Increased brain-predicted aging in treated HIV disease

Editors’ Note: In a survey of US American Academy of Neurology member neurologists who had finished training, Busis et al. found that approximately 60% had at least one symptom of burnout. Burnout was strongly associated with decreased career satisfaction, while meaningful work and job autonomy were associated with increased satisfaction. Several of our readers commented on the study. Bagot et al. note that the practice settings in the report did not specifically reference telemedicine. They suggest that additional telemedicine responsibilities may cause more burnout, but can also moderate burnout risk and augment professional satisfaction via meaningful work. Dr. Giannouli worries that the choice of binary logistic regressions with only individual-level variables neglects the importance of working group dynamics. Dr. Yanofsky opposes the use of the word burnout, finding it demeaning. He argues that the term physician dissatisfaction syndrome should be used instead. Dr. Berger mentions Dr. Cascino’s 2017 Presidential Plenary Address, in which he 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. In his presentation, Dr. Cascino suggested that there was nothing unique about neurologists that predisposed them to burnout, but Dr. Berger proposes otherwise. He explains that neurologists tend to have a unique personality predisposing them to burnout. He further adds that neurologists spend a great deal of time eliciting patient histories and performing detailed examinations, which work against demands for more relative value units, time to input information in the electronic medical record, and fighting with insurance companies, which can lower job satisfaction. Finally, Dr. Sethi mentions 2 additional factors contributing to burnout. One is the electronization of medicine, which makes doctors always reachable electronically to patients. The other is the increasing mandatory continuing medical education requirements and maintenance of certification (MOC) requirements. In response to the telemedicine issue, Busis et al., authors of the study, explain that they surveyed neurologists who mostly practice fee-for-service face-to-face medicine and that telemedicine was not a choice for their questions on primary work setting and primary types of patients seen. Their survey can be adapted to study neurologists practicing under newer health care delivery and payment models, including telemedicine. In response to the issues with the neurologists’ practice context that may influence burnout, they agree that there is an effect of the practice environment on individual physicians and networks of physicians; they suggest that future studies exploring the effects of neurologists’ practice frameworks on burnout, career satisfaction, and well-being using multilevel analyses may yield valuable insights. In response to using the term physician dissatisfaction syndrome instead of burnout, Busis et al. disagree, stating that burnout has been a well-defined construct for more than 40 years and is evaluated in all types of workers, including extensive research in physicians. In response to the idea that neurologist personality type plays a role in burnout, they also disagree, stating that psychiatrists overlap with neurologists in their personality type, yet psychiatrists are among the specialties with the highest work–life balance satisfaction and the lowest burnout rates. However, the authors point out that the high prevalence of neurologist burnout may be due to misalignment of the neurologic method with the current health care environment. Finally, in response to the electronization of medicine and MOC requirements issues, Busis et al. explain that they did study those variables in their surveys. They add that clerical burden, electronic health records, and computerized order entry are associated with physician burnout, but there is no association between attitudes toward MOC and burnout. They conclude that there is a need for evidence-based health care policies, jettisoning administrative tasks that do not add value. —Chafic Karam, MD, and Steven Galetta, MD LETTER RE: BURNOUT, CAREER SATISFACTION, ANDWELL-BEING AMONGUS NEUROLOGISTS IN 2016 Kathleen L. Bagot, Dominique A. Cadilhac, Joosup Kim, Michelle Vu, Christopher F. Bladin, Melbourne, Australia: From a recent workforce survey, Busis et al. reported that 63% of neurologists in clinical practice had at least one symptom of burnout. Burnout and percentage of clinical practice time were associated with decreased professional satisfaction. However, meaningful work and job autonomy were associated with increased satisfaction. We noted that practice settings in the report did not specifically reference telemedicine. We examined consultant neurologists’ experiences conducting acute stroke telemedicine consultations in regional Victoria, Australia. The Victorian Stroke Telemedicine Program provides a 24/7 hyperacute stroke care clinical service (n 5 16 hospitals) via metropolitan-based neurologists. Neurologists participate, in addition to other clinical commitments, under a feefor-service model. Challenges include on-call demands, working with unfamiliar regional systems and colleagues with varying clinical skills, technology-related issues, and lack of feedback on patient outcomes. Perceived benefits include improving equity of access to optimal stroke care and delivering medical education to regional colleagues. The reported challenges may include additional burnout factors, reducing career satisfaction; however, practicing telemedicine may moderate burnout risk and augment professional satisfaction via meaningful work. With telemedicine proposed to improve access to neurologists, understanding telemedicine-specific factors for burnout and career satisfaction should be considered in future surveys.