Thursday, December 13, 2012

Hospital-based Neurologists Worry about Career Burnout, Survey Finds

MAYWOOD, Ill. - A survey has identified career burnout as a significant problem among neurologists who predominantly work with hospital inpatients.

Nearly 29 percent of these "neurohospitalists" said they had experienced burnout, and 45.8 percent said they were concerned about burnout but had not yet experienced it. (Burnout was defined as maintaining a schedule so burdensome as to limit the time a physician will or could spend as a neurohospitalist.)

Results were published in the December 2012 issue of Neurology® Clinical Practice. Among the co-authors is José Biller, MD, chair of the Department of Neurology of Loyola University Chicago Stritch School of Medicine. Biller is chair of the Neurohospitalist Section of the American Academy of Neurology.

Many neurologists have limited or abandoned seeing hospital patients because of reduced reimbursement. At the same time, inpatient neurologic care is becoming increasingly complex. The neurohospitalist movement has emerged as a possible solution to both problems.

In the survey, respondents said advantages of the neurohospitalist model include timely and high-quality care, improved continuity of care during the hospital stay, familiarity with hospital systems and defined work schedules.
Disadvantages included long work hours, poor reimbursement and transitions between the hospital and clinic settings.

Researchers conducted a random sample of 1,293 neurologists, with a response rate of 41.6 percent. Among those who responded, 16.4 percent said they were neurohospitalists. (A neurohospitalist was defined as a neurologist whose predominant focus is the care of inpatients as either a consultant or primary attending physician.)

Researchers surveyed an additional 498 neurologists (response rate, 55.8 percent) who specialize in such areas as critical care, stroke and emergency neurology and are thus more likely to be neurohospitalists. Combining results from both surveys, researchers found that the most common diagnosis neurohospitalists see is stroke and transient ischemic attack (mini stroke), 83.1 percent, followed by delirium/encephalopathy, 9 percent, and seizure, 2.6 percent.

Researchers concluded that neurohospitalists "are a potential solution to a number of the pressures on traditional neurologist practice." However, challenges need to be resolved, "not the least of which are potentially problematic transitions of care and burnout concerns given a small workforce. As the model matures, further study will be worthwhile, of both neurohospitalists and their impact on the inpatient care of patients with neurologic disorders."

Other co-authors are David J. Likosky, MD, of the University of Washington (first author); S. Andrew Josephson, MD, of the University of California-San Francisco; Mary Coleman of the American Academy of Neurology; and W. David Freeman, MD, of the Mayo Clinic, Jacksonville, Fla.

Biller is one of five neurohospitalists at Loyola. "I believe the neurohospitalist model we have developed at Loyola will evolve into a national paradigm on how to optimally provide care of hospitalized patients with a wide array of neurologic disorders," he said.

Biller added that hospital administrators "should support fellowship training for this new breed of neurologists."

About Loyola University Health System

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system that includes Loyola University Medical Center (LUMC), located on a 61-acre campus in Maywood, Gottlieb Memorial Hospital (GMH), on a 36-acre campus in Melrose Park, and convenient locations offering primary and specialty care services throughout Cook, Will and DuPage counties. At the heart of LUMC is a 547-licensed-bed hospital that houses the Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, a burn center, a children's hospital, Loyola Outpatient Center, and Loyola Oral Health Center. The campus also is home to Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. The GMH campus includes a 254-licensed-bed community hospital, a Professional Office Building with 150 private practice clinics, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation. It serves people and communities in 22 states from coast to coast with 93 hospitals, and 120 continuing care locations — including home care, hospice, PACE and senior living facilities — that provide nearly 2.5 million visits annually.