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Satisfaction of Radiologists in the United States: A Comparison between 2003 and 1995¹

¹ From the Department of Radiology, Hospital of University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Research Department, American College of Radiology, 1891 Preston White Dr, Reston, VA 20191 (R.S.L., J.H.S.); and Department of Diagnostic Radiology, Yale University, New Haven, Conn (J.H.S.). Received June 16, 2006; revision requested August 21; revision received September 28; final version accepted November 9. Address correspondence to R.S.L. (e-mail: rlewis@acr.org).

	ABSTRACT

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Purpose: To prospectively ascertain what characteristics of radiologists, their practices, and their work environment affect professional satisfaction and to describe recent changes in satisfaction.

Materials and Methods: Survey respondents were guaranteed confidentiality. Those who consented to participate were informed of the nature of the study. The authors analyzed nonindividually identified data from the American College of Radiology 2003 Survey of Radiologists, a nationally representative, confidential, stratified random-sample mail survey of radiologists in the United States, which had a 63% response rate, with a total of 1924 responses. Data were weighted to be representative of all U.S. radiologists and were analyzed by using univariate and multivariate analyses. The five answer options to questions regarding level of satisfaction corresponded to scores of +2, +1, 0, –1, and –2. Results were compared with those of a similar 1995 survey.

Results: Although 93% of radiologists enjoyed radiology very much or somewhat, the mean satisfaction score for posttraining professionally active radiologists decreased from 1.62 in 1995 to 1.47 in 2003. Thirty-two percent of radiologists reported enjoying radiology more than 5 years ago; 41% said they enjoyed it less. Excessive workload reduced current satisfaction and satisfaction relative to 5 years ago. Working in the Midwest enhanced current satisfaction and satisfaction relative to 5 years ago. Practice type and practice ownership had more varied effects on professional satisfaction; subspecialty type had relatively little effect. In 2003, medicolegal climate, workload, and reimbursement and/or financial pressures were the three most common reasons for decreased satisfaction. In 1995, interference from managed care; government regulations, control, and red tape; and increased administrative burden were the three most common reasons. Lifestyle and/or work hours, and income were the most common causes of increased satisfaction in 2003, but these were also often mentioned as causes of decreased satisfaction.

Conclusion: Radiologists have higher levels of professional satisfaction than do other physicians; however, as with physicians overall, their satisfaction has decreased over time.

Supplemental material: http://radiology.rsnajnls.org/cgi/content/full/2441061049/DC1
http://radiology.rsnajnls.org/cgi/content/full/2441061049/DC2

© RSNA, 2007

	INTRODUCTION

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Professional satisfaction can affect not only work motivation but also career decisions and even personal health and relationships with others (1). Because of the importance of professional satisfaction and dissatisfaction and the factors that influence them, the American College of Radiology (ACR) gives careful attention to these topics, addressing them in its periodic radiologist surveys. Thus, the purposes of our study were to prospectively ascertain what characteristics of radiologists, their practices, and their work environment affect their professional satisfaction and to explain any recent changes in satisfaction.

	MATERIALS AND METHODS

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Data Collection
The data cited herein are from the ACR 2003 Survey of Radiologists (hereafter, the 2003 survey). The 2003 survey was a nationally representative, stratified, and random-sample mail survey of radiologists in the United States, which has been described in detail previously (2–4). Data from the ACR 1995 Survey of Radiologists (1,5), a similar earlier survey with a different respondent pool, were also used and compared with those from the 2003 survey. Survey respondents were guaranteed confidentiality, and those who consented to participate had been informed of the nature of the studies. For further assurance of confidentiality, the 2003 survey was conducted by an outside contractor, not the ACR. The response rate in 2003 was 63%, with a total of 1924 responses, as described in detail elsewhere (3). In this study, we included those posttraining professionally active radiologists and trainees who responded to either of the two survey questions on satisfaction. Retirees and others not active in radiology were not asked about satisfaction and were excluded from this study.

The variables used in the 2003 survey have been defined in previous publications (2–4). It is of special interest for this study, however, that in the 2003 survey, radiologists were asked two questions to measure satisfaction that had been used and validated in the 1995 survey (1,5): First, to evaluate current satisfaction, radiologists were asked, "Thinking about all aspects of your work, what is your feeling about working as a radiologist?" There were five answer options: enjoy very much, enjoy somewhat, neither enjoy nor dislike, dislike somewhat, and dislike very much. Second, to evaluate changes in satisfaction, they were asked, "Compared to 5 years ago, would you say you enjoy radiology now:" Again, they had five answer options ranging from much more to much less. Respondents were next asked to identify the main reasons underlying their answer to the second question from a menu of 15 options developed from the most frequent responses at pretest polling of the ACR leadership.

