How Institutions Can Address Stroke Neurologists’ Mental Health Needs

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Christa O'Hana S. Nobleza, MD, MSCI, a board certified physician who specializes in neurocritical care, highlights the importance of addressing mental health needs and finding solutions for physicians.

Burnout syndrome and mental health disorders among physicians have garnered increasing attention in recent years. Among neurologists, there are high rates of burnout in the United States and across the world.1-4 Neurology has the second highest burnout rate across specialties with approximately 60% of US neurologists reporting at least 1 symptom of burnout.1,5

Nights on call each week and the amount of required clerical work were associated with a greater risk of burnout, while meaningful work and effective support staff were among the factors linked to lower burnout risk.1 

In a paper published in October 2022 in Stroke, Borelli et al suggest that stroke neurologists may have a higher risk for burnout syndrome and mental health disorders than other types of neurologists due to “peculiarities of the subspecialty.” In contrast to outpatient neurology, stroke management is a “24/7 enterprise with unpredictability and disrupted sleep, rest, and recreation for providers,” and it is “by nature high stakes… involving complex decisions under significant time pressure,” Borelli and his colleagues wrote.6

Researchers cite mental health stigma as one of the top factors likely discouraging physicians from seeking help for such concerns. Given the competitive and demanding nature of medicine, such issues may be perceived as a sign of weakness.6

The prevalence of burnout and mental health issues among stroke neurologists are likely underreported, mainly due to the taboo and professional consequences of declaring and reporting psychiatric and psychological strains.

Along with the negative effects on physicians’ career satisfaction and personal lives, the researchers noted that burnout also increases the risk for poor patient care and medical harm.6 Other experts suggest that burnout may be further exacerbated for female neurologists, who face significant pay disparities and underrepresentation in academic leadership compared with their male counterparts. This may be an important factor influencing the gender gap in the field of neurology.7,8

Burnout and mental health concerns among stroke neurologists represent a “problem of the whole health care organization rather than individuals,” Borelli et al wrote.6 To address these issues, there is a need for solutions on the individual level, such as cognitive behavioral therapy, mindfulness-based interventions, and physical exercise; the institutional level, including efforts to increase mental health awareness and solicit feedback from physicians on issues and solutions related to burnout; and the population level, such as providing emergency hotlines for mental health concerns.

As described in the review, signs that may indicate the need for providers to seek help include persistent low mood and career dissatisfaction, feelings of cynicism or detachment, decreased enthusiasm and self-esteem, and thoughts of self-harm.6

To discuss the mental health needs of physicians, particularly stroke neurologists, and finding potential solutions, we spoke with Christa O’Hana S. Nobleza, MD, MSCI, medical director of the neurocritical care service at Baptist Memorial Hospital, and associate professor in the department of neurology at the University of Tennessee Health Science Center in Memphis.

Stroke neurologists have a greater risk of mental health issues compared to other subspecialties.6 What have your personal observations been regarding this, and what factors are linked to the reported risk?

Dr Nobleza: The level of stress any stroke neurologist undergoes is accurate as described in this article. There are stroke neurologists who are coming in during the day to manage stroke patients in house, and they are the same neurologists who are on call overnight. The call schedules are typically at 1-week stretches. The sleep fragmentation and deprivation can easily take a toll on them.

Other factors that can contribute to burnout and mental health issues among stroke neurologists are unpaid obligations in academia that require stroke neurologists to devote hours for academic duties such as teaching, research, and administrative duties.

Uncommonly mentioned are the effects of gender and racial disparities in the professional growth of stroke neurologists that can largely play a role on mental strain and burnout.

The prevalence of burnout and mental health issues among stroke neurologists are likely underreported, mainly due to the taboo and professional consequences of declaring and reporting psychiatric and psychological strains.

What measures are needed on the institutional level to alleviate burnout and other mental health issues in stroke neurology?

Dr Nobleza: Although much work now is being done towards improving physician wellness and decreasing burnout, institutions and societies should still strive for process change beyond the “checklist.” It is not enough to have “pizza night” or a lecture on how to be mindful — these are “checklist” actions that I have noticed a lot.

They also have to consider a personalized approach to each individual faculty in addition to institutional initiatives and make it readily available while protecting the physician’s identity. They also have to invest in hiring personnel to decrease the clerical work being done by physicians to decrease burnout. Their investment vision should not solely be based on a return-of-investment of less than 5 years but instead longer term.

Institutions should focus on ways to retain faculty beyond 5 years, and this largely includes initiatives that focus on mental health and burnout. Adding patients to improve revenue is counterproductive. Requiring wellness lectures in an already busy stroke neurologist to prevent burnout is counterproductive.

Wellness coaches should be made available for all faculty for free or at a subsidized cost. All faculty should have paid “wellness” days included in their contracts, in addition to sick, vacation, and education days. Institutional leaders should be trained on how to both approach faculty as a group and individually when it comes to burnout and mental health issues and not merely sitting down for a meeting.

Lastly, institutional leaders should be sincere in wanting to improve burnout and mental health issues.

On the individual level, what are recommendations for stroke neurologists who may be struggling with mental health issues and need support?

Dr Nobleza: The main advice that I share with my colleagues in stroke is to set boundaries. We have to understand that there are more important things than our clinical duties. We have to start asking ourselves why we are doing something. How does this affect our life goals? How is it affecting our mental health? For example, how is answering an email on a Saturday, while you are sitting at your son’s soccer practice, improving your wellness? If it’s not, then you should set that boundary and not answer that email.

Some stroke neurologists might still think about patients as they go home, and my advice is to start setting boundaries and stop bringing those thoughts home. Coaching can also help if it’s available within the institution. I also advise them to look for a hobby or activity that they can focus on that is not work-related and start incorporating that into their schedules.

This article originally appeared on Neurology Advisor


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