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December 03, 2019; 93 (23) Editorial

Saving neurology

Once more with feeling

Nina F. Schor, Allison Brashear
First published November 5, 2019, DOI: https://doi.org/10.1212/WNL.0000000000008569
Nina F. Schor
From the National Institute of Neurological Disorders and Stroke (N.F.S.), National Institute of Health, Bethesda, MD; and School of Medicine (A.B.), University of California, Davis, Sacramento.
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Allison Brashear
From the National Institute of Neurological Disorders and Stroke (N.F.S.), National Institute of Health, Bethesda, MD; and School of Medicine (A.B.), University of California, Davis, Sacramento.
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Saving neurology
Nina F. Schor, Allison Brashear
Neurology Dec 2019, 93 (23) 989-990; DOI: 10.1212/WNL.0000000000008569

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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 others7,8 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.

Study funding

No targeted funding reported.

Disclosure

The authors report no disclosures. Go to Neurology.org/N for full disclosures.

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • See page 1002

  • © 2019 American Academy of Neurology

References

  1. 1.↵
    1. Hasan TF,
    2. Turnbull MT,
    3. Vatz KA,
    4. Robinson MT,
    5. Mauricio EA,
    6. Freeman WD
    . Burnout and attrition: expanding the gender gap in neurology? Neurology 2019;93:1002–1008.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Brower BA,
    2. Jennings MM,
    3. Butterworth ML,
    4. Crawford ME
    . Women in podiatry and medicine. Clin Podiatr Med Surg 2019;36:707–716.
    OpenUrl
  3. 3.↵
    1. Burns KEA,
    2. Fox-Robichaud A,
    3. Lorens E,
    4. Martin CM
    . Gender differences in career satisfaction, moral distress, and incivility: a national, cross-sectional survey of Canadian critical care physicians. Can J Anaesth 2019;66:503–511.
    OpenUrl
  4. 4.↵
    1. Ceppa DKP,
    2. Dolejs SC,
    3. Boden N, et al
    . Sexual harassment & cardiothoracic surgery: #UsToo? Ann Thorac Surg Epub 2019 Aug 24.
  5. 5.↵
    1. Messias E,
    2. Gathright MM,
    3. Freeman ES, et al
    . Differences in burnout prevalence between clinical professionals and biomedical scientists in an academic medical centre: a cross-sectional survey. BMJ Open 2019;9:e023506.
    OpenUrlAbstract/FREE Full Text
  6. 6.↵
    1. Osborn M,
    2. Satrom J,
    3. Schlenker A,
    4. Hazel M,
    5. Mason M,
    6. Hartwig K
    . Physician assistant burnout, job satisfaction, and career flexibility in Minnesota. JAAPA 2019;32:41–47.
    OpenUrl
  7. 7.↵
    1. Clemen NM,
    2. Blacker BC,
    3. Floen MJ,
    4. Schweinle WE,
    5. Huber JN
    . Work-life balance in women physicians in South Dakota: results of a state-wide assessment survey. S D Med 2018;71:550–558.
    OpenUrl
  8. 8.↵
    1. del Carmen MG,
    2. Herman J,
    3. Rao S, et al
    . Trends and factors associated with burnout at a multispecialty academic faculty practice organization. JAMA Netw Open 2019;2:e190554.
    OpenUrl
  9. 9.↵
    1. Hughes F,
    2. Francis AP,
    3. Sciscione AC
    . Physician burnout among members of the society for maternal-fetal medicine. Am J Perinatol Epub 2019 Jun 6.
  10. 10.↵
    1. Kroth PJ,
    2. Morioka-Douglas N,
    3. Veres S, et al
    . Association of electronic health record design and use factors with clinician stress and burnout. JAMA Netw Open 2019;2:e199609.
    OpenUrl
  11. 11.↵
    AAMC. U.S. medical school faculty. 2018. aamc.org/data/facultyroster/reports/494946/usmsf18.html. Accessed September 12, 2019.
View Abstract

Disputes & Debates: Rapid online correspondence

  • Author response: Saving neurology: Once more with feeling
    • Nina F. Schor, Deputy Director, National Institute of Neurological Disorders and Stroke
    • , Dean, University of California, Davis, School of Medicine
    Published November 19, 2019
  • Reader response: Saving neurology: Once more with feeling
    • Nitin K. Sethi, Associate Professor of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical Center (New York, NY)
    Published November 12, 2019
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