I think I make about 2-3X the UML of salary for neurologists because I do less clinical medicine. I work very hard and a 40 hour week is sadly rare. I'm usually in the office for 10-12 hours 5 days a week. I still take call occasionally and when this is the case, I come in at all times. Because these are discrete events with firm horizons, I’m far from burnout in general. But because
all of clinical medicine is so toxic these days, I think I’m usually burned out by the first few hours on call.
The reasons for burnout are not only multifactorial but highly individualistic. The biggest problem, to this individual's mind, is that neurology has historically drawn some of the brightest young men and women to the ranks. Most of us are interested in neuroscience, see the elegance in the nervous system, and see the extension of neuroscience into practical matters. In fact, neurology can be defined as practical neuroscience. So you take very smart people and have them deal with day to day neurology - there's a mismatch between expectations and reality and that generates burnout. If neurologists could lose 10-20 IQ points, they'd go to work, start gabapentin for tingling, hang out with stupid drug reps, and be much happier. But few of can do that. We've devoted ourselves to horrible, difficult and complex brain problems, then we're dissapointed by the reality that horrible difficult and complex brain problems are horrible and difficult and complex - in a world that doesn't value that. Instead, the world values unnecessary procedures more than a necessary consult that goes into doing the procedure or not.
But there are MANY other forces that make neurology an absolutely miserable slog. As
@Ibn Alnafis MD pointed out, I've weighed in on this before. The worst catastrophe (it is so bad it could account for the top 5 burnout drivers) to affect our field has been the EMR. While this has affected other fields, most can offset this by concentrating on single issues. For example, imagine you do something discrete and curative like derm. (I recently spoke about this issue with
@MOHS_01 on another thread). You can use an electronic template for pretty much anything you do: black spot, carved out, sew up, then note done. You concentrate on the patient, then the note takes care of itself. Neurology, on the other hand, requires both quick and easy gestault impression, but also careful thought about how to support one's thinking, degrees of conviction, possibilities if one is wrong. So we're affected disproportionately, along with other specialties like onc, rheum, and pcp's.
So add this process, thinking fast and slow if I can borrow the phrase, to the way we’re treated by the system. Patients tell me “they told me I need to see you to leave,” after getting admitted for dizziness, having the impression read dizziness, then getting an MRI, MRA, echo, and starting them on aspirin for what turns out to be syncope.
We are getting turned from artisans to assembly line worker bees. It hurts. And with the rise of AI and advance practice folks in medicine, it is getting AND going to get FAR worse.
Add into this that not many patients get better (sure, you give tPA and get Lazarus effects but many are also screwed up and PD gets sinemet). We also give heavy news all the time. The seizure was caused by a tumor, it was a stroke, you have MS. All of these things are bad. And I haven’t even mentioned the PITA folks (and their families).
To combat it, you gotta find what you like doing and then do more of it.
