Key words ER-ratio - working conditions - psychosocial workload - continuing education - resident
- radiology
Introduction
As in every resident training program in Germany, radiology training is faced with
increasing demands regarding cost-effectiveness and efficiency in patient care [1 ]
[2 ]
[3 ]. As a result of the growing number of examinations, the workload has been increasing
for years – among residents in training as well as among specialists and senior physicians
and those authorized to provide training [4 ]. Medical advances, increasing specialization, and technical developments require
greater detailed knowledge and high quality of medical reports. A growing number of
physicians no longer want to work 100 % in the clinical routine: Many begin working
part time already during their training, young mothers and fathers go on parental
leave [5 ], and residents performing research want official research rotations [6 ]. In addition, artificial intelligence will dramatically change the daily routine
for radiologists. Radiology is changing and faces major challenges.
An overview of the actual training situation in Germany and how it is perceived by
residents is not yet available. At present, we can only speculate about the reasons
for dissatisfaction at work with all the associated risks ranging from high number
of sick days to burnout [7 ], high error rate, inefficiency and poor patient care [8 ]
[9 ]
[10 ]. However, they must be clearly identified in order to be able to improve training
and thus prevent dedicated young physicians from emigrating, selecting alternative
occupational fields, or reducing their working hours [11 ]. It is therefore essential to include the next generation of radiologists in the
shaping of working and training conditions and of the future direction of radiology.
The goal of the survey was therefore to assess the opinions of residents in radiology
in Germany and to compare them with the results of other national [12 ]
[13 ] and international professional radiology societies [14 ] Therefore, problems can be detected and improvement potential can be realized in
a targeted manner.
Materials and Methods
Survey
The target population was residents in radiology training. Invitations to participate
in the anonymous survey were sent either directly to participants or to the following
distributors with the request for forwarding: the German Roentgen Society (DRG), the
Conference of Professors of Radiology (KLR), the Chief Physician Forum of the DRG
(CAFRAD) and the Forum of Registered Radiologists (FUNRAD). The survey could be completed
in the 6-week period between January 15 and March 3, 2018. Participation reminders
were sent after two and four weeks. The online questionnaire provider SurveyMonkey® (Survey Monkey Inc., San Mateo, CA, USA) was used for the survey. The sample was
randomly taken from the above-named target population. Due to the anonymous nature
of the survey, it was not necessary to consult an ethics committee.
The questionnaire included 63 questions in 7 subject areas ([Table 1 ]). To ensure cross-discipline comparability, the questionnaire was based in large
parts on surveys among residents in training for internal medicine [12 ]
[13 ] and contained non-validated items except for the model of effort-reward imbalance
and the questions regarding work and family [15 ].
Table 1
Topics and number of questions,
topic
number of questions
work conditions in daily professional life
4
continuing medical education and training
9
compatibility of work and family
12
compatibility of work and research
6
model of effort-reward imbalance (short version)
16
specific questions regarding radiology
4
demographics
12
total: 63 questions
Model of effort-reward imbalance
Questions regarding the psychosocial workload were based on the short version of the
branch-independent effort-reward imbalance (ERI) questionnaire [16 ]
[17 ]. The work-stress model was based on the assumption that employees receive a defined
social reward for their efforts (social reciprocity). Based on the effort scale and
the reward scale (with the subscales of recognition, salary/career mobility and job
security), an effort-reward ratio was created. An effort-reward imbalance as an expression
of an elevated psychosocial workload is defined as an effort-reward ratio (ER ratio)
greater than 1. A third scale measures overcommitment. A high level of overcommitment
is an intrinsic tendency toward excessive commitment that can increase an effort-reward
imbalance.
Statistics
As parametric methods for statistical hypothesis testing, the t-test for independent
samples (95 % confidence interval [95 % CI]) was used to compare two groups while
ANOVA with the Tukey post-hoc test was used for multiple groups. The Mann-Whitney
U-test (MWU) and Kruskal-Wallis test (with MWU tests for post-hoc analysis) were used
as the non-parametric methods. Expected and observed distribution patterns were compared
using contingency tables and checked for statistical significance using the Chi2 test. A p-value < 0.05 was considered statistically significant.
