COMMENTARY

Combating Burnout: A Neurologist's Perspective

Andrew N. Wilner, MD

Disclosures

February 23, 2017

Introduction

Burnout, inversely related to job satisfaction, occurs more frequently in physicians than other professionals.[1] Neurologists rank among the highest for burnout, even more so than pediatricians and family medicine physicians, two specialist groups burdened with clerical work, high patient loads, and relatively low compensation.[1] Why are neurologists so susceptible to burnout?

Burnout Affects Doctor and Patient

Characterized by emotional exhaustion, cynicism, detachment, and a sense of low personal accomplishment at work, physician burnout is increasing.[2] Burnout is not only detrimental to the physician, who suffers a lower quality of life, but for the patient as well, who may experience diminished quality of care from a burned-out physician.[1]

Paperwork and Burnout

Nonclinical tasks can be time-consuming and frustrating for physicians who prefer to spend their time interacting with patients. For example, a recent survey of 1000 physicians by the American Medical Association revealed that prior authorizations consume an average of 16 hours of physician and staff time per week.[3] Another study of outpatient practices revealed that for every hour of patient care, physicians spent 2 hours with the electronic medical record and administrative tasks.[4] Mandates to report "quality" data also result in hundreds of hours lost for patient care and cost billions of dollars.[5]

Neurologists and Burnout

A recent survey of 4127 American Academy of Neurology members (65.3% male, average age 51, 40.5% response rate) revealed that 60% of respondents reported at least one symptom of burnout.[2] Longer hours, larger patient load, more nights on call, and increased clerical work were associated with burnout. Conversely, job autonomy, meaningful work, and support staff were associated with lower burnout risk. Of note, older age and specialization in epilepsy also hedged against burnout. (Some personal good news there—I'm an epileptologist who trained in the 1980s.) Academic neurologists tended to fare better than those in private practice.

All Work and No Play

One obvious cause of increased burnout among neurologists was increased work hours. Neurologists worked an average of 55 hours/week compared with an average of 50 hours/week for all US physicians. The distraction of clerical tasks was also an important source of dissatisfaction. Not surprisingly, burnout strongly correlated with decreased career satisfaction.[2]

Corrective Strategies

Six domains have been identified with burnout: community, control, fairness, reward, values, and workload.[2] Corrective strategies aimed at increasing autonomy; decreasing clerical work; optimizing patient flow; providing adequate time for history-taking, examination, and decision-making; as well as increasing meaning and engagement are likely to improve burnout symptoms.[2,6] Work-hour reduction is one effective strategy, but it's rarely practical when salary is tied to production.[7] Because burnout is a "system issue," individual physicians possess little power to remedy root causes.[8]

Nine potential burnout remedies have recently been promulgated by the Mayo Clinic[8]:

  1. Acknowledge and assess the problem

  2. Harness the power of leadership

  3. Targeted interventions

  4. Cultivate community at work

  5. Use rewards and incentives wisely

  6. Align values and strengthen culture

  7. Promote flexibility and work/life integration

  8. Provide resources to promote resilience and self-care

  9. Facilitate and fund organizational science

Conclusions

Neurologists insist on comprehensive (and time-consuming) patient evaluations, an approach that merits little reward in our volume-based compensation system. Mounting clerical work and decreased time for patient care constitute key ingredients of a potent formula for neurologist burnout. An increase in early retirement and lack of neurologist recruitment are likely consequences. While solutions are possible, their successful implementation requires recognition of the problem and a sea change in the current administrative model of medical care. It will be an ironic future if an insufficient number of neurologists are available to care for an aging population rife with neurologic disorders at a time when scientific advances offer increasingly effective therapies.

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