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Our 500th Blog Post: Amplifying Neurosurgery’s Voice

By HealthNo Comments

For the past decade, Neurosurgery Blog: More Than Brain Surgery has investigated and reported on how health care policy affects patients, physicians and medical practices. Posts have discussed the state of neurosurgical sub-specialties and promoted key health care policy and advocacy initiatives to ensure patients’ timely access to care, improve neurosurgical practice and foster continued advancement of neurological surgery.

Its health policy reporting efforts include multiple topic months and guest blog posts from key thought leaders and members of the neurosurgical community. To mark the 500th post, we combed through the Neurosurgery Blog archives to highlight our most popular blog posts and focus series that showcase the current state of neurological surgery.

The Neurosurgery Blog’s 10 top posts:

The Neurosurgery Blog’s top focus series:

  • WINS Series. The year 2020 marked the historic 30th anniversary of the founding of Women in Neurosurgery (WINS), bringing with it an exciting time for the WINS community and neurosurgery. To celebrate the 30th anniversary of WINS, Neurosurgery Blog published a series of articles highlighting the section’s goals — to educate, inspire and encourage women neurosurgeons to realize their professional and personal goals.
  • COVID-19 Series. The COVID-19 pandemic has significantly impacted neurosurgical practices across the country. To highlight the effects of the pandemic on neurosurgery, Neurosurgery Blog published a series of articles on the impact of COVID-19.
  • Spine Care Series. The Neurosurgery Blog published a series of articles on the spine to shed light on spine facts, innovation and the role of spine interventions. Today, spine-related disability has been called an epidemic. Misinformation regarding spine care in the U.S. is a significant hindrance to understanding the critical issues surrounding the care of patients with spinal conditions.
  • Military Faces of Neurosurgery Series. To pay tribute to the contributions of the many military neurosurgeons who have made significant contributions and sacrifices — whether on the battlefield, in the operating room or research lab — the Neurosurgery Blog published a series on Military Faces of Neurosurgery. Throughout history, neurosurgeons have served our country with distinction and grace. Read how former AANS president Roberto C. Heros, MD, FAANS(L), volunteered for the ill-fated Bay of Pigs invasion. Remember the horrors of the Vietnam War, as seen through the eyes of Patrick J. Kelly, MD, FAANS(L), while he was stationed in Da Nang during the bloodiest year of that conflict.
  • Physician Burnout Series. To explore and highlight the rising prevalence of burnout among clinicians in recent years, the Neurosurgery Blog published articles bringing physician wellness to the forefront of the profession and offering strategies to reduce physician burnout.
  • Faces of Neurosurgery Series. The Neurosurgery Blog published a Faces of Neurosurgery interview video series. Conducted by Kurt A. Yaeger, MD, a member of the AANS/CNS Communications and Public Relations Committee, these neurosurgery luminaries are asked about their early mentors, proudest achievements and advice for neurosurgical residents. Click here to watch the series.

Thanks for following Neurosurgery Blog, and stay tuned for great content in the coming decade!

Editor’s Note: We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by using the hashtag #Neurosurgery and following @Neurosurgery.

The Long Game: The CNS’ Investment in the NINDS/CNS Getch K12 Scholar Award

By Career, DEI, Guest Post, HealthNo Comments

In 2012, the Neurosurgeon Research Career Development Program (NRCDP) set a goal to grow a diverse corps of neurosurgeon scientists at institutions across the United States. The Congress of Neurological Surgeons (CNS) and the CNS Foundation became early partners in this effort by establishing the National Institutes of Neurological Disorders and Stroke (NINDS)/CNS Getch K12 Scholar Award, named in honor of the CNS Past President Christopher C. Getch, MD, FAANS, a respected neurosurgeon, friend and leader, who passed away unexpectedly soon after his presidency.

Having invested $500,000 to fund Getch Scholars alternate years since 2015, why is the CNS doubling down with a $1,200,000 pledge for the next five years to make the Getch K12 award annual?

According to the CNS Past President Ganesh Rao, MD, FAANS, who championed the CNS’s investment in the K12 Awards, “NRCDP is a major driver for improving neurosurgical patient care. Support for neurosurgical research is critical, particularly at the beginning of one’s career; the commitment to mentorship is unparalleled, and we are seeing increasingly diverse awardees. I am a firm believer that the K12 program will improve neurosurgery overall.”

New data from Emad N. Eskandar, MD, FAANS, director of the NRCDP, reveals that the program has successfully hit the three drivers mentioned by Dr. Rao. The result is a remarkable increase in overall grant support for neurosurgeons.

Protected Research is Linked to Subsequent Funding

The following data points demonstrate the continued success of K12 scholars:

  • From 2013 through 2017, the NRCDP supported thirteen scholars. Eleven out of the thirteen scholars received subsequent National Institutes of Health (NIH) funding for an overall success rate of 85%.
  • The second five-year cycle, 2018 through 2022, looks equally promising. During this period, the NRCDP supported sixteen scholars. Thus far, six have completed the program, and three have received additional substantive grants.
  • The number of years from a scholar’s initial NRCDP application until they obtained subsequent NIH funding also revealed success. Within five years, 50% of program alumni received NIH funding, and 85% received NIH funding within nine years.