For the tests mentioned above, the following key figures for effect size were used:
t-test Cohen’s d (magnitude of effect for the mean differences): < 0.5 small, 0.5–0.8
medium, > 0.8 large effect. ANOVA: Eta2 (percentage of explained variance): < 0.06 small, 0.06–0.14 medium, > 0.14 large
effect. MWU test: r (magnitude of effect for median differences): < 0.3 small, 0.3–0.5 medium,
> 0.5 large effect. Chi2 : Cramér’s V (Chi2 -based measure of association): 0.1 small, 0.3 medium, 0.5 large effect. An adjustment
for multiple tests was performed in accordance with Bonferroni-Holm (based on significance
level α = 0.05; 14 statistical hypothesis tests over the entire sample; new level
of significance as αX where appropriate). In all tests, the parametric and non-parametric methods yielded
a consistent result. For the sake of clarity, only the primarily used test method
is specified in the result section. All statistical analyses were performed with SPSS
Statistics Version 25 (IBM, New York, USA).
Results
Of a total of 643 initiated questionnaires, 501 were completed. Thus the percentage
of completed questionnaires that were used in the final analysis was 78 % (501/643).
[Table 2 ] provides an overview of the demographics of survey participants.
Table 2
Demographics of survey participants.
participants
total
501
gender
female/male in %
51/49
age in years
MV±SD
32 ± 3.8
%
≤ 30
35
31–34
45
≥ 35
20
year of training
MV±SD
4.3 ± 1.7
%
1st –3 rd
31
4th –5th
52
≥ 6th
17
working hours
full time/part time in %
83/17
full time female : male in %
72:94
part time female : male in %
28:6
children
no/yes in %
65/35
nationality
german/other in %
92/8
state
%, most common
Bavaria
18
North Rhine-Westphalia
17
Baden-Württemberg
15
hospital ownership
%
public
72
non-profit
11
private
17
place of employment
%
hospital providing specialized/general care
22
maximum care hospital
25
university
46
private practice
7
MV ± SD: mean value ± standard deviation.
Working conditions in daily professional life
65 % (326/501) of participants were very or mostly satisfied with their general professional
situation, 22 % (108/501) were undecided, and 13 % (67/501) were mostly or very dissatisfied.
The undecided and dissatisfied participants were surveyed regarding the reasons for
their dissatisfaction (175 participants, 15 options, multiple answers possible, average
2.9 responses/participant). high temporal workload (40 %), insufficient training quality
(35 %), lack of instruction and supervision (34 %), and work intensification (31 %)
were selected as the four most common factors. With regard to job satisfaction, there
was no statistically significant association with the hospital ownership (p = 0.1),
the place of employment (basic care or maximum care hospital, university, private
practice; p = 0.8) and the presence of children (p = 0.7). Participants were asked
how they felt the quality of patient care had changed in general and in radiology
over the last few years (scale between –5/very negative to + 5/very positive). The
rating of the participants was –0.7 ± 1.9 (mean±standard deviation) in general and
+ 0.5 ± 1.8 for radiology. Finally the participants were asked whether they have considered
or already implemented one of the following options due to dissatisfaction with their
working conditions: 15 % (75/501) have reduced and 42 % (212/501) have considered
reducing their working hours, 31 % (154/501) have changed and 37 % (184/501) have
considered changing their place of work, 3 % (14/501) have given up and 27 % (134/501)
have considered giving up clinical practice, 6 % (28/501) have moved abroad and 33 %
(165/501) have considered moving abroad.
Model of effort-reward imbalance
[Fig 1 ] shows the responses to the 16 questions regarding the short version of the model
of effort-reward imbalance. The psychosocial workload was high among participants
with an ER (effort-reward) ratio of 1.7 ± 1.6 (effort scale 76 ± 19, reward scale
55 ± 16). The ER ratio was > 1 for 79 % of participants and > 2 for 23 % ([Fig. 2 ]).
Fig. 1 Responses of the 501 survey participants to the 16 questions regarding the model
of effort-reward imbalance. Questions are marked with E: Effort; R: Reward; and O:
overcommitment.
Fig. 2 ER ratio of all participants. An ER (effort/reward) ratio > 1 means that effort factors
surpass reward factors. This implies an effort-reward imbalance and an increased psychosocial
workload.
