Article In Brief
During COVID-19, neurologists shifted their workload to home offices, where they met new challenges with cancelled travel schedules and part-time and full-time homeschooling. Some came up with novel solutions. Their stories are here.
From March through May, work life flipped for neurologists—from medical office visits and faculty meetings with colleagues, to telemedicine from home and Zoom chats interrupted by cats and children.
As neurologists across the country made the transition, so too did they face new challenges in balancing the demands of work, home, and family life.
In interviews with Neurology Today, neurologists shared their strategies for achieving that balance—from networking with colleagues, scheduling (or re-scheduling) around their children's demands, and setting up their work environments so that they can disconnect their work life from family needs.
Group Exercise Sessions
Jacqueline A. French, MD, FAAN, professor of neurology at NYU Langone Health's Comprehensive Epilepsy Center, spent her pre-COVID-19 days on the move. Three days a week, she saw patients and oversaw research projects at NYU Langone in New York City, then she'd travel one day a week to Washington, DC, for her work with the Epilepsy Foundation, and then would travel to her home in Philadelphia for the weekend to spend time with her husband, an infectious disease specialist in New Jersey.
But as COVID-19 set in and travel became impossible, she found she missed the camaraderie with her colleagues. “When I was in New York and DC, I was mentoring and teaching the other fellows and there was a lot of face-to-face interaction, and now all of that is on Zoom,” Dr. French said, adding that she's added a device to her treadmill so she can walk a little during meetings.
She was missing her group exercise sessions as well. Typically, she would take Zumba classes several times a week. She still does an online class on Saturdays. But when everything shut down in April, she decided to start an online exercise program with her colleagues.
So once a week, starting a 9 AM on a Sunday morning, she and five to seven other neurologists come together on Zoom to do a group exercise class. Together, these neurologists—dressed in exercise gear— log in from sites across the country and (sometimes) London.
Before the body weight class starts, they chat about how life is going in their various hospitals, from death rates to personal protective gear, and the odd experiences of working from home.
“Most of the doctors are in their 50s and 60s,” Dr. French said, and typically about six or seven doctors show up. “We do class for a half-hour and then we all kind of talk to each other about how things are going at various institutions,” she said.
She finishes up about 8 pm, about the time her husband returns from the hospital. They make the time to have dinner together, something they wouldn't have been able to do while she was traveling.
Rethinking His Job
Scott Mintzer, MD, medical director of the epilepsy monitoring unit at Thomas Jefferson University Hospital, said that, pre-COVID-19, he spent most of his professional time doing outpatient visits and reading EEGs, including long-term EEGs for patients in the ICU.
Now he does most of this from home. He is still on call to go into the hospital if needed, but otherwise, he's seeing patients online and doing his academic work. The last time he saw a patient in person was March 19.
Dr. Mintzer has part-time custody of his two children, but their schedule happily works with his, he explained. “My kids are older, one is a high school sophomore and the other is a college freshman, and they stay up until 3 in the morning and then sleep until noon,” said Dr. Mintzer, a little jealously. “So the whole morning they're in bed.”
Most meetings are happening by Zoom now, and there are more meetings than before—once or twice a week instead of monthly, he said. Although he's usually not a fan of meetings, he said it's been nice to connect with everyone else and get a peek into other people's lives.
“Life happens pretty regularly on Zoom. Someone always has a kid in their lap or suddenly you'll hear someone screaming in the background,” he said. “It's never an issue. You put your mic down, go deal with the situation, and then come back again.”
Dr. Mintzer said it never really occurred to him before now that most of his job, maybe 85 percent, could be done remotely, and that's made him rethink future possibilities. Another silver lining is that his time returning patient phone calls has been drastically reduced.
“Now if a patient calls or sends an email about a situation, we ask if we can schedule a telemedicine visit tomorrow or the next day, and patients are very happy about this because then they have devoted time with the doctor,” he said. “Now I get reimbursed for taking that time, instead of doing unreimbursed phone calls. I think this may cut down on the number of phone calls by maybe 80 percent, and I'm finding that the visits themselves are briefer—patients are generally content to get to the point and get off their phone.”
Juggling Young Children and Work
Jori Fleisher, MD, MSCE, assistant professor in the department of neurological sciences at Rush University Medical Center, has been working from home since March 13 with her charts, her telephone, and her two children, ages 5-and-a-half and 2-years-old. About 80 percent of what she does is research, studying interdisciplinary home visits for patients with Parkinson's disease, and she said it's been more of a change for her patients who are suddenly having to see their caregivers through the computer.
