Abstracts

Rationale: Neurologists have one of the highest rates of burnout among health care provider (HCP) specialties in the U.S. This could worsen as the demand for their services increases. We sought to understand the burnout level in managing patients with refractory epilepsy and identify key contributing factors.

Methods: U.S. board-certified pediatric/adult neurologists devoting ≥ 50% of their time to clinical practice and treating ≥ 10 unique patients with refractory epilepsy annually were invited to take a noninterventional, quantitative survey. The survey was designed to capture key elements of the HCP’s background, level of burnout, and current practice and domains of burden. They were asked about the number of patients seen over the last year, overall workload, differences in managing patients with refractory vs nonrefractory epilepsy, level of difficulty referring between pediatric and adult neurologists, satisfaction with current antiseizure medications (ASMs), and other potential stressors or unmet needs in patient management. Burnout in the 3 domains of emotional exhaustion, depersonalization, and personal accomplishment was assessed by the validated Maslach Burnout Inventory-Human Services Survey.

Results: From March 11 to April 10, 2022, a total of 138 neurology specialists participated in the survey, divided between pediatric neurologists (n = 17), adult neurologists (n = 41), pediatric epileptologists (n = 36), and adult epileptologists (n = 44). Of HCPs treating refractory patients, 61.6% experienced at least some burnout (≥ 1/3 burnout domains high) and 4.3% experienced high burnout (3/3 burnout domains high). High burnout was driven by treating pediatric vs. adult patients, inpatient vs outpatient workload, and unexpected pediatric patient reluctance to transition to adult care (P < 0.001 for these drivers for HCPs with high burnout vs. those with some or no burnout, respectively). HCPs whose total workload included a higher proportion of refractory patients tended to have higher burnout. Of HCPs, ~90% agreed refractory vs. nonrefractory epilepsy was more difficult to manage. Available ASMs satisfied 19.5% of HCPs for managing refractory patients vs. 73.2% of HCPs for nonrefractory patients; dissatisfaction was largely due to lack of insurance approval, out-of-pocket costs, and poor efficacy, safety, and tolerability associated with ASM use for refractory patients. Approximately 32% of HCPs were probable/very probable to leave practice within 5 years.