According to 2017 winner Jennifer Strahle, MD, FAANS, “Winning a K12 award provided me with time and resources to complete the foundational hydrocephalus and iron metabolism experiments that laid the groundwork for my subsequent successful R01.”

While all K12 awards provide two years of protected research time, unique to the Getch award, the awardee may remain at their institution. Preserving this continuum of established relationships and research in their home laboratory is essential to the CNS.

Babacar Cisse, MD, of Weill Cornell Medical School and a 2018 winner of the NINDS/CNS Getch K12 Scholar Award, explained, “When I was hired by my chairman, we both agreed that I needed at least 50% of protected research time. The K12 solidified that agreement and extended it to 5 years.” Three years later, Dr. Cisse is about to publish his findings for the first time.

Diversity of Neurosurgeon Scientists is Just Beginning

The CNS shares the NIH goal to increase the diversity of all health care providers and, in particular, researchers. According to NRCDP data, the K12 program has seen critical areas of improvement since 2012:

  • In the first five years (2013-2017) of the NRCDP, two (15%) of the total thirteen scholars were women, and zero (0%) were underrepresented minorities.
  • In the second five years (since 2018), female scholars increased to three (20%) and underrepresented minorities increased to four (27%).

Sustainable Mentorship

Like all early-career neurosurgeons, mentorship and a community of colleagues are valuable to the K12 awardees. All awardees must attend the annual retreat hosted by the CNS for five years, and new awardees seek the guidance of the Advisory Committee and past K12 winners. Since awardees are committed to attending the retreat for five years, mentees naturally transition into mentors. One awardee responded, “the NRCDP K12 community represents an important community of mentors and colleagues with whom we can envision and affect future paradigm changes in the care of patients with neurological diseases.”

Galvanizing Investment

Compared to other surgical specialties — including orthoapedic surgery, otolaryngology and urology — neurosurgery saw a significant increase in grant funding from 2012 to 2021 (265%). One cannot help but marvel at the increased funding that has occurred since the inception of the NRCDP.

The CNS and the CNS Foundation are proud partners of the NIH, the Foundation for the National Institutes of Health, the NINDS and the NRCDP. The future for our specialty is bright.

Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery, @CNS_Update and @NINDSnews.

Alexander A. Khalessi, MD, MBA, FAANS
UC San Diego Medical Center
San Diego, Calif.

Congressional Docs Urge Americans to Take Action and Get the COVID-19 Vaccine

By Congress, COVID-19, Guest Post, HealthNo Comments

Last year, the entire world was forced to face the COVID-19 pandemic head on. And now, we — the American people — have the opportunity to achieve peace of mind and live life as free as before by choosing to receive a COVID-19 vaccine. Concerned for the health and safety of our nation, I recently joined some of my fellow colleagues in Congress — each of us are also health care professionals — in a public service announcement encouraging Americans to get vaccinated. Very soon we will have more COVID-19 vaccines than we have people willing to take it. In fact, almost half of adults in my home state of Kansas are uncertain about getting vaccinated.

Operation Warp Speed brought us safe and effective vaccines in record time. The process was rigorous and transparent, and a process that I personally followed very closely, resulting in a clear path to the eradication of the pandemic. The Food and Drug Administration (FDA) did not skip any steps. Instead, the FDA cut bureaucratic red tape — not corners — and got the job done in record time. By now, over 200 million vaccines have been given in our country.

Doctors, nurses and pharmacists nationwide recommend the COVID-19 vaccine to their patients, and over 90% of doctors in the U.S. have already chosen to get vaccinated. But, we have much more work to do. I encourage all neurosurgeons, primary care doctors, nurses, and community pharmacists to discuss the vaccine with your patients. Who better to have that conversation than someone who knows their medical history and has their trust? As a physician from Small Town, USA, I’ve given critical advice to my patients facing a number of issues including getting a vaccine for disease prevention. The most respected advice comes from a person’s own health care provider or pharmacist, and it’s conversations with them that help make the best health decisions.

I look forward to the freedom I, along with my loved ones, will regain once the vast majority of Americans are vaccinated. If everyone does their part, in the coming weeks we will once again be able to worship together as a congregation, gather with extended family, and travel near and far with friends.

Please join me in watching and sharing this important message!

Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtags #VaccinesWork and #ThisIsOurShot.

U.S. Senator Roger W. Marshall, MD (Kansas)



Physicians Suffer From Moral injury, Not Burnout

By Burnout, Guest Post, HealthNo Comments

Burnout has come to be defined as a workplace syndrome from chronic exposure to job-related stress. It is the constellation of emotional exhaustion, depersonalization and reduced personal accomplishment. More than half of physicians report at least one of these symptoms. The consequences of burnout are not just detrimental to physicians themselves, but also the people around them. Loss in productivity, high-risk behavior, disregard for safety procedures, more referrals, additional diagnostic tests and poor care are among the manifestations of physician burnout. Additionally, substance abuse, family breakups, poor health, depression and even suicide may also be extreme consequences of burnout. Burnout does not have to manifest by these catastrophic events; it can show up in small ways. Some of the subtler indicators of burnout include anger, aggression, nastiness, snide comments and disrespect for other physicians and health care professionals.

