25:02] Elizabeth Krupinski: so I, we were talking about the signs and symptoms. Yeah. So,

[00:25:05] Christ St John: so, uh, I think I was asking like, what are some of the signs that a radiologist could look for at burnout within themselves?

[00:25:13] Christ St John: Um, and what are some steps they could do to try and mitigate that burnout if they start to recognize those signs?

[00:25:20] Yeah, I think, you know, some of the signs of burnout, you know, as opposed to just, you know, general fatigue and so on. Yeah, because we all get fatigued. Uh, you know, fatigued kind of goes away.

[00:25:32] Um, you know, at the end of the day, you’re fatigued, you go home, you know, you have a nice hot dinner and go straight to bed, you know, by the next morning, you know, things are better, you have a better outlook. Some of the signs of burnout, however, are, um, increased irritability. Uh, increased inability to sleep.

[00:25:51] to deal with frustration, to deal with interruptions. Um, you know, just to deal with things that high anxiety, [00: 26:00] uh, the feeling that you’re way behind, you’re never going to catch up. You know, there’s, it’s, it’s those feelings that are, you know, the above and beyond again, just kind of feeling tired, um, where it really starts to be pervasive.

[00:26:16] And we’re, when you leave at night, it doesn’t go away,

[00:26:20] Christ St John: right?

[00:26:21] So the thoughts continue to haunt you. Uh, you’re up at night worrying that the work list that you’re going to face in the morning is going to be huge and you you’re terrified to go into work. So it’s, it’s, like I said, it’s, it’s that, that level beyond.

[00:26:38] Yeah. And you know, Once it’s at, and those are some of the warning signs, you know, once it gets to that on a continuous basis, then, you know, then you’re probably going to potentially need psychological help. Um, but once you start to experience, you know, some of these and you realize that it’s not just, you know, fatigue, that this is really [00: 27:00] starting to, you know, Dominate your life.

[00:27:03] Um, and you’re starting to see these in increasing, you know, that’s the point in time where you have to then, you know, potentially go and talk to your division director, right? And say, look, this is getting too much. Not that I wanna slack off, not that I wanna give work to others, but I can’t deal with this.

[00:27:23] Mm-hmm . Um, you know, can, can we figure out, you know, potentially, you know. four days on one day off. So, you know, different ways of scheduling and potentially reducing the workload for a bit, whether it’s division director, your department chair, whoever, that’s sort of the first way to start to deal with it is let’s figure out a way to adjust what’s going on once it gets to that extreme point.

[00:27:48] Um, you know, like I said, that’s where potentially getting psychological help, but that’s where a lot of people just say, forget it, you know, I need to take FMLA. I’ve got to [00: 28:00] figure out a different way of doing this, or some people actually just leave radiology. You obviously don’t want to go that far. You want to catch some of the early signs.

[00:28:09] And, you know, the two most common ones I would say are probably anxiety and irritability.

[00:28:14] Christ St John: Mm hmm. Yeah, I remember I remember when I was when I was truly burnt out, like, every everything that I used to do to like recharge from my fatigue stopped working. You know, like that that was that to me was like the really big wake up call when I was like, wow, I can sit at home all day on a Sunday and, and do all of these self care activities and get a massage and a haircut, which makes me feel good.

[00:28:45] Christ St John: And I am no better off than when I stopped working. Like

[00:28:49] exactly. And that’s kind of the problem that, you know, radiologists are facing because everybody is acknowledging the fact that yes, it’s a severe problem that people are fatigued. People are getting to the point of burnout and so [00: 29:00] on. And people are trying to figure out what to do.

[00:29:01] With it. Now, like I said, there’s these well being indices. There’s these burnout surveys. You know, people are looking at, you know, let’s let’s do yoga. Let’s do, you know, let’s take an hour off. Let’s go for lunch,

[00:29:18] Christ St John: right?

[00:29:19] To some extent, you know, those are those are good things. But if going and taking an hour off for lunch, as opposed to, you know, you know, Grabbing the bag of chips and eating it while you’re reading leads to more anxiety.

[00:29:31] Cause you’re taking that hour off. It’s counterproductive.

[00:29:34] Christ St John: Absolutely.

[00:29:35] Yeah. And so, you know, it is, it’s a significant challenge because you can sit there and say, okay, yeah, you know, just stop, go take a nap.

[00:29:44] Christ St John: Right.

[00:29:45] But these, these are great suggestions, but they’re just all not always feasible.

[00:29:51] Christ St John: Absolutely.

[00:29:51] Christ St John: And like the catch 22 of like living in a culture of. Productivity. I’m going to use some air quotes there, uh, [00:30:00] where like you are, you’ve been conditioned your entire life to feel guilty for taking time for yourself, for not feeling productive. Like, yeah, it’s, it’s this horrid little loop, um, that you’re going to get stuck in.

[00:30:15] Right. Yeah. And until, like I said, until we face this at a much broader level. You know, the tools are there. We know what to do. You know, I mean, there, there’s ways we people have studied burnout for years in the field of psychology. I mean, they, they know the signs, they know the symptoms, they know ways to treat it and prevent it and so on.

[00:30:35] But in the practical real world, it just doesn’t always work.

[00:30:40] Christ St John: Absolutely. And so looking, looking to the future, like what, what changes would you recommend? To the next wave of radiologists, what changes would you recommend to ensure that they are better prepared to cope with the psychological [00:31:00] challenges of this profession?

