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Back to Normal? For Many Physicians, the Answer Is 'Not So Fast…'

Kathrin LaFaver, MD

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July 02, 2021

As the pandemic restrictions are being lifted and life is increasingly getting "back to normal," not everyone is ready. Many workers, asked to come back to the office and often facing long commutes again, are looking for greater flexibility or are considering quitting their jobs instead. As a neurologist, I hear concerns from many of my patients. Although some have undoubtedly been missing the socialization that work outside the home provides and are ready to give up a double role as a homeschool teacher, working from home has created greater autonomy that is difficult to give up.

We often teach patients to pace themselves, take breaks when needed, avoid excessive stress, exercise on a regular basis and get 8 hours of sleep — all difficult to do in our busy lives. Having greater control over their environment has benefited people with migraines, Tourette syndrome, and functional neurologic disorders alike, all conditions with frequent symptom worsening related to environmental triggers. As Vivien, one of my patients and an HR specialist in a large company, put it, "It's hard to work in a cubicle and be told to smile more when you feel dizzy and have a headache."

Similar to the patients we are serving, physicians often find themselves sleep-deprived, with little time for the exercise or self-care that we are advising others to do. As we are returning to our previous work schedules, going back to early-morning and after-hour in-person meetings, and are being asked to account for lost productivity in 2020, many are expressing frustration about the lack of acknowledgement over the collective difficulties faced. While some employers extended timelines for salary guarantees, many self-employed and productivity-based physicians have taken pay cuts, while still emotionally drained from difficult experiences on the front lines of the pandemic, the lack of adequate PPE, and keeping up with ever-changing guidelines.

In academic medicine, women have been disproportionally negatively affected by the pandemic in terms of lost productivity, which may cause long-lasting changes in career trajectories. Looking around me, I see many colleagues going part-time, changing to locum tenens positions, or leaving clinical medicine altogether. Facing high rates of burnout even before the pandemic, the past year has been the final straw for many to make career changes. In neurology, these changes will worsen already existing physician shortages, while simultaneously putting greater strains on those in practice to meet the increasing demand.

For the sake of our patients and medicine, it is time to look at organizational strategies to improve career satisfaction instead of seeing burnout as a problem of the individual physician. Learning from the flexibility and swift thinking during the pandemic, we need to bring physicians back to the table and give them greater autonomy and decision-making capacity when it comes to work schedules, securing adequate clinical and administrative support, and protecting time for research for those in academic careers. Taking advantage of virtual or hybrid meeting options will be a sustainable way to ensure participation for those with young children and other caregiving responsibilities. As we support our patients in finding the right balance between work and lifestyle changes to optimize health, let's also give physicians the time to do the same.

Personally, I have made the difficult decision to leave academic medicine this summer. As much as I have enjoyed teaching residents and medical students over the past decade, collaborating with colleagues on research and building new models of care for patients with functional neurologic disorders, this work has required a consistently high personal commitment, often taking a toll on my family.

As funding for research is increasingly difficult to secure, devoting many months of intense efforts toward grant writing and facing multiple rejections is a high price to pay with uncertain rewards. While research training grants, funding from private donations, and philanthropy may provide viable options for a number of clinician-scientists, life decisions cannot and should not always be postponed.

I am looking forward to bringing my talents to a community-based hospital setting and addressing patients' needs in meaningful ways, while following my own advice of living a more balanced life. I hope that we can all learn from lessons of the pandemic in positive and constructive ways rather than simply rushing back to the status quo, and allow physicians to find the joy in medicine again.

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About Dr Kathrin LaFaver
Kathrin LaFaver, MD, is a neurologist and movement disorders specialist with a focus on integrating mental and physical aspects of health. After training at the Mayo Clinic and the National Institutes of Health, and practicing neurology for over 10 years, she believes in lifestyle medicine as a foundation for prevention and treatment of brain disorders. She is co-founder of the Women Neurologists Group and is passionate about the arts and being in nature. Follow her on Twitter @LaFaverMD

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