The World Health Organization refers to burnout as “a state of vital exhaustion.”1 The three main components of burnout have been described as emotional exhaustion, depersonalization and cynicism, and feelings of inefficacy and inadequate personal achievement.2 Burnout can severely impair healthcare by increasing the risk of medical errors, depression, and adverse effects on patient safety.3 The incidence of burnout among radiologists has substantially increased over the past decade.4,5 Factors contributing to burnout include long work hours, increasing workload, unpleasant workplace dynamics, lack of autonomy and control, isolation, mental exhaustion, overwhelming nonclinical and scholarly demands, financial strain, difficulty or delay in academic promotion, and an unclear role in patient care.4–7 Several preventive strategies aim to tackle burnout. These include both individual-directed interventions and organization-directed strategies. The key component of tackling burnout is addressing the underlying/predisposing factors, which may be achieved through fostering a nurturing work environment, promoting autonomy, improving workflow efficiency, creation of mentoring programs, enhancing job security, maintaining open communication with physicians, transparent leadership, and providing internal and external resources for maintaining wellness and preventing burnout.4–8

Radiologists and physicians of all specialties, especially those who are at early stages of their careers (including members-in-training) are encouraged by their institutions and mentors to maintain a healthy work-life balance. Nevertheless, attaining such balance often seems difficult or even improbable. Hence, we aim to provide a personal touch to this topic through an informational interview with five early-career physicians with diverse background in the field of radiology (L.Y., N.K., A.W., A.P., A.C.). These physicians were asked questions about their beliefs on and approaches to personal wellness. The goal of this interview was to highlight and appreciate the similarities and differences in this topic of wellness among people of different backgrounds and at various career stages to appeal to the reader's own. We have highlighted some of the key pearls from the interview below.

WHAT DOES WORK-LIFE BALANCE MEAN TO YOU, AND DO YOU FEEL IF IT HAS CHANGED OVER TIME?

L.Y.: Work-life balance to me means maintaining a relatively low-stress level at all times, being motivated to go to work every day, and enjoying life outside of work. At an earlier age, I mainly focused on saying yes to everything and always pushing my limits. Now I realize the key factor to keeping the work-life balance is to learn how to say no, know my limits and be willing to give up.

N.K.: To me, work-life balance means the balance of the amount of time one spends for work versus doing other things in one's personal life. I love being a radiologist and the academic work that I do, but over time, I have wanted a more balanced work/life pie chart. I am lucky to have an amazing mentor who tells me to judiciously say no to things and checks up on me to ensure I am not overwhelmed with too many academic activities. It has been a challenge to shift my priorities to maintain a healthy work-life balance and I think part of that is from just being a new attending and making the transition.

A.W.: Work-life balance is an interesting topic for those of us who fall into the millennial category. We are old enough to remember a time before the Internet and personal cell phones became common. As a result, we know what it used to be like when there was less connectivity and a clearer divide between work and our personal lives. At the same time, we came of age at a time when this technology developed and allowed for unparalleled connectivity, and therefore the expectations that come with being available seemingly around the clock. And our greater connectivity has encroached on the unaccounted time in a standard work week. In general, I think the millennials' focus on work-life balance is in part due to a revolt against the blurred lines between work and personal lives.

A.P.: Work is such a large part of my life that I have had to redefine work-life balance. I enjoy the research side of my work, which is more than half of it, to the point that for me it often fulfills the role of a hobby. To me, maintaining balance is making sure I am a dedicated spouse and parent on my nonwork hours, and a focused physician/researcher during my work hours.

A.C.: I believe having a career which one is truly passionate about while having sufficient time to enjoy one's life outside work is crucial for an ideal work-life balance. So far, achieving this balance has been an elusive personal goal considering my disposition to “say-yes” to career-related opportunities.

DO YOU EXPERIENCE FEAR OF MISSING OUT (FOMO) OR HAVE TROUBLE SAYING NO? HOW DOES FOMO AFFECT YOUR MENTAL WELL-BEING?

L.Y.: Growing up in China, I was raised in a very competitive culture. I have to constantly do well and then better, so I have validation from my parents and peers. I have to say yes nearly all the time to approve my capability. I fear that saying no, even one time, might cut off future opportunities coming to you and people might think you are unmotivated, incompetent, or arrogant.

