April 18, 2019

Survey Measures Burnout Among Neurointerventionalists

A first of its kind survey of emotional burnout among neurointerventional specialists is part of a larger effort by Harvey L. Neiman Health Policy Institute® Senior Research Fellow Joshua A. Hirsch, MD, FACR, FSIR FSNIS, and Wake Forest University Neurosurgeon Kyle M. Fargen, MD, to inform practitioners in this unique medical subspecialty about its prevalence, causes and remedies.

The survey—published April 11, 2019 in the Journal of NeuroInterventional Surgery (JNIS)—found that 56 percent of the online survey’s 320 respondents met the criteria for burnout. The finding correlates with previously published research showing that roughly 50 percent of neurosurgeons and neurologists and more than 60 percent of radiologists reported some level of burnout.

Hirsch is past president of the Society of NeuroInterventional Surgery (SNIS) and has been the long-term councilor for the society to the American College of Radiology (ACR). SNIS member are multidisciplinary and include interventional neuroradiologists, endovascular neurosurgeons and interventional neurologists. They employ minimally invasive percutaneous technologies to treat diseases of the brain, spine, head and neck. Frequently performed procedures include emergent revascularization in the setting of large vessel ischemic stroke, aneurysm repair and treatment of arteriovenous malformations and various spinal conditions.

Hirsch is vice chair of procedural services and chief of interventional neuroradiology at Massachusetts General Hospital. He is active at the ACR serving on its Commission on Economics as the chair of both the Future Trends Committee and the Committee on Economic and Advocacy Issues in Academic Radiology.

The process that would ultimately lead to the neurointerventionalists’ burnout survey began in 2018 when Fargen discussed the topic during a health policy session at the SNIS annual meeting.

“It was an incredible moment,” Hirsch recalled. “While Kyle’s talk was only slated for 10 minutes, it led to a variety of interesting questions and comments afterward. Importantly, many of those observations came from luminaries in the society including past presidents who were very appreciative that the burnout topic was being discussed.”

As chair of the SNIS health policy committee, Hirsch followed with an editor’s comment in JNIS before again working with Fargen on the survey. “The remarkable success we had gaining traction with the survey is thanks to support from SNIS, the Society of Vascular and Interventional Neurology, and the American Association of Neurological Surgeons/Congress of Neurological Surgeons combined cerebrovascular section,” Hirsch said. “Their leaderships were all engaged and saw obtaining this baseline data as mission critical for the continued health and vitality of the specialty.”

The results established significant relationships between burnout and general life happiness, happiness with career choices, the degree to which work duties affect personal and family life, feelings of underappreciation and past consideration of quitting neurointerventionalist practice.

Based on a 22-question Maslach Burnout Inventory-Human Services Survey (MBI-HSS), 47 percent of respondents recorded high scores for measures of emotional exhaustion, 36 percent for depersonalization and 16 percent for depressed feelings of achievement and personal accomplishment.

Nearly two-thirds reported feeling underappreciated by their hospital or department leadership, with 40.6 percent indicating that they had strongly considered leaving the neurointerventional field in the previous five years.

Nearly two-thirds felt they were inadequately compensated. The survey identified an inverse relationship between burnout and additional call payment, though covering more than one hospital while on call was associated with a greater probability of burnout.

Hirsch noted that half the respondents said they were on call either every day or every other day.

“Just think about that and the impact it must have on the interventionalists’ sleep and their homelife,” he said. “It’s even disruptive professionally when the interventionalist is repeatedly required to ask patients who have elective surgery or clinic appointments to wait while emergency cases are addressed.”

The study noted that burnout is associated with depression, substance abuse and thoughts of suicide. It reported that suicide is the second leading cause of death in female medical trainees. Clinically, burnout is linked to major medical errors and malpractice lawsuits.

From what started as an exercise to raise awareness about burnout through a survey is leading to materials on how neurointerventional specialists can combat it.

“It seems clear that optimized neurointerventional care would come from providers that aren’t feeling emotional exhaustion,” Hirsch said.

Wellness, one of the keys to avoiding burnout, is the focus of a special May issue of the ACR Bulletin. The issue discusses strategies for addressing burnout at the individual, institutional and national levels, and also shares ideas for creating a culture of wellness in the workplace. The issue is slated to reach ACR members’ mailboxes on April 25.