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Burnout among neurologist: A unique predisposition?

  • Joseph R. Berger, Professor of Neurology, University of Pennsylvaniajoseph.berger@uphs.upenn.edu
Submitted June 02, 2017

A study conducted by the American Academy of Neurology (AAN), [1] and highlighted by Dr. Cascino in his Presidential Plenary Address at the 2017 AAN Annual Meeting, addressed the issue of burnout among US neurologists. A study of 1671 US neurologists survey respondents revealed that burnout was common among all neurology practice settings and subspecialties. [1] During his address, Dr. Cascino presented a figure from a larger survey of US physicians in general that correlated the percentage of physicians with burnout identified by specialty with the percentage satisfied with their work-life balance. [2] This graph seemed to indicate that neurology was among the specialties with the greatest degree of burnout and the least satisfaction with work-life balance. [2] A multivariate analysis from the AAN study found that burnout was associated with autonomy, clerical tasks, support staff, and hours worked (among other factors). [1] In his presentation, Dr. Cascino suggested that there was nothing unique about neurologists that predisposed them to burnout, but I propose otherwise. There are unique personality traits shared by neurologists that may, in large measure, be responsible for their increasing job dissatisfaction. Although there appears to be no formal study of the neurologist's personality type, a Myers-Briggs Personality Inventory administered to nearly 100 neurologists at Johns Hopkins revealed that they were "highly analytical, organized and somewhat introverted intellectuals". [3] The neurologist among all other specialists is the quintessential "last physician-scientist" generating hypotheses at the bedside while eliciting the patient's history and then testing the hypotheses, at least with respect to lesion location, with a detailed examination of the patient. [4] These exercises can be time consuming. As the opportunity to spend time evaluating and ruminating about the patient is narrowed by other exigencies (e.g. demands for more RVUs, time required to input information in the electronic medical record, fighting with insurance companies, etc.), the neurologist's job satisfaction must, perforce, be impacted. A unique personality may explain why neurologists experience job dissatisfaction that seemingly exceeds that of many other medical specialties.

1. Busis NA, Shanafelt TD, Keran CM, et al. Burnout, career satisfaction, and well-being among US neurologists in 2016. Neurology 2017;88:797-808.

2. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clin Proc 2015;90:1600-1613.

3. Griffin JW. Training matters in neurology. Nature Clin Pract Neuro 2006;2:345.

4. Berger JR. Neurologists: the last bedside physician-scientists. JAMA Neurol 2013;70:965-966.

For disclosures, please contact the editorial office at journal@neurology.org.

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