Data and Statistical Analyses
Statistical analysis was conducted by using SAS, release 9.1, software (SAS Institute, Cary, NC). The data are weighted to make them representative, as if all radiologists in the United States had been surveyed and had responded. Reported statistics were calculated, taking into account not only the weighted nature of the data but also the complex—that is, multiple-strata—survey design (2–4), by using the SAS procedures "surveymeans" and "surveyreg."

For characteristics of the radiologists (eg, age) and their practices (eg, academic practice), we determined the percentage of radiologists in each characteristic category who gave each of the five possible responses to each satisfaction question. A mean enjoyment score was then created for each category by assigning the value +2, +1, 0, –1, or –2 to the five responses to the question. This technique has been used productively to analyze satisfaction data from previous ACR surveys (6). However, "very much" may be more distant from "somewhat" than "somewhat" is from a neutral answer. Thus, a +3, +1, 0, –1, and –3 scoring system was also tested. As in a 1990 ACR survey (6), in the 2003 survey, both scoring systems yielded virtually identical results; therefore, only the results of analysis performed with the +2 to –2 scoring system are included.

In addition to evaluating categories defined by using a single characteristic (univariate analysis), we performed multiple regression analysis by using a +2 to –2 scoring scale. Multiple regression identifies the independent effect of each characteristic studied while statistically controlling for the effects of all others and thus gives a better understanding of the true effect of each characteristic. For characteristics that can have multiple values (eg, geographic region), with multiple regression analysis, one uses one characteristic as the baseline category and compares the other characteristics with it. We used the most common category (eg, the South region) as the comparison category.

We used P < .05 to indicate statistical significance. However, in the multiple regressions, we also cited variables that yielded P values of .05 < P < .10, defining them as marginally significant. Because the sample size for subspecialties in particular is often relatively small and the regressions have many variables, the statistical power of any individual subspecialty analyzed is relatively low and it is useful to call attention to a wider range of potentially important characteristics that affect satisfaction. The reported reasons for professional satisfaction relative to satisfaction 5 years ago were analyzed by determining the percentage of respondents separately for each satisfaction level.

	RESULTS

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Fewer than 5% of responses to the current satisfaction question were dislike somewhat or dislike very much, so to provide an adequate sample size, these two response categories were combined. Similarly, fewer than 20 respondents were from small subspecialties. Because of the small sample, the results for these small subspecialties are not reported.

Current Satisfaction
Ninety-three percent of radiologists selected the response enjoy (radiology) very much (61%) or enjoy somewhat (32%) (Table E1; http://radiology.rsnajnls.org/cgi/content/full/2441061049/DC1); 3.0% were neutral, 3.5% replied "dislike somewhat," and 0.5% replied "dislike very much." A higher percentage of trainees (69%) than posttraining professionally active radiologists (60%) selected enjoy very much. Concordantly, the mean satisfaction score for the trainees (1.66) was higher than that for the posttraining professionally active respondents (1.47).

At univariate analysis, a number of characteristics of the posttraining professionally active radiologists and their practices were associated with significantly increased or significantly decreased current satisfaction. Radiologists aged 35–44 years, those older than 65 years, those whose workload was "about right," and those working in an academic nongovernment practice had a higher mean current satisfaction score than did other radiologists. Significantly lowered satisfaction was associated with age 45–54 years, desire for decreased workload—even with a corresponding decrease in income, and employment in a private radiology-only practice.

Regression analysis (Table 1) revealed that with all other things equal—that is, after statistically controlling for the effects of all other factors considered in the analysis—posttraining professionally active radiologists who spent more than 10% of their work time in practice management or administration or in professional society work (excluding professional society meeting time) had higher satisfaction than did those who did not. Radiologists who worked in an academic nongovernment practice had higher satisfaction than did those who worked in a private radiology practice. (Private radiology practice was used as the baseline comparison category.) Radiologists in the Midwest were more satisfied than were those in the South, and radiologists who subspecialized in abdominal or breast imaging were marginally more satisfied than were nonsubspecialists. With all other things equal, decreased satisfaction was found among male radiologists and radiologists who desired a decreased workload, even with a corresponding decrease in income (relative to about right workload).

