Are Neurocritical Care Staff More At-Risk for Burnout?

Neurologists and intensivists reported the highest rates of burnout of any specialty, according to Medscape’s 2018 National Physician Burnout and Depression Report, almost double that reported by plastic surgeons. Neurologists also reported one of the highest rates of suffering from both burnout and depression at the same time.

In 2019, the World Health Organization (WHO) included burnout in the 11^th Revision of the International Classification of Diseases as an occupational phenomenon. Defined as a “syndrome conceptualized as resulting from chronic workplace stress than has not been successfully managed,” burnout is typically characterized by feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy.

Prompted by such high rates of burnout among neuro and critical care staff, researchers at Johns Hopkins University recently sought to characterize levels of burnout and resilience among care providers in the Neurocritical Care Unit (NCCU), the first study of its kind.

Their study, “Burnout and Resilience Among Neurosciences Critical Care Staff,” published in Neurocritical Care, examined the burnout and resiliency rates of 65 NCCU staff members who had spent at least two weeks in the NCCU between August 2016 and June 2017.

Using the abbreviated Maslach Burnout Inventory (aMBI) and 10-question Connor-Davidson Resilience Scale (CD-RISC 10), they found that 45% of participants reported high emotional exhaustion scores and depersonalization scores.

Among the study’s key findings:

• • A longer time working in the NCCU (1 to 5 years vs. less than a 1 year) was independently associated with high emotional exhaustion scores.
  • Older age was found to be associated with higher resiliency scores.
  • Those reporting high levels of burnout were also more likely to self-report suboptimal patient interactions.

“NCCU is a particularly challenging work environment,” one of the researchers, Dr. Taylor Purvis, said recently on the Neurocritical Care Society podcast, “because you have high numbers of patients with brain death and high incidence of uncertainty regarding functional outcomes, survival, and quality of life prognostication.”

As the COVID-19 pandemic continues to put a strain on all aspects of modern life, particularly on those in healthcare settings, burnout levels may be compounding existing stress. A recent Mental Health America survey of 1,119 healthcare workers conducted from June to September found that 76% reported exhaustion and burnout, and 93% reported that they were feeling stressed.

Furthermore, in a 2015 report, the Journal of Neurosurgery found that the burnout rate for nonacademic neurosurgeons was much higher than that of academic neurosurgeons, with their rates of burnout being 62.9% and 47.7% respectively.

In a recent interview on the Neurocritical Care Podcast series, Dr. Phil Stieg, the Chair of Neurosurgery at Cornell, asserted that some of the factors contributing to burnout among neurosurgeons include long work hours, loss of autonomy, inability to get into the operating room, hostile faculty, and social stressors such as the death of a relative.