The level of overcommitment (47 + 20) was moderate among participants. There were
no statistically significant associations between psychosocial workload and the hospital
ownership (p = 0.5) and the place of employment (p = 0.6).
Continuing medical education and training
When hired, 38 % (183/501) of those surveyed received an employment contract for the
entire training period. This was the case significantly more often at non-university
hospitals (Chi2 , p < 0.001). In contrast, only 16 % at university hospitals received such a contract
compared to 42 % at maximum care hospitals.
The use of a structured training curriculum was confirmed by 37 % (186/501) of those
surveyed and was most common at university hospitals. 52 % of those surveyed from
university hospitals had a structured curriculum in contrast to 29 % of participants
from maximum care hospitals (Chi2 , p = 0.001).
62 % of participants (311/501) expected to complete training in the defined regular
training period. 51 % of those surveyed (253/501) assumed that they will have learned
the training content required by the logbook by the end of the training period.
When asked about the occurrence and quality of the mandatory yearly interview with
the training supervisor, 40 % (197/501) of participants stated that interviews are
held but primarily to fulfill the documentation requirement. 37 % (187/501) reported
structured and constructive yearly interviews with the training supervisor, while
23 % (117/501) reported a lack of interviews. There was no statistically significant
correlation between the mode of the yearly interview with the training supervisor
and the place of employment (p = 0.024, α6 = 0.008). The existence of a structured training curriculum and regular constructive
yearly interviews with the training supervisor was statistically significantly associated
with a higher job satisfaction (MWU, p < 0.001, r 0.22 or Kruskal-Wallis, p < 0.001)
and a lower psychosocial workload (t-test, p = 0.003, α7 = 0.007, 95 % KI –0.68–(–0.11), Cohen’s d 0.25 or ANOVA/Tukey, p < 0.001, Eta2 0.04) ([Fig. 3 ]).
Fig. 3 Association of a structured training curriculum and a structured yearly interview
with the supervisor with the psychosocial workload (ER ratio) and job satisfaction.
Mean ± standard deviation. Job satisfaction on a scale of 1 to 5: 5 = “very satisfied”;
1 = “very unsatisfied”. (Mean values for better understanding. Ordinal-scaled values
were used for statistical analysis). Structured training curriculum (existent vs.
non-existent): ER ratio 1.4 ± 0.6 vs. 1.8 ± 1.9 and job satisfaction: 4.0 ± 0.9 vs.
3.5 ± 1.0. Structured yearly interview (structured vs. incidental vs. non-existent):
ER ratio 1.3 ± 0.6 vs. 1.8 ± 1.2 vs. 2.1 ± 2.7 and job satisfaction 4.1 ± 0.8 vs.
3.5 ± 1.0 vs. 3.4 ± 1.1.
42 % (211/501) of those surveyed rated participation in external continuing education
as indispensable, 51 % (2554/501) as helpful and 7 % (36/501) as not necessary. The
participants were then asked to assess which basic conditions or training instruments
would be particularly helpful (10 options, multiple selections possible, average 2.9
responses per participant, [Table 3 ]).
Table 3
Measures to improve training, compatibility of family and work as well as scientific
and clinical work.
Which basic conditions/training instruments are particularly effective for you?1
supervision by specialist or senior physician with regular case discussion
92 %
structured curriculum with fixed, transparent rotation plan
47 %
online reference works and books
43 %
congress visits and external training courses
38 %
Which of the following factors would provide a good balance between work and family
life for you?2
more flexible working hours, e. g. by having more say in determining the working time
59 %
completion of some work at home (teleradiology)
42 %
less overtime
35 %
more predictable or regular working hours
33 %
Which of the following points would make research more attractive for you?3
more time for research during clinical training
85 %
structured education and training in scientific skills
50 %
support during topic selection
27 %
Participants could choose from 1 10, 2 13, and 3 10 measures per question. The most frequent answers are given.
With respect to career, participants were asked questions about their ideal future
position and place of work ([Table 4 ]). With respect to gender (Chi2 , p < 0.001, Cramér’s V 0.32) and full-time/part-time work (Chi2 , p < 0.001, Cramér’s V 0.28), there were statistically significant associations with
the ideal future position (“other” option (6 % (31/501)) excluded from the analysis).