At univariate analysis, the reported satisfaction (in 2003) relative to that 5 years ago was increased for radiologists younger than 35 years, those aged 35–44 years, those not a partner in their practice, those with a self-reported workload that was about right, those spending less than 10% of their work time in practice management or a professional society activity, those working in the West, those working in a practice that mainly served the main city of a large metropolitan area, those working in a practice that served nonhospital sites only, and those working in a practice partly or wholly owned by persons or entities other than physicians in the practice.

At univariate analysis, low reported satisfaction relative to that 5 years ago correlated with age 45–54 years or 55–64 years, being a partner, spending more than 10% of work time in practice management or a professional society activity, subspecializing in interventional radiology, desiring a decreased workload even with a corresponding decrease in income, working in the South, working in a private radiology-only practice, working in a practice that served both hospitals and nonhospital sites, and being in a practice owned entirely by physicians in the practice.

Multiple regression analysis (Table 2) revealed that with all other things equal, reported satisfaction (in 2003) relative to that 5 years ago was high for radiologists in the Midwest or West (compared with that for those in the South) and for radiologists working in practices serving nonhospital sites only (compared with that for those in practices serving both hospitals and nonhospital sites). Reported satisfaction relative to that 5 years ago was marginally high among respondents subspecializing in neuroradiology or pediatric radiology (compared with that among nonsubspecialists) and among radiologists working in practices partly owned by outsiders (compared with that among those working in practices completely owned by physicians in the practice).

Reasons for Enjoyment or Dislike of Radiology
Those radiologists who reported that they enjoyed radiology much more (in 2003) than they did 5 years ago (Table 3) cited the following most common reasons: lifestyle and/or work hours (63%), income (56%), new technology (40%), interest (36%), and changes in arrangements for after-hours shift coverage (28%). Those reporting that they enjoyed radiology much less than they did 5 years ago (Table 3) most often cited medicolegal climate (75%), workload (56%), reimbursement and/or financial pressures (55%), government regulations (48%), and lifestyle and/or work hours (47%) as the most common reasons. Respondents who enjoyed radiology somewhat more and somewhat less than they did 5 years ago emphasized much the same reasons, respectively, as those who enjoyed radiology much more and much less than they did 5 years ago.

Among those radiologists who reported that they enjoyed radiology much more or somewhat more than they did 5 years ago, the most frequently cited reasons were work duties and/or environment, and new technology in 1995, compared with lifestyle and/or work hours, and income in 2003 (6). In 2003, among those radiologists who reported that they enjoyed radiology much less or somewhat less than they did 5 years ago, medicolegal climate, workload, and reimbursement and/or financial pressures had replaced interference from managed care; government regulations, control, and/or red tape; and increased administrative burden as the three most common reasons.

	DISCUSSION

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Our finding that 93% of radiologists in 2003 enjoyed their work very much or somewhat shows that they enjoy their profession more than physicians in general do. Data from the 1997–2001 Community Tracking Study Physician Survey, a nationally representative telephone survey in which the same two questions about enjoyment of work were asked, show that overall, just over 80% of all physicians answered with these two responses (7).

The reported above-average satisfaction of radiologists is somewhat surprising given that patient contact is a major source of satisfaction for physicians overall and that radiologists, in comparison, have little patient contact. However, relatively recent research (7,8) suggests that while physicians derive satisfaction from patient care, income and lifestyle have become increasingly important for their satisfaction. This finding is supported by our finding that in 2003, lifestyle and income were the main reasons cited for high levels of radiologist satisfaction—both currently and relative to 5 years ago.

Several previous studies (7–10) have revealed slightly decreased levels of satisfaction over time among physicians in general despite high levels of current enjoyment of medicine. We found that mean current satisfaction scores among posttraining professionally active radiologists decreased significantly from 1995 to 2003, continuing the trend seen between 1990 and 1995 (1).

The overall downward trend for physician satisfaction in general may be part of a larger trend of decreased satisfaction over time found for professionals including lawyers, teachers, and nurses as well as physicians (10), which may be related to increased workload. However, other changes that influence medicine specifically, including changes in patient populations and patient expectations, and changes in financial and regulatory factors may also be important. In any case, the most frequently cited reasons for radiologists' increased or decreased satisfaction have changed over time, with different major phenomena in the work environment—such as managed care or malpractice woes—waxing and waning.

