There is much talk about the “new normal” as the pandemic rolls on. The number of reported cases still changes daily — dipping and spiking depending on where you live or who you ask — and the uncertainty surrounding how physicians can and must return to work is an exacting reality for the imaging community.

Since the pandemic first broke, many radiologists have found themselves working remotely or drastically reducing in-person hours. Economic strains from hard-hit volume and isolation from colleagues, residents, and patients have compounded an already unprecedented healthcare crisis. When facing the daunting challenge of delivering radiology services at maximum capacity, women have been particularly hard hit, shouldering more responsibilities at home while also striving to keep up at work.¹

“One of the biggest stressors I’m hearing from colleagues is the uncertainty,” says Rebecca L. Seidel, MD, associate professor in the department of breast imaging at Emory University School of Medicine and chair of the Bulletin Advisory Group. “In two-physician households especially, the thought of balancing work schedules and potentially managing additional months of virtual school is particularly daunting.”

There are some childcare providers who refuse to provide in-home care for the children of physicians, Seidel says, because of fear of a higher risk of COVID-19 exposure. “There were economic pressures for many after COVID-19 hit, and some were hit harder than others,” she says. That adds to the stress of returning to a potentially heavier workload, while being diligent about staff and patient safety.

Refocused Return

“The return to work is a huge deal,” says Debra L. Monticciolo, MD, FACR, professor of radiology at Texas A&M University and immediate past president of the ACR. “How do we get back to a better practice in dealing with patients moving forward? The post-COVID-19 world is upon us,” she says.

In breast imaging, Monticciolo says, her department’s main concern has been patient care and the safety of technologists. “All of our technologists are women, and many of them are younger with small kids,” she points out. “Not only do they have to juggle the children at home — with schoolwork assignments and becoming homeschool teachers — but they are struggling to manage their work hours.”

As more radiology staff transition back to work under more stressful circumstances, it is important for the team to recognize individual needs. “We have always been a close-knit group here, trying to accommodate each individual need,” Monticciolo says. “COVID-19 has made us focus even more on our internal needs. That’s a good thing for radiology as a whole — to not just be thinking of ourselves, but to really consider what’s going on with our support staff and our technologists.”

The well-being and availability of staff are critical to quality care at a time when many patients are nervous about returning to imaging facilities for scans postponed by the pandemic. Letting patients know it is safe to come in for services will revitalize business, Monticciolo believes, while creating a more comfortable, less stressful environment that benefits everyone (see sidebar).

Willing Support

Reaching out to patients with the message that their safety is the hospital’s primary concern has been successful so far, Monticciolo says. “Patients know when they come in that we are cleaning the machines and the door handles, that waiting rooms will be monitored, and that we are really paying attention,” she says.

To cover the needs of returning patients, Monticciolo’s staff discussed what shifts would work best based on their needs at home. They talked about who could work early morning hours, evening hours, or provide weekend coverage. “Some staff — especially the women — said that they really needed to be home at certain times for their kids,” Monticciolo says. Those same women, she adds, were happy to work on weekends — and even some overtime to recover economically — if they could get extra support from partners, spouses, or other family members.

“There has been a good response from the community,” Monticciolo says. “We are filling most of our available slots. We take everybody who wants to come in. Although women are worried about COVID-19, they are also worried they might have breast cancer. We try to do everything possible to make their visit and their screening exam as safe as possible.”

Screening mammography and other imaging services have begun to rebound, despite scheduling challenges. Radiology groups who are largely unencumbered by staff trying to maintain a work-life balance — due to childcare issues brought on by the pandemic — may see a faster recovery.

Dependent Business

“We’ve been fortunate,” says David T. Boyd, MD, MBA, a neuroradiologist with Reston Radiology Consultants (RRC), a private practice group in Northern Virginia that serves multiple hospitals. “We’re coming through this better than some other groups I think.”

Outpatient and inpatient volumes are coming back strong, Boyd says. “We believe that our hospitals will allow us to begin performing overnight reads from home soon and I’m not sure that would have happened before COVID-19”, he says.

Everyone in the group sacrificed when the pandemic hit, Boyd says. “Everyone took a pay cut with reduced hours, including radiologists and staff,” he says. “As business has picked up, we have been able to bring just about everyone back to full-time.”

Patient messaging has helped allay COVID-19 fears and bolster volume. An email blast went out to RRC patients, he says, and David E. Dubois, MD, president of the group, posted a message on the website reassuring patients that their safety was paramount. “We told them they would be in and out quickly, that we were performing extra cleaning, and that they could wait in their car until it was time for their appointment,” Boyd says.