Historically, neurosurgery has been a high-stress medical specialty. As a result, there has been a heightened awareness of the issue over the past several years. Manuscripts addressing burnout in neurosurgery started to appear in 2011, with the many more written in the past three years. Joseph C. Maroon, MD, FAANS, was one of the first neurosurgeons who talked openly about the negative effects a neurosurgeon’s lifestyle has on the body and mind, his challenges and the changes he made. Dr. Maroon argues that a balanced life is needed to thrive as a neurosurgeon. Gary R. Simonds, MD, FAANS and Wayne M. Sotile, PhD, are well-known spokespersons on physician wellness and resilience, having co-authored “The Thriving Physician: How to Avoid Burnout by Choosing Resilience Throughout Your Medical Career” and “Thriving in Healthcare: A Positive Approach to Reclaim Balance and Avoid Burnout in Your Busy Life.” They argue that being a neurosurgeon is difficult and challenging and that we need to train and prepare ourselves. Dr. Simonds states, “Everybody involved in health care are like elite athletes — they’re expected to perform their best every day.” Every day is “game day” for a neurosurgeon. This concept of perpetual peak performance is, on the one hand, completely unrealistic, but on the other hand, expected by society. An elite athlete doesn’t just walk onto the field and do that. They spend a great deal of time in preparation and injury prevention. Of course, they only have to perform once a week.

The concept of preparation for injury prevention is important for neurosurgeons. While much focus has been dedicated to the syndrome of burnout, there is another emerging concept important to the chronic stress of physicians: moral injury. Burnout should be considered an end-organ failure — it is a failure of our resilience. Moral injury is what causes that failure. The term moral injury first was used to describe soldiers’ responses to their actions in war. Journalist Diane Silver describes it as “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.” Physicians may find it increasingly difficult to provide the care we want for our patients. This might occur due to misaligned priorities and barriers to delivering optimal, efficient care. As health care professionals, we are accountable to our patients, to ourselves and to our employers, but also beholden to payors for reimbursement for the care rendered. The goals of these various stakeholders are often divergent, leaving physicians feeling of lack of efficacy and frustration. The result may be considered a moral injury that results in the collapse of our resilience and leads to burnout.

This problem is bigger than us, and changes need to happen not only within health delivery organizations but also at the legislative level. We need leaders who recognize that caring for their physicians results in thoughtful, compassionate care for patients, which ultimately is good business. As Wendy Dean, MD and Simon G. Talbot, MD said in STAT News, “We need leadership that has the courage to confront and minimize those competing demands. Physicians must be treated with respect, autonomy, and the authority to make rational, safe, evidence-based, and financially responsible decisions.”

We also need self-compassion. As sensible as self-compassion sounds, physicians have difficulty with the idea as it sounds like self-pity or self-indulgence. Instead of mercilessly judging and criticizing oneself for various inadequacies or shortcomings, self-compassion means you are kind and understanding with yourself when confronted with personal failings. Take the time to visit this website on self-compassion.

If you want to know more about the concept of moral injury, listen to Zubin Damania, MD (ZDoggMD) — he says it best.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following @Neurosurgery and using the hashtag #PhysicianBurnout.

Martina Stippler, MD, FAANS, FACS
Beth Israel Deaconess Medical Center
Boston, Mass.

Preventing Moral Injury: An Interview with ZDoggMD

By Burnout, Guest Post, HealthNo Comments

Zubin Damania, MD (ZDoggMD) graciously sat down for an interview with the Neurosurgery Blog for the Physician Burnout focus series. He spoke with Kurt A, Yaeger, MD, neurosurgery resident at Mount Sinai Hospital in N.Y., and chatted about neurosurgery and moral injury/burnout.

Dr. Yaeger: Thanks for taking the time to chat with me for the Neurosurgery Blog. As a resident, a lot of your messages really resonate, especially reframing the phrase “burnout” to “moral injury.” Can you tell me about your motivation behind that?

ZDogg: Wendy Dean, MD and Simon G. Talbot, MD, wrote a piece for STAT News, which discussed how physicians aren’t suffering from burning out, they’re suffering from “moral injury.” It resonated with me because I realized that’s really what it is: it’s this conflict that we want to do the right thing. Physicians are very resilient, and yet we fail to be happy and succeed, not for lack of resilience, but because of the system in general. I wanted to draw attention to the fact that there’s a lot of victim shaming and a lot of over-simplification.

Especially as a surgeon, there’s a culture of “suck it up” and “what doesn’t kill you makes you stronger.” It’s part of the culture of medicine to be like that: if you can’t hack it, you can go someplace else. One of my biggest pet peeves are administrators that say, “Ah, you guys should get a massage, some essential oils, and we’ll hire a wellness officer who isn’t a doctor…” Directly in response to the video I made, some PhD wrote in Medical Economics, saying it was “burnout” and not “moral injury.” His title was, get this, the “director of provider well-being.” I thought, there’s so much wrong with that. First of all, you’re not a physician. Second, doctors tend to bristle at the term “provider” because it is an administrative commodification of all health care professionals. So, this is an ongoing problem and why I chose to focus on the terminology.

Dr. Yaeger: Do you think subspecialists like neurosurgeons are more or less prone to moral injury?