The reported low satisfaction in radiology, both currently and relative to 5 years ago, that was due to work overload and was so serious that the radiologist not only wanted less work but also was willing to accept a proportionately lower income (eg, take a 15% income cut to receive a 15% reduction in workload) is not surprising. This finding is bolstered by the results of multiple regression analyses of the 1995 ACR survey data and the 1997–2001 Community Tracking Study Physician Survey data for primary care physicians, both of which show that physicians who work particularly long hours have lower current satisfaction (1,7,8).

The negative effect of aging on satisfaction relative to satisfaction 5 years ago may represent a tiring of one's career. The peak of this effect at about retirement age probably is reflected in the fact that only those radiologists who particularly enjoy their work remain active in the profession past the usual retirement age and thus that average satisfaction is higher among radiologists who continue to work well past the usual retirement age. Multivariate analysis of the 1996–1997 Community Tracking Study Physician Survey data for all physician specialties revealed a similar U-shaped curve with age (7,8). However, analysis of the 2003 survey data did not reveal a significant age-related effect (1).

The enhanced current satisfaction in academic nongovernment practices found at regression analysis probably does not reflect differences in workload between academic nongovernment practices and private practices, as differences in undesired workload should be accounted for in the work overload variable. We believe, instead, that this finding reflects the satisfaction in academic work—such as teaching, research, and working with junior colleagues. Regression analysis of the 1995 survey data also revealed higher satisfaction in academic practices (1).

If it is true that the "hassle factor" generally decreases satisfaction, how can radiologists who spend more than 10% of their work time in practice administration and professional society activities have enhanced current satisfaction? We believe the enhanced satisfaction of these radiologists is reflective of the following: (a) that professional society work can be very fulfilling, (b) that in practice groups, those (generally few) radiologists who enjoy managerial activities generally are the ones who take them on, and (c) that radiologists involved in practice administration and management have a greater sense of control over their work environment than do those who do not.

We are uncertain why female radiologists, with all other things equal, were more satisfied professionally than male radiologists, especially since the regression analysis controlled for the effects of correlates such as age, part-time status, and practice characteristics. Whatever the explanation is, this may be regarded as a positive finding and probably should be emphasized given that relatively few women enter the field of radiology (11).

It is surprising that specialty type was found to have no clearly significant (P < .05) effects on satisfaction, since at any given time some specialties seem to be undesirable owing to reasons related to lifestyle, income, and/or risk, whereas others are in "hot" demand. In any case, it is reassuring that no subspecialist radiologists seemed to be particularly dissatisfied either currently or relative to 5 years ago. The finding that radiologists subspecializing in breast imaging enjoyed radiology marginally significantly more than others did is surprising, because failure to diagnose breast cancer is by far the most common reason for malpractice lawsuits against radiologists and medicolegal climate was the leading reported cause of dissatisfaction.

Reports of satisfaction relative to that 5 years ago were potentially biased because the relative-to–5 years ago responses were subjective recollections rather than concrete information recorded 5 years ago. However, the moderate preponderance of "enjoy less than 5 years ago" responses over "enjoy more" responses and the slightly negative mean score for satisfaction relative to that 5 years ago are consistent with the objective moderate decrease in mean current satisfaction score between 1995 and 2003 and thus suggest minimal bias.

Controlling for other factors, we found radiologists in the West to have high satisfaction relative to that 5 years ago but not high current satisfaction. This probably reflects the fact that managed care was most prevalent in California (a large part of the West) and as the tide of managed care ebbed, the situations of radiologists in the West greatly improved. Controlling for other factors, we found similarly that neuroradiologists and pediatric radiologists had marginally significantly high satisfaction relative to that 5 years ago but not above-average current satisfaction. The explanation for this may be that these two subspecialties were experiencing particular difficulties 5 years ago.

The limitations of our study were related to both the subject matter and the surveys in general. Much of our data comprised self reports and perceptions. Perceptions can be time sensitive and subjective. Also, when using tools to evaluate professional satisfaction, one risks oversimplifying a complex subject by excluding other important variables such as home environment, job autonomy and expectations, and relationships with co-workers and patients (8). Furthermore, individuals vary in their disposition regarding satisfaction and dissatisfaction. We attempted to compensate for some of this simplification by focusing on comparisons rather than absolute levels, providing multiple-choice options, referring to prior research findings, and using some open-ended responses. Similar to its predecessors, this study offers a "snapshot" of radiologist satisfaction within the current medical environment, and the results do not serve as absolute measures but rather as points of reference to gauge changes in radiologist satisfaction and in reasons for satisfaction over time.