The firm’s business has recovered as referring physicians have increased their in-person and virtual office visits as well as elective surgeries, Boyd says. “Things are looking pretty good at the moment, and we should be full steam ahead hopefully.”

Literature supports that men are doing more domestic work than they once did, but they still aren’t taking on as much as women.

Uneven Path

Predicting radiology volumes will be one of the next major challenges for radiology practices, and recovery of imaging volumes will likely vary by geography and infection rates.² Radiology groups can ready themselves through preparing safety protocols and changes to physical spaces. They can reevaluate bandwidth and leave policies, and hone in on more efficient scheduling. Even as imaging practices begin to reopen, balancing personal and professional responsibilities moving forward will be incredibly hard, says Lucy B. Spalluto, MD, MPH, vice chair of health equity at Vanderbilt University Medical Center and president of the American Association for Women in Radiology.

“I think work-life balance is hard for men and women during the pandemic — but I think it’s currently harder for women,” Spalluto says. “Literature supports that men are doing more domestic work than they once did, but they still aren’t taking on as much as women.”

Since COVID-19 hit, everyone is working more hours each week from a frazzling mix of professional and domestic work, Spalluto says. Single physician parents are especially taxed. “What I see and what I have experienced first-hand is a very real mental health toll on women who are trying to juggle increasing personal and professional activities,” she says (see sidebar).

By July, volume was nearly back to normal at Vanderbilt, Spalluto says, and it may go up even further to make up for missed visits. “It is very hard to have flexibility when the work needs to get done,” she says, “but in a lot of ways the necessary responses to COVID-19 have demanded changes to a system that has been too static for a long time.”

The forced flexibility that came with COVID-19 is something some radiologists have been asking for with no response in many situations, Spalluto says. “If one of the changes that comes out of this is more long-term flexibility within the system, that’s a very positive thing,” she adds.

People work in different ways, based on their style, personality, or home life. “What makes radiology so interesting to me is that our field is made up of a diverse group of people who think and work differently,” Spalluto says.

Some people may be thriving in the current atmosphere, she says, working from home and creating a schedule around family-related commitments. Other people want to get up early, go to their office, get their work done, and go home, she says.

“We’ve thought about things like staggered shifts for studies that don’t need to be read right away,” Spalluto says. “Screening mammograms, for instance, can be read at night or on the weekends.” The idea is that if people really need flexibility for childcare or other family-related reasons, they could change their shifts to accommodate it, she says.

These types of accommodations depend largely on the willingness of the work group and its geographic location. The same holds true for home workstations — depending on cost and the type of work involved (mammography stations are more expensive than others, for instance). “It will be interesting to see, moving forward, if healthcare professionals are given the opportunity to continue to work in these new more flexible environments and schedules in which they’ve proven to excel,” Spalluto says.

New Wave

“I don’t think the impact of COVID-19 on medical practice is going away anytime soon,” Spalluto says. “It is a new disease that will be in the mix for at least the next year or two.” The more physicians learn about the virus, the more they will be able to pivot to handle it, she says. “We have to adapt our systems to the new normal.”

It is difficult to discuss a possible new or next wave of COVID-19 as the climate shifts constantly. It can be said, however, that a lingering or resurgent COVID-19 means more of the same challenges — especially for radiology teams staffed with parents of young or school-aged children, Seidel says.

Even pre-COVID-19, attending to family matters has at times waylaid female radiologists seeking leadership roles. Household responsibilities can be a potential impediment to securing tenure, publishing research, and finding opportunities to lecture. The pandemic has only magnified these challenges as time becomes an increasingly scarce commodity.

If they can find time, the current climate may offer unique chances to connect and stay relevant. “When someone is asked to be a visiting professor or to give Grand Rounds at another institution — now that these are all virtual — it could open up opportunities to more junior faculty who may not have been afforded the chance before the pandemic because they were passed over for more senior faculty,” Seidel says.

“Isolation is another problem radiologists are facing,” Spalluto says. Engaging with other radiologists, residents, and patients is incredibly important to overcome this isolation — even if virtually, she notes.

The stress and worry radiologists endure over caring for patients, tending to their own families, and protecting both from COVID-19 exposure — all while practicing medicine with the same intensity as before — is a complex burden to ease. “I don’t think we will go back to shutting down the way we had to the first time,” Seidel says, “but we will have to use everything we’ve learned to keep everyone safe and well.”

“Ignoring the impact of COVID-19 on radiologist well-being is not an option,” says Spalluto. “Instead, we should embrace this opportunity to adapt the radiology work environment to add much needed flexibility.”