ZDogg: I don’t want to speak for my surgical colleagues, but because I have a platform where many medical professionals follow along, I get the sense that everyone is suffering in their own way. It may be that a surgeon’s kind of suffering is that they want to operate, and they want support from a primary care team. Yet they find themselves having to deal with everything because the system is so fragmented, there’s poor communication, everyone is siloed, and nobody has walked in each other’s shoes. Surgeons may feel like they’re patching up the failures of preventative medicine, which creates moral injury. They still have to chart. They have the pressures of trying to run a business and be successful financially. All this while doing good for patients. Thus, I think it’s more universal, though surgeons may compartmentalize a little bit more.

Dr. Yaeger: Do you think the evolution of technology in health care is enhancing the provider experience, or is it making them less productive and less able to spend time with patients?

ZDogg: So, I’m a big fan of technology in general. My whole platform is built on technology that didn’t exist when I was a kid — but as soon as it did exist, I was able to do the things I’ve always wanted to do. So, I’m a believer in that. The problem is, having been to some of these health IT (information technology) conferences like HIMMS (Healthcare Information and Management Systems Society), usually, it’s just a bunch of buzzwords and a bunch of people trying to capitalize on some concept — like building an app that counts steps and then pays you. But the truth is that without actually adding value to the physician’s day, those things are bound to fail. So EHRs (electronic health records) added value to administrators and hospital systems and insurance companies by capturing all this data that they couldn’t see before, but it doesn’t add much for patient care and just adds more to the plates of physicians. I think a lot of technology is seen as doing that currently, but it doesn’t have to be that way.

A good example is a company called Suki, whose creator I interviewed on my show. It’s a startup using artificial intelligence and natural language processing to automate clinical note documentation. Right now, it’s software that has to be invited into the exam room by a doctor. Doctors have to say, “this is something I want to assist me.” Suki designed its technology to take stuff off the doctors’ plates and make their lives easier. I think that’s the technology that’s going to help us.

Finally, I hate the terms telehealth and telemedicine, but some new companies do virtual, text-based primary care. Well, that’s an interesting way to rethink the practice of primary care because most people want the convenience to communicate with the physician the way they communicate with their kids. So, there is a lot of hope, but the parallel to EHRs is that you get the technology wrong, and it creates more work, and that’s the last thing we want.

Dr. Yaeger: What can we do, as professionals in neurosurgery, to lead the charge against moral injury?

ZDogg: Neurosurgeons are highly respected, even among other physicians. They’re are perceived as the apex of diligence with a complex skill set and work-intensive profession. What we haven’t seen yet — because you’re all so busy — is the leadership neurosurgeons can show in helping to reorganize medicine around principles we all care about. I call it the Health 3.0 Movement, where medicine is team-based. Neurosurgeons can be leaders in this — and have the gravitas to do it — so getting involved in organizations such as the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS), and getting engaged in social media, can actually make a difference.

Dr. Yaeger: How can neurosurgical department leaders, such as the chairs and program directors, emphasize the wellness of residents without sacrificing education?

ZDogg:  What a great question. What I’ve noticed is that the “elders” in medicine — the Gen Xers and Baby Boomers — like myself, notice young people are coming in and saying, “I’m going to clock in and clock out and hit my work hours. If a particular task doesn’t fit my learning, I’m not going to do it.” The elders notice a general erosion in work ethic, some of which may be a “fragilization” of Millennials and Gen Z with over-parenting, social media — but it’s not their fault. It’s been documented. They’re more anxious and more suicidal because we’ve turned them into fragile creatures rather than anti-fragile, where they get strength from adversity. So I think the first step is for program directors to be open.

It’s hard in neurosurgery because you have to be that focused and that diligent. What that means to me is that we need the leaders to have a little bit of emotional intelligence. To say, yes, there is some suffering here, and to recognize that. But then really, still holding those expectations and saying to trainees, “If this really is a calling, you will put in the effort. If we see that you put in the effort and passion, we will do our best on our end to make work-life integration happen.” Because it’s really not work-life balance, it’s just life. You’re trying to create something that’s sustainable, with a purpose and a calling. You have to show your mentors that this is a calling for you, and your mentors need to return the favor by helping to make this better together. It’s a partnership.

There’s a term, “communalization of pain.” Sometimes you see it in the military. We in medicine tend to suffer in silence, alone. There is a perceived isolation here that creates more moral injury. But, if you have other colleagues who say, “Yes, we are also suffering,” there are ways to communalize the suffering, and it’s healing for everyone. It’s validating that your suffering was witnessed. You’re not just doing it silently. Part of my platform is to help communalize the experience. The reason why our moral injury video had so many views is because it communalizes pain and reminds us that it’s not so much “I’m crazy” as “THIS is crazy.” Residency program directors can help to communalize pain by acknowledging suffering.

Dr. Yaeger: Well, thank you very much for your time. It’s been a great conversation.

ZDogg: It’s been great talking to you, thanks for the opportunity!

ZDoggMD (Zubin Damania, MD) is an internist from the University of California San Francisco (UCSF)/Stanford University and founder of Turntable Health, who speaks out against the dysfunctional U.S. health care system. He has taken to social media to campaign against physician burnout — or moral injury — using the term he prefers. ZDogg was the keynote speaker at the 2019 AANS Annual Meeting. Visit his website for more information.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following @Neurosurgery and using the hashtag #PhysicianBurnout.