The 2003 survey, while enabling us to benefit from the experiences with prior surveys, had limitations inherent of surveys—for example, sampling variability (measured by using standard errors)—which have been previously described (2–4). Also, data were collected from small samples for some response categories—particularly, the neutral and dislike response categories for current satisfaction and for some subspecialties. Although the data obtained from these groups are potentially important, the statistical power in analyzing them was low.

Our survey-based study results indicate that radiologists have higher levels of professional satisfaction than do other physicians—more than 90% of radiologists reported that they enjoyed radiology very much or somewhat—however, as with the satisfaction of other physicians, radiologist satisfaction has decreased over time. Medicolegal climate, workload, and reimbursement and/or financial pressures were the three most common reasons for decreased satisfaction, replacing managed care interference, increased administrative burden, and government regulations, control, and red tape, which headed the list of reasons for decreased satisfaction in 1995. Lifestyle and/or work hours, and income were the leading reasons for high levels of satisfaction, but these were also commonly mentioned as reasons for dissatisfaction by relatively dissatisfied radiologists. The expectations, incomes, and/or work hours of dissatisfied radiologists may differ from those of relatively satisfied radiologists. Overall, we found that (a) radiologists working in academic nongovernment practices were more satisfied than were those working in private radiology-only practices, (b) female radiologists were more satisfied than were male radiologists, (c) subspecialization affected satisfaction very minimally, and (d) radiologists who felt seriously overworked were particularly dissatisfied.

	ADVANCES IN KNOWLEDGE

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION ADVANCES IN KNOWLEDGE References

 

• Radiologists have higher levels of professional satisfaction than do other physicians: 93% of radiologists, as compared with about 80% of physicians overall, reported that they enjoy radiology very much or somewhat.
  
• Despite higher levels of overall satisfaction, the mean current satisfaction score for posttraining professionally active radiologists decreased significantly from 1995 (1.62) to 2003 (1.47), continuing the trend seen between 1990 and 1995.
  
• Medicolegal climate, workload, and reimbursement and/or financial pressures were the three most common reasons for decreased satisfaction among radi-ologists.
  

	FOOTNOTES

 

Abbreviations: ACR = American College of Radiology

Authors stated no financial relationship to disclose.

Author contributions: Guarantor of integrity of entire study, H.M.Z.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; manuscript final version approval, all authors; literature research, H.M.Z.; statistical analysis, all authors; and manuscript editing, all authors

	References

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1. Crewson PE, Sunshine JH. Professional satisfaction of U.S. radiologists during a period of uncertainty. Radiology 1999;213(2):589–597.[Abstract/Free Full Text]
2. Sunshine JH, Lewis RS, Bhargavan M. A portrait of interventional radiologists. AJR Am J Roentgenol 2005;185:1103–1112.[Abstract/Free Full Text]
3. Bhargavan M, Sunshine JH. Workload of radiologists in the United States in 2002–2003 and trends since 1991–1992. Radiology 2005;236(3):920–931.[Abstract/Free Full Text]
4. Meghea CI, Sunshine JH. Who's overworked and who's underworked among radiologists? an update on the radiologist shortage. Radiology 2005;236:932–938.[Abstract/Free Full Text]
5. Deitch CH, Chan WC, Sunshine JH, Shaffer KA. Profile of U.S. radiologists at middecade: overview of findings from the 1995 survey of radiologists. Radiology 1997;202(1):69–77.[Abstract/Free Full Text]
6. Chan WC, Sunshine JH, Owen JB, Shaffer KA. U.S. radiologists' satisfaction in their profession. Radiology 1995;194:649–656.[Abstract/Free Full Text]
7. Landon BE, Reschovsky J, Blumenthal D. Changes in career satisfaction among primary care and specialist physicians: 1997–2001. JAMA 2003;289(4):442–449.[Abstract/Free Full Text]
8. Landon BE. STUDENTJAMA: career satisfaction among physicians. JAMA 2004;291(5):634.[Free Full Text]
9. Leigh JP, Kravitz RL, Schembri M, Samuels SJ, Mobley S. Physician career satisfaction across specialties. Arch Intern Med 2002;162(14):1577–1584.[Abstract/Free Full Text]
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This Article Abstract Full Text (PDF) Table E1 Table E2 All Versions of this Article: 2441061049v1 244/1/223    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Zafar, H. M. Articles by Sunshine, J. H. Search for Related Content PubMed PubMed Citation Articles by Zafar, H. M. Articles by Sunshine, J. H.