Objectives To evaluate work expectations of radiologists at different career levels, their fulfillment, prevalence of exhaustion, and exhaustion-associated factors. Methods A standardized digital questionnaire was distributed internationally to radiologists of all career levels in the hospital and in ambulatory care via radiological societies and sent manually to 4500 radiologists of the largest German hospitals between December 2020 and April 2021. Statistics were based on age- and gender-adjusted regression analyses of respondents working in Germany (510 out of 594 total respondents). Results The most frequent expectations were “joy at work” (97%) and a “good working atmosphere” (97%), which were considered fulfilled by at least 78%. The expectation of a “structured residency within the regular time interval” (79%) was more frequently judged fulfilled by senior physicians (83%, odds ratio (OR) 4.31 [95% confidence interval (95% CI) 1.95–9.52]), chief physicians (85%, 6.81 [95% CI 1.91–24.29]), and radiologists outside the hospital (88%, 7.59 [95% CI 2.40–24.03]) than by residents (68%). Exhaustion was most common among residents (physical exhaustion: 38%; emotional exhaustion: 36%), in-hospital specialists (29%; 38%), and senior physicians (30%; 29%). In contrast to paid extra hours, unpaid extra hours were associated with physical exhaustion (5–10 extra hours: OR 2.54 [95% CI 1.54–4.19]). Fewer opportunities to shape the work environment were related to a higher probability of physical (2.03 [95% CI 1.32–3.13]) and emotional (2.15 [95% CI 1.39–3.33]) exhaustion. Conclusions While most radiologists enjoy their work, residents wish for more training structure. Ensuring payment of extra hours and employee empowerment may help preventing burnout in high-risk groups. Key Points • Most important work expectations of radiologists who work in Germany are “joy at work,” a “good working atmosphere,” “support for further qualification,” and a “structured residency within the regular time interval,” with the latter containing potential for improvement according to residents. • Physical and emotional exhaustion are common at all career levels except for chief physicians and for radiologists who work outside the hospital in ambulatory care. • Exhaustion as a major burnout criterion is associated with unpaid extra hours and reduced opportunities to shape the work environment.

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