Neurology: the high mental demands of speciality contribute to burnout


By Andrew Bracey

22 Oct 2020

Neurology is among the most demanding of specialities when it comes to mental, physical and time burden contributing to doctor burnout, researchers say.

A US study, based on national data from more than 5000 specialist doctors collected in 2018, calculated physician task load (PTL) scores for 23 distinct specialties with neurology scoring in the ‘red zone’ for mental demand.

Overall, neurology ranked around average for overall task load, due to having a lower burden on time and physical effort compared to other specialities such as emergency medicine.

Emergency medicine recorded the highest task load total of 295.3 out of a possible 400.

Neurology (256.7) and dermatology (255.9) and both sat toward the middle of the range, ranking closely alongside family medicine (257.9), ophthalmology (255.7), pathology (255), and orthopaedic surgery (253.7).

Psychiatry (224) recorded the study’s lowest score, while urology (290) and anaesthesiology (274.8) placed second and third highest respectively sitting well above the mean score of 260.9.

The authors of the study, published in the Joint Commission Journal on Quality and Patient Safety, identified a strong association between PTL and burnout.

While the direction and possible causality of the association were both elements requiring further examination, they wrote, the relationship between the two suggested “areas of particular focus to improve the practice environment and reduce physician burnout”.

“Even a modest decrease in PTL was associated with a decrease in burnout, suggesting standard process improvement has the potential to positively impact PTL when looked at using this lens,” the authors wrote.

“This knowledge offers front line providers and administrators the opportunity to consider the impact of the overall PTL of new procedures, policies, and quality improvement projects.”

Oncologist and senior staff specialist at the Flinders Centre for Innovation in Cancer, Professor Bogda Koczwara, said that while the study’s relatively small sample size was cause for caution, the results provided “exciting” insights into the impact of systemic factors on physician burnout.

“Traditionally we tend to think of burnout as an individual issue – as an outcome for an individual that is very much meant to be controlled by that individual, and this is reflected in how we tend to approach issues of burnout by arguing that people [need to focus on] more well-being activities, taking time to rest and build resilience,” she told the limbic.

“This paper recognises that there is a system level problem that contributes to burnout that goes beyond the individual and, therefore, the solution may need to be targeting the system as well.”

Melbourne oncologist Dr Ranjana Srivastava said that while cognitive load was just one of many factors impacting burnout, junior doctors needed to be made aware of the different stresses, workloads and demands that come with various specialties so they could make informed career decisions.

“To go into oncology expecting that you will somehow shield yourself from the emotional turmoil is not going to possible,” Srivastava told the limbic.

“You have to pre-emptively think of how you are going to manage that and you may decide that it is not the specialty for you. Similarly, you can’t possibly go into surgical training thinking that you will shield yourself from long nights, and on-call.

“It does behove everyone to look at their personal circumstances and decide how they will best fair in that environment.”

Already a member?

Login to keep reading.

Email me a login link