Kurt A. Yaeger, MD
Mount Sinai Medical Center
New York, N.Y.

The Time Has Come to Bring Physician Wellness to the Forefront of Our Profession

By Burnout, Health, Work-Life BalanceNo Comments

I chose to be a neurosurgeon because I sought a life bringing healing to those with neurological diseases. After completing my training with a tremendous sense of pride, I was prepared to have an impact on patients and families in their time of greatest need and hopelessness. I ended each day with the knowledge that I had given my all. Like many others, I ignored fatigue and underestimated the accumulated trauma of occasions where I gave all I had, but the patient’s disease won. My blessings were my family, my resolve and my mission.

Eleven years ago, in an unanticipated instant, my resolve was gone and replaced by fear, hopelessness, and a sense of inadequacy. I lacked the skills to process emotions I had never acknowledged. I could not turn for support to loved ones lest I lose their respect. I was trapped. I was one of the grim statistics — a burned out and depressed physician. The administrative, clinical and personal stressors had whittled away my physical and mental reserves.

Every year almost 400 physicians die by suicide. Simply reading that sentence should be enough to give anyone who has dedicated their lives to helping and saving others cause for concern.

Two recent articles on burnout of U.S. neurosurgeons and neurosurgical residents found the burnout rate was 56.7% for neurosurgeons and 67% for residents. However, paradoxically 81.2% of neurosurgeons and 81% of residents say they are satisfied with their careers. Some of the factors associated with burnout for neurosurgeons included anxiety over future earnings and the ability to achieve work-life balance outside the hospital. For residents, the key factors were hostile faculty and social stressors outside work, such as debt.

Our work in neurosurgery involves the brain health of our patients, and integral to maintaining their brain health is taking care of ourselves while sustaining a work-life balance. A lot has changed in neurosurgical training and technology in recent decades. Now is the time to challenge the status quo. We need to raise awareness about physician wellness and remove the stigma and the tendency to keep physician burnout a secret. Burnout can lead to anxiety, depression, suicidal thoughts, marital and family stress, anger issues, addiction and substance abuse — any of which can lead to dissatisfaction and, ultimately, physicians ending their marriages, their careers and their lives.

Consider the following statistics:

  • Physicians are twice as likely to be dissatisfied with their work-life balance than the average working adult;
  • In 2015, almost 50% of physicians reported they were burned out;
  • Medical students’ rate of depression is 15 to 30% higher than that of the general public;
  • Physicians are more than twice as likely to take their own lives than the general population; and
  • Female physicians are 2.5 to 4 times as likely to die by suicide than women in other occupations.

We can, and should, do better. If we recognize and reduce the stressors that lead to burnout, we can create a supportive environment for physicians that fosters our own physical and mental well-being. This will allow us to provide the best quality care for our patients.

I know recovery is possible. I recovered through ultra-running, friendships, and other coping strategies. Acknowledging insecurities is vital, but it’s how we deal with them that is key. We should show compassion and kindness to ourselves and the members of the teams we lead.

My efforts over the past four years have been to help colleagues focus on wellness strategies and overcoming burnout. I have shared my story countless times with colleagues, medical students and staff. I do this to destigmatize burnout and let those facing pain in silence know they are not alone. I have also taken the empathy resultant from my pain and turned it into a career focused on healing for the vulnerable. In June 2018, I was recruited by Michigan State University (MSU) to help develop a safer and healthier campus following the trial and sentencing of former U.S. gymnastics and sports medicine physician, Larry G. Nassar, D.O., who went to prison for criminal acts of sexual assault. I help to develop strategic initiatives and programs to increase efficiency, safety, compliance and quality practices across all MSU’s health care services to ensure best practices and exemplary care in a learning and healing environment.

We also formed a wellness and patient experience committee. We developed a faculty peer support program to foster an environment that promotes healthy work-life balance, the continued physical and emotional development of our colleagues, role-modeling of professional and healthy behaviors, and compassionate recognition of unhealthy behaviors. Under the leadership of Claudia Finkelstein, MD, our peer support program offers a safe way for physicians impacted by adverse events, medical errors, litigation or other workplace stressors to talk about their experience and emotions with someone who has empathy from having “been there.” The goal is to ensure all physicians understand stress management and burnout prevention, and to make resources available to help.

We must all listen, learn and heal with each other to achieve a healthier, more peaceful and purposeful life with optimum performance in body, mind and spirit. We must remember we are never alone. And we must find hope even in the darkest moments for the lessons learned can give us insights on how to bring light to others.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following @Neurosurgery and using the hashtag #PhysicianBurnout.

Anthony M. Avellino, MD, MBA
Michigan State University
East Lansing, Mich.

Our Health Care Workers Are Struggling — That’s Why I Introduced Legislation to Help

By Burnout, Health, Work-Life BalanceNo Comments

As the husband of a physician, I like to say that issues affecting health care workers aren’t just dinner tables issues — they’re breakfast, lunch and dinner table issues. This has never been truer than it is during the current coronavirus crisis.

