Saving neurology

Burnout among all physicians and the persistent predominance of men in the neurology workforce are 2 topics increasingly studied and discussed in medical literature. The review by Hasan et al.¹ in this issue of Neurology® proposes a link between these 2 seemingly disparate phenomena and suggests that they, together, will be responsible for a widening gap between the need for and supply of neurologists in the global workforce. As women increasingly make up medical school classes, choose medical fields with salary parity between men and women, seek positions that provide flexibility in workload and work hours, and retire before 65 years of age, the neurology workforce will shrink, they posit.

There is much wisdom in these authors' synthesis of these timely topics and much credibility in their warning. In many fields and on 6 continents, women physicians, nurses, physician assistants, and residents deal with larger clinical workloads, longer clinical hours, lower salaries, and more personal caregiving and homemaking duties than their male counterparts.^2,–,6 They encounter incivility in the workplace and often exhibit imposter syndrome and a sense of powerlessness to change what they perceive to be being less valued by their superiors than are men.³

The most important question that Hasan et al.¹ just begin to address is what can be done to stem the tide of inadequate recruitment and partial or premature total departure of women to and from the neurology workforce. They and others^7,8 suggest structuring positions to allow having more time to carry out administrative tasks; having more flexible work hours; providing daycare at the hospital, clinic, or school; setting salaries at a level that encourages hiring someone to do daily home tasks and chores; and making it routine that early career neurologists (both men and women) seek out and engage regularly with a mentor or mentors.

One study suggested that protected time free of patient or family care responsibilities and reserved for education and regular exercise would prevent burnout.⁹ Of interest, while coping strategies such as making time for more relaxing and personally refreshing activities help prevent burnout, a recent study suggests that this accounts for only 1% to 2% of the variance in burnout among physicians.¹⁰ This should not be surprising given that putting the onus on the burnout-susceptible individual to create the “supra-environment” that mitigates against the effects of work overload, lack of control, lack of appreciation by others, workplace incivility, salary inequity, and home and family responsibilities places additional burdens on the person most at risk for burnout.

We are making progress in adding women to the senior ranks of academic neurology, one sign of recognition. From 2015 to 2018 female professors increased from 16% to 21% and associate professors from 33% to 39%, but the number of permanent women chairs of neurology departments remained fixed at 13.¹¹ Improving the recognition of the unique and substantive roles women neurologists play, both within and outside of the workplace, and creating an environment that allows them to flourish in those roles and as professional and personal people will likely be the catalyst for encouraging more women to join the ranks of the neurology community. But if these changes are portrayed as concessions made to accommodate the shortcomings and selfish needs of women, the catalysis will not be long-lived, and the encouragement will be seen as a ruse. Similarly, bringing more women into the neurology workforce will eventually change the culture of the field to one of equity, respect, and humanity for men and women. But without a culture change that precedes the retention of those women in the field, the shift in the gender complement of the field will not last long enough to effect durable and meaningful change. The culture change must start with the current workforce—both men and women—and it must feel to everyone like we really mean it.

• © 2019 American Academy of Neurology