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Majority of Neurologists Report Symptoms of Burnout

News  |  By MedPage Today  
   January 27, 2017

Returned surveys from 1,671 U.S. neurologists showed that six out of 10 have experienced some symptom of burnout -- including emotional exhaustion, depersonalization, or low personal accomplishment. From MedPage Today.

This article first appeared January 26, 2017 on MedPage Today.

By Alexandria Bachert

High rates of self-reported burnout continue to plague U.S. neurologists, yet many still report being satisfied with their job overall, according to a recent survey from the American Academy of Neurology.

Returned surveys from 1,671 U.S. neurologists showed that six out of 10 have experienced some symptom of burnout -- including emotional exhaustion, depersonalization, or low personal accomplishment, Terrence Cascino, MD, of the Mayo Clinic in Rochester, Minn., and colleagues reported online in Neurology.

Still, 67% said they were satisfied with their job in general, and the same proportion said they would choose to be a neurologist if they were starting all over again.

"We love taking care of our neurological patients," Raghav Govindarajan, MD, a neurologist at the University of Missouri, who was not involved in the study, told MedPage Today. "In fact, neurology is one of the few specialties where we spend a lot of time taking history and doing exams."

The burnout, he said, "is due to external factors like increased paper work, insurance hassles, and ever-increasing regulation that is keeping us away from our patients and taking the pleasure out of being a neurologist."

In a statement, Cascino said the findings "confirm our recognition of burnout as a serious issue facing our profession and why the well-being of neurologists -- starting with decreasing regulatory hassles -- must be addressed to ensure our patients receive the highest quality care."

Cascino and his team sent their survey to 4,127 AAN members, and garnered a response rate of about 41%. Median responder age was 51, and they had an average of 17 years in practice, working about 56 hours per week. Most were from clinical practice, but a third spent time in academic practice.

The three subscales of burnout were measured using the 22-item Maslach Burnout Inventory–Human Services Survey (MBI-HSS).

The researchers found that 60.1% of neurologists reported at least one symptom of burnout, including high emotional exhaustion (53.4%), high depersonalization (41.4%), and low personal accomplishment score (21.2%).

A higher likelihood of burnout was tied to more hours worked per week (OR 1.016, 95% CI 1.005 to 1.027, P=0.003), more nights on call per week (OR 1.092, 95% CI 1.019 to 1.171, P=0.013), and a higher number of outpatients (OR 1.011, 95% CI 1.003 to 1.018, P=0.004).

Conversely, greater job autonomy, meaningful work, reasonable amounts of direct clerical tasks, and effective support staff were associated with lower burnout risk, the researchers reported.

Clinical practice neurologists had a higher burnout rate than academic neurologists (63% versus 56%, P=0.004), with higher scores in both emotional exhaustion (P=0.008) and depersonalization (P=0.014).

However, despite the high prevalence of burnout, 67% of neurologists indicated satisfaction with their work. The same proportion said they would choose to become a neurologist again, and 88% reported that their work was meaningful to them.

But the researchers noted that these numbers are somewhat lower than they are for all physicians, of which 71% would choose the same specialty over again, according to earlier data, they said. And oncologists, they noted, have higher rates of satisfaction than neurologists and only average burnout rates.

Cascino said burnout is especially troubling when paired with rising demand for neurologists that is growing faster than the supply: "By 2025, it's estimated that we will need nearly 20% more neurologists than are available. The high rate of neurologist burnout may contribute to -- and be exacerbated by -- this shortage," he said in a statement.

Efforts to help neurologists combat burnout include improving work efficiency, optimizing workload, decreasing clerical burden, and providing greater flexibility and control over support staff. Physician-friendly national policies to decrease regulatory burden and mandate clerical tasks could also benefit neurologists, Cascino concluded, acknowledging that the study was limited by the use of cross-sectional data.

Govindarajan shared his own advice for keeping neurologists content: Focus on doing what you love, which is taking care of patients.

"I would also advise adding teaching, leadership work or research to the clinical work so it does not become monotonous" he told MedPage Today. "Finally, participating in organized medicine through AAN or your local state societies to fight for your patients and profession would reduce the feeling of helplessness."

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