‘Time has come’ to impose radiology workload, duty limits to enhance patient care and provider safety
An American College of Radiology leadership expert is advocating to cap radiologists’ workloads and obligations in an effort to safeguard the health of patients and providers.
“I propose that national radiologist workload limits and duty rules should be set to optimize radiologists’ performance and to protect their health and professional longevity,” Frank J. Lexa, MD, MBA, chief medical officer of the ACR’s Radiology Leadership Institute, wrote recently in JACR.
Lexa said maximum shift lengths should not exceed 10 hours, with an hourly limit based on the type of cases and exams being interpreted. He maintained that such restrictions should be based on scientific data and rooted in the desire to provide the best possible care for patients.
Medical errors are a significant cause of morbidity and mortality and diagnostic radiology errors are a “clear contributor” to such outcomes, Lexa explained. He cited a handful of scientific studies showing how higher caseload demands often lead to more errors and potential harm.
And like many medical specialties, radiology workloads are increasing each year. One Mayo Clinic study found the number of images read per minute by a radiologist jumped from 2.9 in 1999 up to 16.1 in 2010. Another recent analysis reported that on-call workloads have skyrocketed by nearly 300% over the past 15 years, with rising CT utilization a top driver.
The combination of soaring workloads and the pressure to keep up also exposes readers to potential medicolegal consequences, Lexa noted.
Physicians take an oath to protect their own well-being when they put on their white coat, Lexa wrote. Exhaustion, sleep deprivation and adverse health effects have all been linked to long-term consequences such as hypertension, diabetes, and other diseases, he added.
Poor health and burnout not only impact job performance but also patients and fellow providers.
“As we have been reminded during the coronavirus pandemic, healthcare workers who become sick increase the burden on the remaining workforce, with further consequences for patient care,” wrote Lexa, who is also vice chair of Faculty Affairs at the University of Pittsburgh School of Medicine's Radiology Department.
There’s no doubt many will object to capping rad workloads. Significant impacts on salaries, staffing schedules, workforce training and other factors will be top concerns. But the paradigm shift would reduce burnout, improve patient safety and create a more sustainable profession, Lexa explained.
“If we truly put our patients first and if we also want to take care of ourselves and our careers, then it is the right solution,” Lexa argued. “The time has come to create mandated, data-driven national radiology work standards for safe patient care in a sustainable physician environment,” he added.
This opinion piece is part of the Journal of the American College of Radiology’s special “provocative issue.” Read the feature in full here.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.