COVID-19 Pandemic, Political Climate Create Challenges for Community Neurologists

Roman Ayele, PhD, MPH

A recent qualitative study published in Neurology concluded that the COVID-19 pandemic created challenges unique to community neurologists. Investigators identified 4 main themes when interviewing participants, including the political climate, a lack of support for new care models, being on the frontline of suffering, and clinician self-care. 

In order to combat these challenges and the “unusual environment” that community neurologists practice in, investigators, led by Roman Ayele, PhD, MPH, health research scientist, Veterans Health Administration; and assistant professor adjunct, Colorado School of Public Health, suggest implementing efforts to improve care delivery and incorporate new models of care, with particular focus on reducing clinician burnout. 

A total of 20 community neurologists from a multisite comparative-effectiveness trial of outpatient palliative care—spanning from July 23, 2020, to November 11, 2020—were included in the study. Participants were asked about their experience with the COVID-19 pandemic and its effect on their practice, their patients’ lives, and their own personal lives. Interviews were conducted remotely and lasted between 30 minutes and 1 hour. 

When addressing the challenges of the current political climate, clinicians said that patient skepticism and wavering trust were associated with the COVID-19 pandemic, which then impacted their practice. Speaking with NeurologyLive, Ayele cited this finding as being surprising, saying, “The political rhetoric was impacting patient-doctor relationship. Clinicians are finding it difficult to maintain a therapeutic relationship with patients during a period of politicized pandemic and misinformation. Patients they have provided care for are now doubting their expertise.”

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Community neurologists further noted a lack of support for new models of care, particularly the introduction of telemedicine. As clinicians were learning alongside patients as to how to best provide care remotely, there was a sense of frustration, particularly for older patients who were unfamiliar with having serious conversations about their health in a virtual format. 

Ayele commented on the COVID-19 pandemic and its effect on the personal lives of community neurologists, adding, “Clinicians had the front row seat in observing human suffering, which created a heartbreaking environment. They felt like patients were just giving up, and there was hopelessness.” The pandemic also contributed to a lack of self-care and resultant burnout. Being unable to take time off to connect with family or friends was an issue that further contributed to feelings of burnout, as well as increased isolation due to the inability to socialize with colleagues. 

The study did present limitations in that findings may be difficult to generalize outside of the United States, as its specific political climate was a large contributing factor. Experiences may change and evolve as the pandemic continues, and due to interviews being conducted over the phone, investigators noted that rapport might have been more difficult to build. 

Addressing these challenges requires an ongoing, collaborative effort, with Ayele noting that multilevel tactics must be employed to maintain quality of care and ensure that neurologists feel supported in their practice. “I believe different institutions are doing work to reduce burnout among their staff. However, our findings call for multilevel, structural strategies to support the neurology workforce during the pandemic and beyond at individual, organizational, and societal levels. We need multipronged approach to curtail burnout, improve neurologist well-being and connect clinicians with resources that impact patient care,” she told NeurologyLive.

“At the societal level, broad resources and funding are needed to enhance mental health programs and provide opportunities to mitigate the culture of silence around discussing and addressing clinician wellbeing. At the organizational level, efforts should address clinician isolation by building infrastructure to enable physicians to engage with peers and process moral injury to reduce burnout and associated negative impacts on patient care. At the individual level, neurology workforce burnout should be addressed by identifying and providing resources that are tailored to meet their needs,” Ayele added.

REFERENCE

Ayele R, Macchi ZA, Dini M, et al. Experience of community neurologists providing care for patients with neurodegenerative illness during the COVID-19 pandemic. Neurology. 2021;97(10):e988-e995. doi:10.1212/WNL.0000000000012363