Male gender and full-time work tended to be associated with the aspiration for leadership
positions in hospitals or self-employment. 37 % (185/501) specified private practice
as their ideal future place of work, 26 % (130/501) specified a maximum care hospital
or university hospital without an academic career, 18 % (89/501) specified a university
hospital with an academic career, 12 % (62/501) specified a primary care hospital
and 7 % (35/501) specified industry/other. The most common desired fields of work
were as follows [446 participants answered this optional question, 11 options (including
6 options from general diagnostic radiology), multiple selections were possible, on
average 2.3 options were selected per participant]: At least one area of general diagnostic
radiology 70 %, interventional radiology 35 %, diagnostic neuroradiology 29 %, interventional
neuroradiology 16 %, and pediatric radiology 12 %.
Table 4
Career goals of survey participants dependent on gender and working hours. The career
goals of survey participants varied significantly according to gender and full-time
or part-time work (Chi2-Test: p < 0.001). 6 % (31/501) chose “other” and were not
included in the statistical analysis.
career goal
total
men
women
full time
part time
salaried specialist
n
%
79
17 %
16
7 %
63
26 %
48
12 %
31
39 %
senior physician at hospital
n
%
199
42 %
95
42 %
104
43 %
169
43 %
30
38 %
head physician at hospital
n
%
48
10 %
39
17 %
9
4 %
46
12 %
2
3 %
independent radiologist
n
%
144
31 %
78
34 %
66
27 %
128
33 %
16
20 %
total
n
%
470
100 %
228
100 %
242
100 %
391
100 %
79
100 %
p < 0.001
p < 0.001
Specific questions regarding radiology
Participants were asked to specify what they find attractive about radiology (12 options,
multiple responses possible, on average 2.7 options selected per participant). Exciting
clinical work was named as the main reason in 74 % of cases, the mix of diagnostic
and interventional work in 51 % of cases, and new technical developments and good
compatibility of family and work in 35 % of cases, respectively. 20 % (100/501) of
respondents switched to radiology after starting training in a different area of specialization.
In response to a question regarding the increase in specialization in radiology, 44 %
(222/501) of those surveyed stated that a radiologist should be a generalist for all
modalities and areas. 45 % (227/501) were of the opinion that a radiologist should
specialize in one clinical area, while 10 % (52/501) felt that a radiologist should
specialize in a specific modality. With respect to teleradiology (6 options, 1 option
per participant), 55 % of participants who provide teleradiology services to other
hospitals stated that problems occur more frequently in teleradiology examinations
than in examinations performed inhouse (e. g., technical problems, miscommunication).
75 % of participants whose hospital receives teleradiology services indicated that
teleradiology usually functions smoothly. 87 % of participants without own experience
with teleradiology have a positive opinion of the process. 64 % viewed the increasing
use of technology to analyze radiology images (e. g. with big data, artificial intelligence,
and radiomics) as an opportunity, while 23 % (114/501) saw it as a risk [14 % (68/501)
did not respond].
Compatibility of work and family
83 % (416/501) of participants worked full-time and 17 % (85/501) worked part-time.
46 % (39/85) of those working part-time felt that they are at a disadvantage with
regard to advancing in their training. 35 % (173/501) of participants had children
and answered the questions regarding the compatibility of family and work ([Table 5 ]).
Table 5
Questions regarding compatibility of family and work. 173 participants with children
answered these questions. Number/percentage.
strongly agree
tend to agree
undecided
tend to disagree
strongly disagree
I am satisfied with the compatibility of family and work at my place of employment.
22/13 %
40/23 %
52/30 %
36/21 %
23/13 %
36 %
34 %
I regularly have to neglect family obligations for work or vice versa.
44/25 %
64/37 %
40/23 %
15/9 %
10/6 %
62 %
15 %
I feel that my employer supports me in balancing work and family (e. g. with flexible
hours).
26/15 %
49/28 %
42/24 %
31/18 %
25/15 %
43 %
33 %
I feel that my colleagues support me in balancing work and family (e. g. with flexible
hours).