When the greater Chicago area was overrun with COVID-19 patients this past spring, my wife, an anesthesiologist, was among those on the front lines placing intensive care unit (ICU) patients on ventilators. She did so while wearing a welder’s mask that she purchased from a hardware store because there was simply not enough personal protective equipment (PPE) to go around. Our children and I could not have been prouder of her bravery, but we worried about her constant exposure to the virus and the pressures of being a frontline health care worker during a pandemic.

Although case numbers have come down in our area, the virus is far from quashed, and any amount of progress feels fragile. For many who served in hot spots like New York City in the early days of the pandemic — and those in areas currently experiencing surges, like Miami and Houston — navigating the emotional toll of being on the front lines has proven to be among the pandemic’s greatest challenges.

As with so many other areas of policy, the COVID-19 crisis has forced us to confront the ways we have failed as a nation to look out for the well-being of our health care workforce. Too many have struggled in silence for decades; now, they have been called to respond to a once-in-a-century public health crisis without an emotional safety net. It is for these reasons that I introduced the bipartisan Coronavirus Health Care Worker Wellness Act (H.R. 7255), along with my colleagues Reps. John Katko (R-N.Y.) and Frederica Wilson (D-Fla.). This legislation seeks to accomplish two goals:

  • First, the bill will authorize U.S. Department of Health and Human Services (HHS) to distribute grant funding to health care providers who wish to establish or expand programs dedicated to promoting the mental wellness of their workers on the front lines of COVID-19; and
  • Second, the bill will authorize a comprehensive, multi-year study on the issue of health care worker mental health and burnout, including an assessment of underlying factors, barriers to seeking and accessing treatment, implications for the health care system and patient outcomes, and the impact of the COVID-19 crisis.

Studies and events of the past several months have confirmed that many health care workers are indeed struggling with their mental health as a direct result of COVID-19. Consider the following:

  • Health care workers have witnessed death on an unprecedented scale, and social distancing orders have put them in the agonizing position of denying families access to their loved ones and notifying them of deaths over the phone;
  • With morgues overflowing, some hospitals have parked refrigerated trucks outside to store additional bodies;
  • Critical shortages of PPE in the spring forced health care workers to re-use equipment or go without it, and there is a fear that shortages could return if cases spike again this fall;
  • Over 135,000 health care workers have been infected with COVID-19 to date, and more than 600 have died;
  • Data from China — a country that experienced an acute outbreak much like our own in March and April — put startling figures on reported rates of depression (50.4%), anxiety (44.6%) and insomnia (34.0%) among frontline workers;
  • Another study conducted between March and May found that the average U.S. health care worker — not just those on the front lines — reported enough depressive symptoms to be considered clinically depressed;
  • Rates of post-traumatic stress disorder (PTSD) among frontline workers are expected to rival those among first responders to the 9/11 terrorist attacks; and
  • Lorna M. Breen, MD — an emergency room physician in New York City who contracted COVID-19 herself — tragically believed she had no choice but to take her own life amid the devastation.

As dire as the current situation is, the unfortunate truth is that burnout and mental health challenges were common among health care professionals long before the world had ever heard of SARS-CoV-2 — something that likely comes as no surprise to members of the neurosurgery community.

COVID-19 will, unfortunately, be with us for an extended period. Frontline workers needed our support back in March — not just with our words, but with Congressional action — and we failed to provide it. We simply cannot overlook this situation any longer, nor can we continue to ignore the importance of the long-term job satisfaction of our nation’s health care workforce. We must pass the Coronavirus Health Care Worker Wellness Act as soon as possible.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following @Neurosurgery and using the hashtag #PhysicianBurnout.

U.S. Congressman Raja Krishnamoorthi (IL-8)

Burnout to Wellness: Dr. Joseph Maroon’s Journey to a Balanced Life

By Burnout, Health, Work-Life BalanceNo Comments

Joseph Maroon, MD, FAANS, tells an interesting story that sets the scene for his journey from burnout to wellness in his book, Square One: A Simple Guide to a Balanced Life.

FLIPPING HAMBURGERS and working at gas stations are jobs some people might do during the summer months in high school, or maybe to make a living if they haven’t pursued a higher education. I, however, did both of these jobs at the age of 41, after I’d been a successful neurosurgeon for over a decade. Decidedly out of order on a résumé, right? But exactly one week after serving as the chief neurosurgeon in an operating room at a premier teaching hospital in Pittsburgh, I was filling up 18-wheelers and figuring out how to use the deep fryer at a truck stop in the small town of Wheeling, located in West Virginia’s northern panhandle.

The reader immediately wants to know how he got to the truck stop, what the circumstances were, and, most importantly, did he make it back to neurosurgery. Fortunately, he did; however, Dr. Maroon’s journey of highs and lows were made public long before his recent book. For the last several decades, he has regularly used his own example of an Icarus-like fall as a teaching lesson for both residents and staff. To this end, it was also the subject of his presidential address — From Icarus to Aequanimitas — to the Congress of Neurological Surgeons (CNS) in 1986.