“It's better than nothing, and it's better than waiting for months to see the doctor,” Dr. Fleisher said. “The priority for me is to keep my patients safe and aging in place for as long as possible.”
She and her husband, who is also a physician, have an au pair who works 40 hours a week. Her husband is an OB/GYN and he is still going into the hospital, so she's handling most of the work-arounds.
Dr. Samantha K. Holden's 4-year-old daughter, Eleanor, has popped up unexpectedly in some of her virtual visits with patients.
Dr. Jennifer Rubin shares an office with glass doors with her husband, where she said, she has full exposure to her children's hijinks.
Dr. Amanda Piquet said her daughter plays a telemedicine doctor after seeing her mom at home. She takes her toy laptop and headphone to ‘talk’ to her patients. “When I ask her what she's doing she says she's ‘taking care of her patients.’”
Dr. Fleisher tries to make it to the spare bedroom by 7:30 AM, where she has a laptop, a “thousand” cords, and a makeshift dry erase board. She's there until about 6 at night before handling dinner and baths and playtime and bed.
Overwhelmingly, patients have been understanding.
“Every once in a while I can hear the 5-year-old screaming from downstairs, and sometimes a patient will make a face and I'll say, ‘We're all in a bit of a crisis moment and sometimes you just need to have a temper tantrum.’”
What helps her keep her sanity she said, is her Peloton bike, riding at 11 at night.
“I was not a great exerciser and I felt guilty about it because I tell my patients how important it is, and to make sure they get good sleep. I'm a hypocrite because I sleep four hours a night,” she said. “So it felt like a ridiculous amount of money to spend but that thing is my sanity. I'm a total convert and a zealot. I'm not in great shape but I will tell you I am in much better shape than I was, physically and mentally.”
Working Around Each Other
Tracey A. Milligan, MD, MS, FAAN, assistant professor of neurology at Harvard Medical School, said shortly after moving to telemedicine full-time, she found herself trying to talk to a patient struggling with Zoom in Spanish, so she tried to get them another virtual platform, and—at the same time—was sending text messages on her phone trying to get IT help.
“By the time we got things to work the office visit was over and I had another video call waiting and we had to reschedule for next week,” Dr. Milligan said. “There's a picture of me with my Zoom headset and mic, another phone headset and mic for the phone, and then a separate computer headset, all of them totally tangled up.”
Dr. Milligan said she has seen some real benefits to online medicine, particularly being able to include other family members and caregivers who might not normally be able to attend an inpatient visit. One Friday, she had a telemedicine appointment with a patient in a rehabilitation facility and the patient's physician at the facility was also on the video, along with a family member who lives in a different state.
“It gives us the ability to communicate with everyone,” she said.
With her daughter, a senior in high school and her son, a senior in college, she doesn't have to worry about the kids so much. But she and her husband, who works from home regularly, have had to figure out a way to work around each other, making sure they have their own dedicated work areas.
She used to be really good about leaving work at work. No emails at night or weekends.
“Now that all is completely gone,” she said when we caught up with her by phone one Saturday. “I did some emails this morning.”
But there are benefits, she said—one of them is that her family makes sure to eat dinner together, and they'll play a game afterwards, or some cards.
Dr. Milligan said she's trying to be aware when she's been at the desk too long. One day her step counter said she'd had 33 steps. Total. For the day.
“I made sure to go for a nice, long walk,” she said.
Learning More Through Telemedicine
Samantha K. Holden, MD, MS, assistant professor of neurology at the University of Colorado School of Medicine, encountered her first work-family challenge during her first week of full-time telemedicine at home. Dr. Holden had asked an older patient to walk around his room so she could examine his gait—when all of a sudden, a little 4-year-old face appeared behind her on the screen.
“I'm thinking ‘How do I get her out of the room?’ and then I realized the patient wasn't wearing pants, and I hear my daughter, Eleanor say, ‘Why is that man in his underwear?’” said Dr. Holden.
Dr. Holden has been on lockdown since March 16. Her husband, a school administrator for Denver public schools, has most of his meetings in the morning, so she schedules most of her appointments for the afternoon and they switch off.
