Covering Multiple Hospitals Promotes Burnout Among Neurointerventionalists

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Studies have shown that more than half of all physicians report symptoms of professional burnout. For physicians, burnout is associated with depression, substance abuse, suicidal ideation and suicide. For patients, physician burnout is a safety issue because it's associated with major medical errors.

The prevalence of burnout had never been studied in neurointerventional physicians, even though the frequent call burden and overnight procedures might put them at high risk. To investigate, Joshua A. Hirsch, MD, past president of the Society of NeuroInterventional Surgery (SNIS) and fellow of that society, and Thabele M. Leslie-Mazwi, MD, a specialist in Neuroendovascular and Neurocritical Care, together with other physician thought leaders from that specialty, surveyed members of three relevant professional societies.

In the Journal of NeuroInterventional Surgery, the researchers report a burnout rate among neurointerventionalists of 56%. They give suggestions about how hospitals could reduce that high rate.

A Nationwide Survey

Six members of the SNIS, Society of Vascular and Interventional Neurology, and the combined cerebrovascular section of the American Association of Neurological Surgeons and Congress of Neurological Surgeons developed an online survey. It comprised 17 questions about demographics and practices, followed by the 22-question Maslach Burnout Inventory–Human Services Survey for medical personnel (MBI-HSS).

The MBI-HSS captures scores in three domains, based on frequency of symptoms:

• Emotional exhaustion, scored 0–54
• Depersonalization, scored 0–30 (measures "an unfeeling and impersonal response toward recipients of one's service, care, treatment or instruction")
• Personal accomplishment, scored 0–48

The researchers estimated that there are 1,000 to 1,200 neurointerventional physicians in the U.S. In total, 293 surveys received had complete data and were tabulated, the estimated response rate was between 27% to 32%. In this study, burnout was defined as a composite emotional exhaustion score ≥27 and/or a composite depersonalization score ≥10. The survey period was four weeks in November and December 2018.

Prevalence of Burnout

164 respondents (56%) met the study definition of burnout: 57 respondents met it based on emotional exhaustion alone, 27 met it based on depersonalization alone and 80 met both criteria.

Some other striking findings:

• 43% of respondents cover two or more hospitals while on call
• 65% feel underappreciated by a hospital or departmental leadership
• 41% have strongly considered quitting their specialty within the past five years
• 65% consider themselves inadequately compensated for their neurointerventional call duty. More than half (54%) receive no additional financial payment for each 24-hour call period

Career stage, call frequency and procedural volumes had little influence on burnout.

Risk Factors for Burnout

A multiple logistic regression analysis identified three significant predictive or protective factors:

• Feeling underappreciated (odds ratio, 3.71)
• Having to cover more than one hospital when on call (odds ratio, 1.96)

Suggestions for Improvement

Covering more than one hospital during a given call period contributes to burnout because it increases stress and depersonalization, the authors suspect. Reasons could include:

• The potential for concurrent emergencies in more than one facility
• Longer commute times while having to meet treatment time metrics
• The need to cope with the logistics and expectations of multiple call teams, with less opportunity to build rapport
• The challenges of using multiple imaging and medical record software systems
• Suboptimal follow-up and feedback

Given the trends toward higher thrombectomy volumes, the authors advise neurointerventionalists to be cautious about entering into arrangements that involve covering multiple hospitals.

They add that societies should consider discouraging shared-call models, despite their advantages, because of their association with burnout.

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