The stresses Dr. Maroon experienced as a neurosurgeon, the toll on his personal life and the concurrent physical as well as mental decline are today recognized as burnout. At the time, however, burnout was only a taboo topic whispered in the halls of medical institutes. Dr. Maroon famously recounts his story of overcoming burnout after rediscovering a childhood book, I Dare You, by William H. Danforth. In the book, Danforth relates a balanced life to a square, with each of the four sides being labeled as family, physical, work and religious. In a balanced square, each side would have equal length indicating the same participation in each category. Dr. Maroon relates how his “square” was a flatline EKG with his life totally consumed by work.

Using Exercise to Overcome Burnout and Depression

During his recovery from burnout, Dr. Maroon reconnected with his inner athlete. As a former collegiate All-American running back, he used physical exercise to help rebuild both his body and brain to overcome the depression that ensued with his burnout. His passion for exercise ultimately led to him becoming an 8-time Ironman Champion.

With a background in playing football, and realizing his own benefits for mental health with routine exercise, he became an advocate for team sports and exercise.

Burnout to Wellness Programs

As a living example of professional burnout, Dr. Maroon has worked with numerous neurosurgical residency programs, including his program at the University of Pittsburgh Medical Center (UPMC), to advance the recognition and interventions needed to reduce burnout. Neurosurgery as a profession now speaks openly about burnout with the initiation of several wellness programs nationally,

At UPMC, Dr. Maroon, along with a group of senior faculty and residents, initiated a wellness program several years ago based, in part, on the concept of Danforth’s square. The following characterizes the UPMC Wellness Program goals:

  • Improve work/life balance;
  • Decrease psychological stress;
  • Increase social support through activities and mentorship; and
  • Improve general health and fitness by monitoring biomarkers of physical and psychological health.

A significant milestone for the program recently occurred with the dedication of the Maroon Fitness Center. The center is located within a dedicated room in the department with both aerobic and weight lifting equipment that can be accessed by both staff and residents 24-hours a day. Dr. Maroon continues to lecture on the subject of burnout prevention within UPMC and beyond. His leadership by example continues to be an inspiration for past, present and future generations of neurosurgeons.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following @Neurosurgery and using the hashtag #PhysicianBurnout.

Nitin Agarwal, MD
Chief Resident
University of Pittsburgh Department of Neurological Surgery
Pittsburgh, Pa.



Jeffrey Bost, PA-C
Clinical Instructor in the Department of Neurosurgery at University of Pittsburgh Medical Center
Clinical Assistant Professor at Chatham University
Pittsburgh, Pa.

Physician Burnout in Neurosurgery: An Under-Recognized Phenomenon

By Burnout, Health, Work-Life BalanceNo Comments

As conversations about work-life balance are becoming more prevalent, and given the stresses associated with the COVID-19 pandemic, there has been a renewed interest in the issue of physician burnout. Burnout is a long-term stress reaction marked by emotional exhaustion, depersonalization and a lack of sense of personal accomplishment. In recent years, the rising prevalence of burnout among clinicians — more than 50 percent according to a Medscape report — has led to probing questions on how it affects access to care, patient safety and care quality. Burned-out physicians are more likely to leave their practices or the practice of medicine altogether, which reduces patients’ access to and continuity of care. Burnout can also threaten patient safety and care quality when depersonalization leads to poor interactions with patients, and when burned-out physicians suffer from impaired attention, memory and executive function.

In addition to the impact of burnout on physicians and patients, according to a recent study published in the Annals of Internal Medicine, the health care system loses more than $4.8 billion a year due to this phenomenon. Although neurosurgeons work long hours, balance outpatient and inpatient practices, and deal with life and death issues, we have paid limited attention to burnout in this field.

For the next few weeks, Neurosurgery Blog will highlight the issue of burnout — including in the field of neurosurgery. Here are some staggering facts about burnout in neurosurgery:

  • A recent survey of 783 neurosurgeons found the rate of burnout to be 62.9 percent among nonacademic neurosurgeons and 47.7 percent for academic neurosurgeons;
  • Poor work-life balance, health care reform and financial uncertainty were the major factors contributing to career dissatisfaction; and
  • Burnout and depression — sometimes associated with emotional exhaustion — were a significant predictor of preventable major medical errors in a study using data from 7,905 members of the American College of Surgeons.

Among neurosurgeons, many factors were found to lower the chances of burnout. High volume surgeons, with stable families, who are intellectually challenged, with leadership roles and a good work-life balance, are more effectively shielded against burnout.

Understanding burnout will push more health care organizations to adopt strategies to protect their members from this phenomenon. Physician engagement will undoubtedly be crucial to the prevention of burnout. We must take the lead by being active and vocal for ourselves, our colleagues and our patients and fight against the forces that erode our mental health and the quality of our work.

Join us in an insightful journey, understanding burnout as it pertains to the field of neurosurgery. We aim to identify the reasons behind this phenomenon and the best strategies to prevent it or minimize its impact on the careers of neurosurgeons.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following @Neurosurgery and using the hashtag #PhysicianBurnout.

Kimon Bekelis, MD
Vice-chair, AANS/CNS Communications and Public Relations Committee
Catholic Health Services of Long Island
West Islip, N.Y. 



Kristopher T. Kimmell, MD, FAANS
Vice-chair, AANS/CNS Communications and Public Relations Committee
Rochester Regional Health
Rochester, N.Y. 