20/12 %
46/27 %
62/36 %
26/15 %
19/11 %
39 %
26 %
Family-friendly policies are discussed at my place of employment, for example, in
continuing education programs, newsletters, and support programs and they are thus
part of the corporate culture.
12/7 %
32/19 %
41/24 %
57/33 %
31/18 %
26 %
51 %
So far, I have decided against more family responsibility because it is not compatible
with my career path.
15/9 %
29/17 %
30/17 %
42/24 %
57/33 %
26 %
57 %
Employees without family obligations often have to fill in for employees with family
obligations.
29/17 %
62/36 %
45/26 %
29/17 %
8/5 %
53 %
22 %
66 % of the mothers and 12 % of the fathers worked part-time. The participants with
children were asked about factors that would facilitate a good balance between work
and family life (13 options, multiple selections possible, on average 2.7 options
selected per participant, [Table 3 ]). 82 % (141/173) of the participants with children went on parental leave including
89 % (89/100) of the mothers and 71 % (52/73) of the fathers. The median duration
of parental leave was 12 months. On average, women took 14 + 5 months parental leave,
while men took 3 + 3 months.
Compatibility of clinical work and research
59 % (293/501) of participants had received a doctorate. An additional 31 % (154/501)
aspired to receive a doctorate. 51 % (254/501) of participants were performing scientific
work or were planning to do so. Those performing scientific work were asked questions
with respect to the existing or expected conditions for their research. 31 % (80/254)
of participants were very or mostly satisfied, 25 % (63/254) were undecided, and 44 %
(111/254) were mostly or very dissatisfied. The following were named as the three
main reasons for (partial) dissatisfaction (6 options, multiple selections possible,
on average 2.4 options selected per participants): 87 % said that the majority of
their research must be performed in their spare time, 54 % stated that there is insufficient
material and/or personnel support from the hospital, and 52 % said that they receive
insufficient instruction/support from their supervisors. Finally, the researchers
were asked to specify which measures would improve conditions for scientific work
(10 options, multiple selections possible, on average 2.6 options selected per participant,
[Table 3 ]). Participants not performing scientific work were asked to specify the main reason
for their lack of research (6 options). The most common responses were: 26 % of participants
said “insufficient time/other priorities” and “no time in addition to clinical work”
and 17 % said “research is not important for my planned career path”.
Discussion
For the first time, this study systematically recorded the opinion of doctors in radiology
training in Germany regarding work and training conditions, compatibility of work
and family, research, and radiology. This study enables the identification of conflict
areas across locations and thus creates a basis for improvement approaches and future
strategies.
Working conditions and workload
65 % of the radiology residents were satisfied with their work situation during specialist
training – significantly more than in other disciplines like internal medicine (38 %)
[13 ], urology (44 %) [18 ], and ophthalmology (40 %) [19 ] or a cumulative evaluation of five different disciplines (46 %, including radiology)
[11 ]. In the pooled analysis 26 % were dissatisfied compared to only 13 % among radiologists.
This high degree of satisfaction conflicts with the high psychosocial workload among
those surveyed. With an ER ratio of 1.7, radiologists scored only minimally better
or even worse than internists (1.8) [13 ], anesthesiologists (1.6) [20 ] and urologists (1.4) [18 ]. Thus, residents in training had a significantly higher psychosocial workload than
other people working full-time in Germany, who had an average ER ratio of 0.6 [21 ]. One possible explanation for this seeming discrepancy could be the extremely positive
identification with the profession as a radiologist.
The high psychosocial workload of residents can have negative effects ranging from
health problems to an increasing lack of physicians and reduced quality of patient
care [8 ]
[22 ]. The quality of patient care was assessed by residents as declining both in the
present study and in other studies [11 ].
Not only prospective radiologists but also internists [13 ] and urologists [18 ] cited the high time requirement, high workload, and deficits in training as the
main reasons for dissatisfaction with current working conditions. The high percentage
of physicians considering reducing their hours and changing jobs due to dissatisfaction
with their working conditions shows that there is a risk of or there have already
been consequences. Almost one third of survey participants already changed jobs because
of dissatisfaction. Despite better job satisfaction, this percentage was higher than
in the pooled analysis including multiple disciplines (22 %) [11 ]. One possible reason could be that residents in radiology training are less willing
to accept poor working conditions. It is not clear whether this comparatively high
rate can be explained by the relatively high migration rate from other disciplines
to radiology.
