Neurologist Burnout an Escalating Crisis

Megan Brooks

November 13, 2014

Burnout is a "neurologic crisis," experts say, with the prevalence of burnout currently exceeding 50% among neurologists, higher than among other specialist groups.

But many neurologists suffer burnout during their career and may not even realize it.

"Most physicians, including myself in the past, are unaware that they are burned out," Bruce Sigsbee, MD, from Pen Bay Medical Center, Rockport, Maine, and past president of the American Academy of Neurology (AAN), told Medscape Medical News.

In retrospect, he said, there were many over his career that he was burned out. "Given the lack of insight, no active steps were taken or are typically taken to combat burnout. The first step is to recognize the problem," Dr Sigsbee said.

Dr Sigsbee and coauthor James L. Bernat, MD, from Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, address physician burnout in an article published online November 5 in Neurology.

Dr Sigsbee said, "both the prevalence and the lack of insight into the issue" was the impetus behind their article. Burnout "impacts career satisfaction, but more importantly it has a deleterious impact on patient care," he said. Further, burned-out physicians "lack empathy and make errors." Burnout has been linked to higher rates of depression and suicidal thoughts and behaviors.

Hallmarks of physician burnout are loss of interest and enthusiasm for work (emotional exhaustion), feelings of cynicism (depersonalization), and a diminished sense of personal accomplishment (career dissatisfaction).

No Choice But to Address It

"The American Academy of Neurology under the leadership of the President Elect Terry Cascino, MD, is actively working to identify opportunities for the AAN to mitigate the severity and prevalence of burnout amongst its members," Dr Sigsbee said.

"Neurology is the only medical specialty that has both one of the highest rates of burnout and the poorest work–life balance," Neil A. Busis, MD, Department of Neurology, University of Pittsburgh School of Medicine, Pennsylvania, notes in a linked editorial.

The AAN Workforce Task Force has predicted a future shortage of neurologists; neurologist burnout could contribute to the shortage but could also result from a shortage, Dr Busis notes.

"If burned out neurologists continue to practice, patient care may suffer due to poor medical judgment and more errors. If neurologists drop out of the workforce, access to care will decrease. If medical students consider neurology undesirable, few will enter the field," he writes.

 
We really have no choice but to address burnout. Dr Neil A. Busis
 

"We really have no choice but to address burnout," Dr Busis noted in an interview with Medscape Medical News. "If we take the nation's health as a priority, we have to have caregivers who are healthy," he said.

Dr Sigsbee and Dr Bernat note that studies of workplace motivational factors suggest several preventive interventions for combating burnout. They include:

  • Providing counseling for physicians either individually or in groups, with a goal of improving adaptive skills to the stress and rapid changes in the healthcare environment;

  • Identifying and eliminating meaningless required hassle factors, such as electronic health record "clicks" or insurance mandates;

  • Redesigning practice to remove pressure to see patients in limited time slots and shift to team-based care; and

  • Creating a culture that promotes career advancement, mentoring, and recognition of accomplishments.

Dr Busis points out that most interventions to help burned out physicians center on the individual and are reactive, focusing on methods to handle stress and better adjust to the current system. "That is not enough. We must be proactive to prevent burnout from developing in the first place," Dr Busis told Medscape Medical News.

"To revitalize our specialty we need to advocate for another triple aim: revising the structure, processes, and outcomes of health care systems to recognize, value, and optimize physician wellness and career satisfaction," he notes in his editorial.

"If our efforts are successful, we will be better able to accomplish our professional mission: to increase the quality of neurologic care, decrease health care costs, and improve patient satisfaction," he concludes.

Neurology. Published online November 5, 2014. Abstract Editorial

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