AAN Survey Shows 60% of US Neurologists Report Burnout

Deborah Brauser

February 07, 2017

Neurologists in the United States have high rates of burnout and emotional exhaustion, according to a new study sponsored by the American Academy of Neurology (AAN).

In a survey of more than 4000 members of the AAN in 2016, 60% of respondents reported having at least one symptom of burnout and 41% reported experiencing "depersonalization."

Significant contributors included long work hours, a large number of outpatients, and large amounts of clerical work. On the other hand, job autonomy and being older were linked to a lower risk for burnout.

Interestingly, having a subspecialty in epilepsy was also associated with a lower burnout risk compared with being a general neurologist. But subspecializing in sleep was linked to 70% less professional satisfaction.

Dr Neil A. Busis

"With this data, we can more effectively develop solutions to help reduce burnout and increase career satisfaction, which will improve the quality of care for our patients with neurologic disorders," lead author, Neil A. Busis, MD, chief of neurology at UPMC Shadyside Hospital, Pittsburgh, Pennsylvania, told Medscape Medical News.

Coinvestigator and president of the AAN, Terrence L. Cascino, MD, added that it's important to improve a clinician's external and internal environment.

"Part of our advocacy effort, with CMS [Centers for Medicare & Medicaid Services] and with Congress and with insurance companies, is to talk about fixing the regulatory hassles that produce no value," said Dr Cascino. "Also, how can you make your practice more efficient? We're trying to work on helping both individuals and practices."

The study was published online January 25 in Neurology.

Demand Exceeding Supply

Previous studies have shown that neurologists have one of the highest rates of burnout and lowest rates of satisfaction with work-life balance compared with other physicians, said Dr Busis.

Dr Terrence L. Cascino

The AAN Workforce Task Force released findings in 2013 showing that the demand for neurologic services exceeded supply in almost all US states. "By 2025, demand for neurologists will be even higher," write the investigators.

"In fact, by then we estimate that we'll need nearly 20% more neurologists than are available. The high rate of neurologist burnout may contribute to and be exacerbated by this shortage," added Dr Cascino.

In response, the organization formed a task force specifically to assess burnout and career satisfaction issues in the field.

Surveys were mailed out between January and March 2016 to 4127 US members of the AAN who had already finished their training. Of these, 1671 (40.5%; mean age, 52 years; 65.3% men) responded to the survey's 57 questions.

In the full group, 31.9% reported being general neurologists. Epilepsy (8.4%), child neurology (8.3%), movement disorders (7.4%), and vascular neurology/stroke (6.6%) were the most reported subspecialties. The least reported subspecialties were neurocritical care (2.3%) and neuroimmunology/multiple sclerosis (3.0%).

The mean years in practice for the participants was 17.3 and the mean hours worked per week was 55.7. The investigators note that the median hours of work per week for all US physicians is 50.

Significant Burnout Factors

High emotional exhaustion was reported by 53.4% of the respondents, and low personal accomplishment was reported by 21.2%. The burnout rate was 60.1%.

Although 87.6% of the overall group said their work had meaning and 67.2% said they would choose to become a neurologist again, only 32.3% reported that "their work schedule left enough time for personal/family life."

This latter figure compared with 40.9% of all physicians and is "lower than every other medical specialty," write the researchers.

Greater burnout risk was significantly associated with increases in the following:

  • Hours worked per week (P = .003);

  • Nights on call per week (P = .01); and

  • Number of outpatients (P = .02).

Significant factors for lower burnout risk included the following:

  • Having greater job autonomy (P < .001);

  • Having a "reasonable amount" of clerical work (P < .001);

  • Considering overall work to be meaningful (P < .001);

  • Being older (P < .001);

  • Having an effective support staff (P < .001); and

  • Subspecializing in epilepsy (P = .03).

Dr Busis noted that they don't know why this last factor was associated with less burnout. "This was a cross-sectional study of people at just one time. We didn't follow them longitudinally," he said. "And the nature of the questions gave us a high-level overview but not enough to delve into these issues in more detail."

However, the study did compare academic practice neurologists (n = 529) with clinical practice neurologists (n = 959).

Not only did the first group have lower rates of burnout than the latter group (55.7% vs 63.3%, respectively; P = .004), they also had higher rates of both career satisfaction and quality of life.

The academic practice group worked significantly more hours per week than did the clinical practice group (58.1 vs 55.3, respectively), but they spent fewer nights per week on call (1 vs 2), cared for fewer outpatients (29.5 vs 52.3 per week), and reported fewer weekend hospital rounds per year (8.1 vs 11.3; all comparisons, P < .001).

Strategies Needed

When asked whether the investigators were able to compare men vs women in terms of burnout, Dr Busis said they were, "and that study is being prepared right now" for publication. But in the current paper, multivariable analysis of professional satisfaction showed that sex was not a significant factor.

However, the same model showed that sleep medicine vs general neurology was significantly associated with less job satisfaction (odds ratio, 0.3; P = .002).

The investigators note that strategies are now needed to help clinicians to improve office efficiency, flexibility, and workload.

"Physician-friendly national policies that decrease regulatory burden and mandated clerical tasks would also enhance neurologists' engagement in the practice of neurology," they write.

"The overall view is that we would like workflow scheduling regulations to basically better enable neurologists to practice neurology," said Dr Busis. "They went into [the field] to practice neurology — not to be clerks or to tick boxes off for meaningless measures."

He noted that the AAN is coming up with several suggestions to fight burnout and is aggregating data and providing individual guidance on the "Live Well" section of their website.

A Hypothesis and Optimism

"Burnout represents a growing problem because it leads to serious harm to both physicians and patients," James L. Bernat, MD, Department of Neurology, Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, writes in an accompanying editorial.

Dr Bernat adds that the finding that more neurologists experience burnout than other specialities leads to questions of why — and he offers his own "untested hypothesis."

Neurology traditionally attracts detail-oriented, thorough individuals, who "may become particularly frustrated when, because of the time constraints of a busy practice, it becomes impossible for them to…work up to their personal standards," he writes.

He also notes frustrations with health record documentation and other tasks that take time away from patient care.

"It is also possible that these personality traits make neurologists less able to say no and, as a result, they assume an excessive patient workload, as revealed in the survey."

Possible corrective strategies he suggested include redesigned workflow, including automatic importers of patient conversations into electronic health records, and ongoing monitoring of a clinician's engagement and well-being.

"For neurologists who already have burnout, counseling individually or in groups can help provide them adaptive skills," he said, adding that mentoring from a senior associate could also prove helpful.

Dr Cascino reported that at the upcoming AAN meeting in April, his Presidential Plenary session will include "in depth" talk about burnout in neurology. In addition, several sessions on physician wellness will be presented throughout the course of the conference.

"I think it's important for our members to know that we're not only studying this issue, we're actively trying to help on a number of fronts," he said.

"When you turn it around, we tell patients every day, 'there's no one cure but there are several things we can do to make things better,' and I'm very optimistic that things will get better for our profession."

The study was funded by the AAN. Dr Busis reports being a member of the AAN board of directors and receiving honoraria for speaking at courses for the organization and for serving as an Alternative CPT Advisor for them. As reported, Dr Cascino is the president of the AAN. Disclosures for the coauthors are in the original paper. Dr Bernat has disclosed no relevant financial relationships.

Neurology. Published online January 25, 2017. Study full text, Editorial

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