Working virtually has worked fairly well, Dr. Holden said. It's nice to see patients in their environments and view how their house is set up for them. But she is taking it one day at a time.
There are Zoom meetings and clinic and office time, and not much else in terms of papers or research is being done right now.
“At my office, I'd use open time to do research or write, but now if it doesn't have a set schedule on my calendar it's not getting done,” she said. “Any open space is Eleanor time.”
The couple tries to limit work to weekdays, keeping social media and news off limits. And while Dr. Holden enjoyed spin classes before the pandemic, she and her husband hesitated before getting a Peloton bike. No longer.
“It's the best thing we've ever done,” she said. “It's about what I'd be paying for a gym, and I'm on it for at least 30 minutes a day, and he rides it as much as I do.”
After a month of living in shutdown, things are just starting to open up a little in Colorado, and Dr. Holden said that they've finally settled into the “new normal.”
“When we started everything felt like a constant battle and there were a lot of temper tantrums from all three of us,” she said. “It's gotten a lot more comfortable.”
She Needs a Vacation After This
Amanda L. Piquet, MD, assistant professor of neurology at the University of Colorado School of Medicine, said it was after the first day that the five weeks of “stay-at-home” restrictions had been lifted that she realized she really needed a vacation.
Dr. Piquet, who has a 4-year-old and an 8-month-old child, is a neurohospitalist and works part-time in the hospital where she has inpatient duties. About half her time is in
outpatient clinics from home, and she said that her specialty in autoimmune diseases has made it easy to convert to telehealth, because a lot of what she does is counseling patients.
“Patients are thankful to be able to see their doctor, even if it is virtual,” she said.
The kids were normally in daycare, and her husband is in finance, so they've been trying to juggle schedules, with most of his work taking place in the early morning.
“We're doing our best,” she said. “At least I have the luxury of being in Colorado, and with sitting at a computer for so long, we make sure to get out for walks and we've been increasing the number of bike rides, and the time the baby sits in the trailer” of their actual bicycles.
One of the challenges is creating a separation between work time and family time, she said, adding that it's hard not to fall into working 24/7. So the couple made sure to create as much structure as possible, with some planned fun time. Now every Friday is family game night, which Dr. Piquet said they plan to continue when things revert back.
“My daughter used to take my stethoscope and reflex hammer to play doctor,” said Dr. Piquet. “Now she takes her toy laptop and headphone and ‘talks’ to her patients. When I ask her what she's doing she says she's ‘taking care of her patients.’ It's pretty entertaining to see how much they pick up on the changing times.”
Glass Doors and Glass Ceilings
Jennifer Rubin, MD, is a pediatric neurologist at the Lurie Children's Hospital of Chicago with three children, ages 8, 11, and 13. The transition during COVID-19 from work to home and from school to home has been pretty seamless, she said, except for the glass doors.
Usually she and her husband share an office downstairs, but it has glass doors, which is normally a good thing because they can see the children. Now it is not such a good thing.
“We had to put a new desk in the master bedroom because there is no way either of us could work and have phone calls or meetings this way,” Dr. Rubin said.” We'd have meetings and you could see the kids running by and screaming and yelling.”
So now they take turns watching the kids and working from the master bedroom. Sometimes both of them have to work and the kids need to fend for themselves for a minute, she said.
Dr. Rubin works 80 percent, and she still goes into the hospital some days for urgent in-person visits, and because the hospital does not yet have the capacity for telemedicine in every doctor's home. She does phone follow-ups at home.
She said her husband had been incredibly supportive, and she's lucky that her kids are healthy. But at the end of the day, things aren't normal. Particularly for her second-grader, some things are just not going to get done and they all have to be OK with it.
There have been some surprises. Apparently the school asked students to have parents be around during Zoom calls so they could listen in. One day Dr. Rubin was getting out of the shower when she heard her son's teacher's voice as she was about to open the door.
“He decided that my husband was working and I was not working so that moment was an opportunity to take a Zoom call,” Dr. Rubin said. “I did not know that was happening, but I'm glad I heard her voice before I came out of the bathroom.”
Dr. Rubin is particularly concerned about what will come next when hospitals start to re-open even as schools do not.
“It's not reasonable to expect everyone to be able to come in, particularly women who are still often in charge of child care,” she said. “Women are already unequally represented in the workforce and in terms of promotions. I worry that this will be another obstacle.”