In case you missed it, the annual meeting of the American Academy of Neurology (AAN) was held last month (April 2017), and a big topic of conversation was neurologist burnout. “[Burnout] is an epidemic, and we need to do something about it,” said Academy president Terrence Cascino, MD, FAAN in his Presidential Lecture. Physician burnout in general is increasing, but neurologists have among the highest levels of burnout and the lowest levels of work/life balance in all of medicine.

“We have known this since 2012 with the research on burnout done by Dr. Tait Shanafelt, but it is getting worse.” In an effort to understand the problem better, Cascino and his colleagues at the AAN formed a task force in 2015. “We had at our charge to study burnout prevalence and primary drivers in practicing neurologists, residents and fellows,” said Cascino. “And at the same time to look for methods we might use to mitigate burnout.” Their first order of business was to survey their members on the subject.

More than 2,000 neurologists responded to that survey, and the results were published in Neurology (Jan 2017) in an article titled “Burnout, career satisfaction, and well-being among US neurologists in 2016.” The prevalence of neurologist burnout, they found, was 61 percent. Cascino also presented other results from the survey:

  • 61% would choose to become a physician again
  • 67% would choose to become a neurologist again
  • 67% of neurologists were satisfied with their job
  • 60% reported they have significant autonomy
  • 88% reported their work is meaningful to them

“These figures are alarming,” he said. “Sixty-one percent of us have symptoms of burnout.” But he pointed out, there is something interesting in the results: “Eighty-eight percent of us found our work to be meaningful.” In other words, the problem isn’t neurology. The problem, he said, is that neurologists work too many hours and spend too much time dealing with insurance and regulatory hassles.

“One thing that has become obvious is that people in small and solo practices (25% of our members) are especially struggling with regulations, reimbursements and other issues,” he said, giving the following examples:

  1. Inadequate staffing
  2. EHR frustration
  3. Insurance preauthorization
  4. Numerous quality reporting groups
  5. RVUs
  6. Scorecards

So, what can we do about it?

The solutions, said Cascino, need to happen on a number of levels: personal, practice, state, and national.

National Level

National strategies need to be a big part of of the solution. We need to “Advocate for physician friendly national policies, meaningful measures, and fair reimbursement,” said Cascino.

“The AAN helped to pass the 21st Century Cures act, which helped to reduce regulatory hassles, but there is a lot more that needs to be done.” The AAN has a political action committee called BrainPac dedicated to advocacy full time.

State Level

Many state and local medical associations are already engaged in work to ease physician burnout. When you become active with them, you can voice concerns specific to neurologists. In September 2017, the AAN is rolling out a new leadership program, Live Well Lead Well, to help neurologists learn how to take on a greater leadership role and increase autonomy.

Practice Level

An efficient, well-run medical practice can go a long way toward managing the changing insurance and regulatory environment. The AAN has a robust Live Well resource section on their website. Here you or your office staff can beef up your EHR and clerical skills and learn best practices in the workplace. The AAN also offers the Axon Registry (free for members) to help with quality reporting and insurance navigation.

Personal Level

“I’m convinced that the cause of this is not us,” said Cascino. “It’s not some sort of character flaw. It’s because of circumstances and changes put upon us by outside forces.” Even so, he recommends doing what you can on a personal level. “Self-care is the foundation for cultivating well-being and resiliency.” The AAN recommends the AMA’s Steps Forward program as well as UMass’ Mindfulness-Based Programs to improve stress-management and resiliency.

Neurologists are bright and innovative, they love what they do, and they are needed, said Cascino. That is why, he said, “I am optimistic. We must stand up, speak out, and stick together.” It is the only way we can have the future we want for our patients, ourselves, and our profession.