Continuing medical education and training
Compared to other disciplines, fewer radiology residents received an employment contract
for the entire training period (38 % vs. 45 %). Particularly at university hospitals,
the rate was significantly lower (16 %). Short-term employment contracts and the associated
uncertainty that prevents long-term planning can also result in an increased psychosocial
workload. Especially given the increasing lack of physicians, it would make sense
to provide long-term employment contracts and systematic development and support of
employees during their professional careers.
Interestingly, a structured yearly interview with the training supervisor and a structured
training curriculum correlated across disciplines in a statistically significant manner
with higher job satisfaction and a lower risk of effort-reward imbalance. Although
the yearly interview with the training supervisor seems to be a relatively simple
means of improving job satisfaction, it is performed in a structured and constructive
manner in only 37 % of cases. A structured training curriculum is also promising but
more difficult to implement. Most participants viewed supervision with case discussion
to be the most effective training instrument. However, it requires significant time
and personnel making it significantly more cost-intensive than books and medical congresses.
Given the increase in workload and the lack of financing for specialist training in
Germany, special importance should be placed on ensuring that this valuable direct
transfer of knowledge is not further reduced. It would be desirable to institutionalize
case discussions so that they are considered as important as mandatory radiological
demonstrations and rounds in disciplines with wards. Regular case discussions ensure
a steeper learning curve with higher quality findings that can then reduce the time
needed for validation by a specialist. One study regarding the extension of student
training from 1.8 to 6.5 hours per day at a university hospital did not have a negative
effect on report turnaround times [23 ]. Hopefully, an expansion of internal training also wouldn’t have a significant negative
effect on the daily routine. Measures to improve training are summarized in [Table 6 ].
Table 6
Measures to improve training conditions.
primary time-intensive measures
structured and constructive yearly interview with training supervisor
supervision with case discussion
structured training curriculum with fixed, transparent rotation plan and internal
continuing education
primary money-intensive measures
One fifth of all participants indicated an inability to complete training within the
regular training period due to a lack of rotations, a lack of report numbers, or a
lack of personnel. In addition, the wait times for examination dates can be very long.
Depending on the German state, it can take a few months up to one year. The negative
consequences affect residents in training as well as employers who are faced with
greater scheduling uncertainty and a shortage of specialists.
Specific questions regarding radiology
Exciting clinical work and the mix of diagnostic and interventional work were stated
to be the main reasons for the high attractivity of radiology. In tumor boards and
clinical conferences, radiologists are increasingly included in essential clinical
decision processes and are thus part of the clinical routine. This coincides with
survey results among students completing their practical year [24 ]. The results showed that young radiologists would like to actively participate in
patient care.
Teleradiology received a generally positive rating but was viewed more critically
by participants personally using teleradiology since they were directly confronted
by problems more frequently. New technical developments were also rated highly. Residents
had a positive view of the future: The majority of participants viewed big data, artificial
intelligence, and radiomics as an opportunity.
Compatibility of work and family
35 % of participants considered the good compatibility of family and work to be one
of the advantages of radiology. Although this was confirmed in a direct comparison
with other disciplines, the absolute numbers show clear improvement potential.
Only 15 % of residents in internal medicine were satisfied with the compatibility
of family and work [13 ]. In comparison, residents in radiology were significantly more satisfied (36 %).
Nonetheless, every third participant in this study was dissatisfied with the compatibility
of family and work.
Residents in internal medicine felt significantly less supported by their employer
(16 %) and colleagues (27 %) with respect to the compatibility of family and work
[13 ] than residents in radiology (43 % and 39 %, respectively). Interestingly, radiologists
did not indicate any major difference between support from the employer and support
from colleagues, while internists found their colleagues to be significantly more
helpful. One possible explanation is the standardized workflow in radiology that is
not as dependent on colleagues as work on a ward.
Family-friendly policies, e. g. as a result of regular continuing education and support
programs, were already part of the corporate culture at one of four radiology training
centers, while this was the case at only one of six internal medicine training centers
[13 ]. Part-time models seem to be slightly easier to integrate into radiology training.