Clemens M. Schirmer, MD, PhD, FAANS, FAHA
Chair, AANS/CNS Communications and Public Relations Committee
Wilkes Barre, Pa.

Lasting Change: Assessing the Potential Long Term Impact of COVID-19

By COVID-19, HealthNo Comments

“Real change, enduring change, happens one step at a time.”

Ruth Bader Ginsburg

Associate Justice, U.S. Supreme Court

The economic, medical, political and psychological tsunami unleashed by the COVID-19 virus is unlike anything we have seen in our lifetime. The traumatic disruption of 9-11 was limited in comparison to our current crisis. While impossible to include up to the minute statistics, already more than 15 million cases have been confirmed with at least 620,000 deaths, and U.S. unemployment is approximately 11%. Is it possible that any good will come of these months of tragedy and lock-down? What do we know about the immediate and longer-term consequences on us as humans, on the health care community and neurosurgery? I have been given the monumental task of trying to peer into that future as the Neurosurgery Blog’s focus on COVID-19 draws to a close.

Silver Linings: Our World

Today, the canals of Venice are clear, and dolphins have returned — an amazing and rapid transformation. During the pandemic lock-down, our environment improved dramatically with blue skies seen across India, air pollution around major cities visibly and measurably improved, leading to improved health, and images from space revealing stunning clarity. Beyond recognizing how reversible the damage to our physical world is, we have witnessed the very best of humanity in our communities. Touching stories have filled our news feeds:

These represent the many things individuals are doing every day to make the lives of those around them safer and more fulfilling.

To fill the void left by social distancing, many have become facile with video technology to provide essential human contact during long weeks of isolation. Religious services, theaters, concerts and more have rapidly adapted to provide their communities invaluable connection and engagement.

Silver Linings: Health Care and Neurosurgery

As grim headlines unfolded, the health care community united. Traditionally competitive institutions have reached beyond those boundaries to share expertise, resources and staff to provide the best care for patients. Necessary innovation has blossomed creating change that will survive beyond COVID-19 such as:

The Centers for Medicare & Medicaid Services (CMS) authorized payment for telemedicine services, with many private insurance companies following on their heels. This marks a crucial advance and should herald a new era of health care delivery. A world free of many of the inconveniences associated with a visit to the doctor — days off work, parking, travel, navigating complex hospital corridors — is no longer a figment of the imagination. Reimbursement for these services will drive technological innovation that will enhance the value and experience of these visits. While there will always be an essential role for the face-to-face appointment —especially in the surgical disciplines such as neurosurgery — and the importance of human touch, the provision of telemedicine care should be more comfortable and more convenient.

Neurosurgery stepped up and came together in many meaningful ways. Many of our national and international organizations, as well as neurosurgical publications, provided state of the moment information to connect us around the world. Neurosurgeons continued to keep their practices afloat to provide care to those with emergent conditions despite considerable risks to themselves and, by extension, their loved ones. Many stepped into roles of supporting other physicians overwhelmed by the sheer volume and acuity of COVID-19 patients. In contrast, others assumed leadership roles helping their hospitals and communities in many ways — designing systems for surge redeployment of staff and creating new operating room policies to enhance airflow. Each institution has found ways to protect their resident team while ensuring they continue to receive valuable education and feel fully supported during a time of great strain.

Not All Roses

Still, many vulnerabilities were revealed, and scars will be left from the crisis. Neurosurgery lost one of our most beloved colleagues when COVID-19 took the life of James T. Goodrich, MD, PhD. Questions arose, such as how could things as simple as masks, gloves and gowns become such a challenge to procure? Known health care disparities were shown to exist, likely reflective of such differences at every level of medical care, but poignantly and tragically demonstrated in COVID-19 related deaths, morbidity and availability of resources. This was further brought into the spotlight by the death of George P. Floyd, Jr. and the dramatic national response that followed. Finally, people learned it isn’t so glamorous or pleasant to wear a mask, as neurosurgeons have known our whole careers.

Lasting Change

Most meaningful change does evolve incrementally; however, cataclysmic events like the COVID-19 crisis instigate sudden and dramatic change. Given the potential for positive unintended consequences, here is my wish list (please add your own!) for enduring gifts we deserve from COVID-19:

  • A deep appreciation not only for the fragility of the world around us but also its capacity for resiliency — let us remain mindful of how all of our actions impact the earth, our health, and our fellow humans;
  • A new dawn of real innovation in medicine that builds new frontiers of access and engagement by leveraging the best of augmented intelligence and melding it with the personal touch that only humans can provide;
  • Restoration of travel because of all the good it brings but with a profound sensitivity on how to preserve the beauty of the natural and man-made world; and
  • A renewed and sustaining appreciation for the difficult work done by neurosurgeons and all physicians, along with their dedicated teams, to care for patients and their loved ones every day.

We thank our readers for following Neurosurgery Blog as it recorded the real-time impacts of the COVID-19 global pandemic. As the world emerges from these trying times, we invite you to continue the conversation on Twitter by following and using the hashtag #COVID19. With new therapeutics and promising vaccines, the glimmer of hope becomes stronger with each passing day.

Deborah L. Benzil, MD, FACS, FAANS
Cleveland Clinic, Vice-Chair, Neurosurgery
Cleveland, Ohio