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The Neurologists Are Not Alright


Since March of 2020, the editorial team of Neurology Today has reviewed and published more than 100 stories chronicling the impact of the COVID-19 pandemic on our profession. We have covered scientific advances, the work of intrepid members of neurology teams on the frontline, innovations in education, and the never-ending challenges posed by this global health care crisis. Medical students, residents, fellows, attendings, and allied staff on neurology services volunteered for COVID duty and cared for patients under extraordinarily demanding circumstances. Throughout it all, we were honored to share their stories of remarkable sacrifice, dedication, compassion, and resilience.

But so too did these stories uncover less-publicized tales of grief, pain, and suffering. Over these past 10 months, our roles have evolved and become increasingly complex—creating stressors we could not have anticipated. When the pandemic hit, neurologists in the inpatient setting were pulled in to deliver care on COVID wards and neurology trainees were redeployed to COVID-facing teams. Neurologists in hospital-based practices were asked to function in roles for which they were not formally trained and those in office-based practices saw sudden and precipitous changes in how they delivered care.

On an almost daily basis, we have had to transition to new ways of doing things—how we practice, train our workforce, and conduct research. With community spread of COVID, we have faced more exposure to infection or death in our practices, among our staff, and in our own families. The typical cycle of psychological recovery after a disaster has been prolonged. This crisis has worsened the psychological health of neurologists and potentially endangers the health of the profession for years to come.

The feature, “The Emotional Fallout of the Pandemic on Our Neurology Workforce” offers a hint of what is to come—as more among us experience burnout, anger, depression, post-traumatic stress, and even suicidality.

In this issue, which highlights the most noteworthy developments of 2020, we would be remiss not to mention the impact that COVID-19 has had on us as a profession. Given our specialty's high burnout rate even before COVID-19, and our workforce deficit, we all need to pay heed. The human toll of the pandemic on our workforce is yet to be fully determined

The toll of COVID-19 will likely leave permanent scars for years. As your stories have revealed, neurologists, neurology residents and fellows, and advanced practice practitioners are (most assuredly) not alright. As a specialty, we must work together to identify colleagues who are in trouble, facilitate help, and focus on prevention.

Towards that end, we ask our readers to encourage a culture that destigmatizes mental health issues and consider these four strategies for addressing the emotional burden of this pandemic.

  • Recognize the warning signs in others: exaggerated responses to situations; disruptive or avoidant behaviors; repeated requests for special consideration; changes in behavior or appearance; mentions of feeling trapped or being a burden to others
  • Respond: If you recognize signs of stress in someone, listen calmly. Find a quiet space to allow them to talk. Allow people to share their story and listen without expressing judgment.
  • Refer and encourage colleagues to seek support. Learn in advance where the resources are at your place of work so that you can direct neurologists who are in trouble to sources of assistance.
  • Remember: “It is in the nature of illness and physician identity that many physicians are not motivated to seek assistance. There are many potential obstacles to an ill physician seeking care including denial, aversion to the patient role, practice coverage, stigma, and fear of disciplinary action. Most physicians who become ill or are impaired are able to function effectively during the early stages of their illness due to their training and dedication. Treatment, even if the illness progresses to impairment, usually results in remission and restoration of function.”—The Federation of State Physician Health Programs