Although almost half of those working part time in radiology felt disadvantaged with
regard to advancing in their training, this number was significantly higher among
internists (almost two thirds) [13 ].
Despite the better compatibility of family and work among radiologists compared to
internists, these results do not yet fully coincide with the reputation of radiology
as a family-friendly discipline. In this study more flexible working hours and a home
office are the key factors that could improve satisfaction. Particularly in radiology
it is possible for planned routine examinations to be assessed on a flexible time
schedule in home office or while working part-time. The radiology home office has
already be studied with promising results [25 ]. These models should be established soon and comprehensively. Corresponding recommendations
are already available [26 ]. This would not only make work easier for residents with children but would also
free up currently unused resources. In the face of all of the (justified) excitement
about the potential of the home office, possible disadvantages should also be taken
into consideration in the practical implementation. The right of radiology to exist
as a clinical discipline as well as continuing education and training must not be
jeopardized by the lack of clinical work, such as patient consultations and direct
contact with colleagues in one’s own discipline and in other disciplines, as often
occurs in the case of a home office [26 ]. Avoiding such errors when introducing this work model is essential particularly
in light of the rapid development of artificial intelligence and automated image analysis.
The majority of those who stay home with their children are still women: They went
on parental leave almost 5 times longer than men and were 5 times more likely to work
part time. However, the number of fathers taking time off or working part time to
be with their children has increased significantly in recent years [27 ]. The reduction of working hours among women also seems to affect their career planning:
17 % of men but only 4 % of women aspired to a position as head physician. We can
only speculate about the reason for this difference. However, it can be assumed that
women find the compatibility of work and family to be more problematic and therefore
plan a different career path.
Since the number of women in medicine continues to increase, it is essential for medicine
to become more flexible and for the working and training conditions to be adapted
to the changing reality. Particularly in radiology, it would be comparatively easy
to implement structures that promote the compatibility of family and work in a targeted
manner.
Compatibility of clinical work and research
Half of the residents who participated in the survey were performing or wanted to
perform scientific work. That number was significantly higher than in internal medicine
or anesthesiology where only 19 % and 27 %, respectively, were interested in research
[13 ]
[28 ]. The high rate shows both interest in research as well as a desire to perform research.
However, this was not supported by basic conditions with which not even one third
of participants were satisfied. The main criticisms were the shifting of research
to personal time and the lack of support from supervisors and the hospital. In contrast,
59 % of American residents were satisfied with the research opportunities at their
institution [14 ]. However, this data coincides with the criticism of the German Research Society
[29 ] and the German Council of Science and Humanities [30 ] regarding research in university medicine in Germany.
To be able to keep up with rapid technical advancement and perform well in the national
as well as international comparison, conditions must be favorable for productive scientific
work and research in radiology. For this purpose, most residents wanted more dedicated
research time during their clinical education. Clinician Scientist Programs, for example,
are suitable for this purpose. They could also provide the necessary structured education
regarding scientific skills. Only in this way can we guide radiology, which has been
at the center of the digital disruption because of its extensive use of technology,
toward a successful future. Residents have the necessary potential and interest.
Limitations
The following limitations must be taken into consideration in the interpretation of
the survey results: The percentage of unvalidated and possibly suggestive questions
can distort the results. Since the participants were invited to participate in the
survey via different organizations, the basic characteristics (such as age, gender,
and place of residence) of the target population could not be recorded. Therefore,
the representativeness of the study population compared to the target population unfortunately
cannot be examined. There could be a selection bias since the satisfaction of the
participants could have affected the participation rate.
Conclusion
The working and training conditions in radiology are rated better by residents in
training compared to other disciplines. However, consequences of the increase in workload
are also seen in radiology. The current working and training conditions and the high
psychosocial workload of residents can affect the health of employees and ultimately
result in a lower quality of patient care. By improving the compatibility of family
and work, development possibilities, particularly for women, can be strengthened.
Clinical relevance of the study
The high satisfaction of residents in radiology with their professional situation
compared to other disciplines makes it attractive for prospective doctors.
The high psychosocial workload can jeopardize the health of residents and thus also
affect radiological care in the long term.
This study shows relatively simple measures that can result in an improvement of the
working and training conditions of residents in radiology.