[00:31:03] Boy, that’s a good question. Yeah. You know, do you want to, you know, they know in advance, I mean, they, you know, because they, they experience and they, they see what, what the field is about. So, you know, a lot of them are, are going in with wide, you know, with eyes open, um, you know, but I mean, that’s health care in general.

[00:31:21] I mean, there’s other, um, you know, specialties that are far more, uh, susceptible to burnout than radiology. Um, you know, but they all really are, you know, I think it’s a matter of, um, you know, Kind of acknowledging one that it exists. I mean, you can’t pretend that it doesn’t. Um, but providing them with the tools, uh, for example, AI is clearly at some point in time going to help with this, I think.

[00:31:52] Um, you know, we’re not there yet. Nowhere near. Um, you know, unfortunately, I think it’s probably a good 10, 15 years down the road [00: 32:00] before we, um, Truly see the full potential of what I can do for efficiency and efficacy. Uh, you know, and not just a little isolated pockets. Um, and so I think it’s You know, and it’s funny.

[00:32:17] So we know what the tools are there. They’re out there. I think it’s a matter of getting them into the workflow, getting people to recognize what the symptoms of burnout and fatigue are. Um, you know, but a lot of the younger generation radiologists coming in now are already aware of this stuff and, you know, saying my well being matters.

[00:32:38] Whereas, you know, older generations were like, you know, you plug through, you go to work at seven, you leave at seven. And if you’re tired, who cares? You just plug through it. You got to get the, you know, you, you’ve got to accomplish these cases. They’re there. We’re new generation coming in and saying, no, wait a minute.

[00:32:56] There is such a thing as work life balance. [00: 33:00] And they’re still kind of exploring what that means. Yeah. But they are insisting upon it, and they are saying, you know, that, that, that it is important that their psychological well being is just as important as what they do at work. And if they don’t have that sense of psychological, emotional, mental, physical well being, it will impact their work.

[00:33:26] Christ St John: Right.

[00:33:26] And, and that’s the acknowledgement. And that’s sort of this, this generation coming up now and the ones that are coming up after them are, they’re the ones that are going to, you know, lead to changes because they’re, they’re not going to put up with it. And so they’re, to some extent, I can say, okay, well, okay, you’re not going to put up with it, but now you’ve got to figure out how to figure out what the solutions are.

[00:33:51] And to some extent, that’s where it’s going to end up is because they’re, they’re the generation that’s going to be coming in. Um, that are going to have these tools that are going to, [00: 34:00] uh, you know, have a sense of, of what they want and how they want it. Um, and they may be the best ones to figure out how to make it happen.

[00:34:07] Christ St John: Absolutely. Um, Alright, so, um, that, that is all that I had for you in terms of questions today. Before I do a little wrap up and let you go, I just wanted to give you the opportunity. Are there any, is there anything you wanted to touch on specifically? Any questions that you want me to ask? Anything you want to plug?

[00:34:31] Christ St John: Like, do, is there anything that you want to use our last couple of minutes to touch on? Or are you feeling, uh, pretty good about stuff?

[00:34:39] I’m feeling good. I think we’ve touched on just about everything I would have wanted to talk about.

[00:34:44] Christ St John: Absolutely. Um, okay. And so, uh, with that, that brings us to the end of our episode.

[00:34:52] Christ St John: Once again, Dr. Elizabeth Krupinski is a professor and vice chair for research in the department of radiology and imaging sciences at Emory University [00:35:00] School of Medicine. Dr. Krupinski, thank you so, so much for joining us today. Um, and I can’t wait to chat with you again sometime. Thank you so much.

[00:35:09] Thank you for the opportunity.

[00:35:11] Christ St John: Absolutely. You have a wonderful day.

[00:35:13] You too.

[00:35:14] Christ St John: Um, that’s it. You are free as a bird. Um, thank you for some. Excellent, excellent episodes. Um, I will follow up to you, uh, with an email about when it’s going to come out. I’ll send you like little assets and clips that you are welcome to share on your LinkedIn or whatever.

[00:35:35] Christ St John: If, if that’s your speed, if you’re not into that, there’s no pressure from us. Um, and, um, I also will be sending you a nice little jacket and a little thank you card, uh, and I will absolutely continue to stay in touch with you. Thank you so much.

[00:35:51] Thank you.

[00:35:52] Christ St John: Absolutely. Yeah, right. It’s fun. Um, awesome. Thank you so much.

[00:35:58] Christ St John: You have a wonderful day. [00:36:00] All right. Bye.

Questions from This Episode

What is driving burnout among radiologists?
Dr. Krupinski points to the sheer volume of images and cases radiologists must process, which has grown dramatically as imaging technology has advanced. Combined with the complexity of modern studies, this creates a sustained cognitive load that pushes readers toward burnout.
How is burnout different from ordinary fatigue?
Burnout is a chronic condition, not tiredness that a nap or a vacation resolves. Dr. Krupinski notes that it is now recognized by psychologists and psychiatrists as a distinct problem, and that it shows up as increased irritability and an inability to deal with frustration, not just exhaustion.
What can imaging departments do about it?
Dr. Krupinski argues for changing the culture around what is expected of radiologists, recognizing warning signs early, and building supportive work environments. She also sees promise in AI as a way to reduce workload, and points to the newer generation of radiologists who are making wellbeing a stated priority.