N.K.: I definitely have trouble saying no to things, but I try to judiciously say no. I think it's easier to say no once you realize what your interests truly are and how you view your career to be. That is different for everyone, and I think that mentorship can play a role in helping people figure out what they want their careers to be. It's important to know your bandwidth because it's better to say no to things and do a few things really well rather than say yes to everything and give <100%.

A.W.: I definitely have a huge fear of missing out. Up until recently I essentially said “yes” to everything, and I had the bandwidth to do it. The key is having mentors who can guide you in the process of keeping your goals in mind and weighing the pros and cons of opportunities.

A.P.: Saying “no” is more doable than you think (I didn't say easier than you think). You just have to do it, but when you say “no,” try to offer an alternative and be helpful. For example, find someone else who would like to (and can) do what you were asked to do. I benefit from having mentors in my corner who help me decide what to take on versus what to pass on, and they back me up on those decisions.

A.C.: I experience FOMO all the time, and I feel it's almost inevitable at an earlier career stage (such as mine), since every opportunity appears to be a “not-to-be-missed-golden-chance.” This often means ‘saying yes’ to every possible opportunity, and thereby having considerably less time for oneself and subsequently increased stress. I try to tackle FOMO by seeking guidance from mentors and using self-reflection to identify goals of importance to me, which in turn helps me to prioritize tasks, which I say yes to.

HOW DO YOU PRIORITIZE SELF-CARE?

L.Y.: Self-care is so important and yet often neglected. It's challenging to squeeze time for myself after fulfilling my roles as a physician, mother of two, and wife. I try to do Pilates every week and treat myself with massage therapy every other month. I realized that the key is to plan ahead and make things happen.

N.K.: I try to meditate every night before going to bed to give me some “me” time and to help clear my head. I try to eat healthy and work out. I am still learning to better prioritize self-care, but I think that will happen once I establish a healthier work-life balance.

A.W.: Self-care has definitely been a challenge for me over time. If you were to plot my exercise habits and weight over time, you could probably easily derive where I was at in my education. The pandemic significantly limited my ability to work out given gym closures. Yet now that I've completed my training and matters are stabilizing in my new position, self-care has come back into focus for me. I'm constructing a home gym now and look forward to the changes ahead!

A.P.: Not much at this point, which probably is not good, but the current demands of my personal and professional life make it rather challenging to prioritize self-care. It's a good thing that I very much enjoy my job, and also enjoy spending time with my family.

A.C.: I often find it challenging to set aside time for self-care, although I make a conscious effort to do so. My idea of self-care includes spending time with my family and close friends who are 8 miles away, and thus, keeping homesickness at bay. Also, I often spend some “me-time” on weekends by cooking an elaborate meal, going on a long-walk, or exploring new dine-out options.

CONCLUSION

Attaining work-life balance is paramount to personal and professional success for all radiologists and trainees, but it has proven to be challenging, often unsuccessful, and ultimately leading to burnout. In fact, it has been proposed that instead of searching for a healthy work-life balance, one should pursue work-life integration, as work is not opposite of life, but rather a major part of it, as are family, friends, and hobbies. Although the meaning of wellness and self-care varies across individuals and generations, resulting in different approaches to mitigating stress and burnout, their overall value remains unquestionably important. Although the increase in rate of burnout and the need for a healthy work-life balance are both recognized among radiologists and organizations/hospital systems, much work remains to be done to address this issue. The success of efforts aimed at reducing and ultimately minimizing burnout highly depends on an in-depth understanding of the underlying contributing factors. For instance, the impact of technology on burnout among radiologists is undeniable. Hence, organizational and structural workplace changes aimed to improve the work environment require substantial input from (and active involvement of) the early-career/millennial faculty and even trainees. This generation has a unique perspective on the role of technology on burnout: they are not true digital natives but rather individuals that grew up with the evolution of technology who also harbor invaluable insight and experience with a less technically advanced world and workplace. Hence, these individuals/future leaders are uniquely positioned to envision the organizational change needed to prevent burnout and attrition in current times. Inclusion and participation of these individuals within the leadership framework of radiology departments/hospital systems as well as national and international radiological and medical societies is arguably the single-most impactful path to utilizing their unique perspective and experience.

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