Do Headache Clinic Patients Require More Care Outside of Office Visits?
by Lauren Doyle Strauss, DO
Recently, there has been a lot of attention focused on identifying, understanding and addressing sources of physician burnout as a way to improve physician wellness. One of the first national surveys to draw attention to this concern was published in JAMA in 2012. The study examined the rates of physician burnout in 7,288 physicians. A staggering 45.8% of physicians exhibited at least one symptom of burnout, and physicians fared much worse compared to the general population. The incidence of burnout varied substantially by specialty, with neurology ranking third-highest for burnout among specialties. More recently in 2018, Medscape released a National Physician Burnout and Depression Report that studied 15,543 physicians across 29 specialties. The report again showed that neurology, along with intensivists, has the highest rate of burnout at 48%.
In 2014, former AAN President Dr. Bruce Sigsbee and Dr. James Bernat published an article in Neurology citing the main aspects of physician burnout including: emotional exhaustion, the loss of interest and enthusiasm for practice; depersonalization, a cynical attitude that results in treating patients as objects; and career dissatisfaction, a diminished sense of personal accomplishment and low self-value. Burnout affects both affects physicians and the patients they care for, and studies show that burnout can result in reduced work hours, relocation, depression, suicide or patient errors.
There is some evidence that suggests the increased use of electronic medical records (EMR) may contribute to burnout by increasing the workload of physicians. Roland Brilla, MD, PhD, along with Kaitlin Woo, MS, and Susanne Seeger, MD, published a study in Headache® that examined the number of remote encounters, remote encounter messages, telephone encounters or email (MyChart) encounters per patient at an academic neurology referral clinic. Conducted at University of Wisconsin Hospital and Clinics, the study followed 3,164 patients over a one-year period. Results showed that the Headache Clinic patients required the second highest frequency of all types of encounters per patient across multiple neurologic specialties with a median of 10 additional encounters per patient. Multiple Sclerosis Clinic was the highest with a median of 15 additional encounters per patient. When looking specifically at MyChart email message usage, the percentage was higher in the Headache Clinic compared to all other clinics at 47%, with a mean of 1.9 encounters per patient (P < .001).
Increasing the number of headache specialists may reduce the likelihood of burnout for clinicians. In an effort to help better the field of headache medicine, the American Headache Society has several programs in place aimed at increasing the number of headache specialists and practitioners in the field. Pre-courses are available to all members at the Annual Scientific Meeting and Scottsdale Headache Symposium. Additionally, the Resident Education Program, Emerging Leaders Program, and the International Headache Academy all aim to inspire young neurologists and research scientists to pursue careers in headache medicine. Through networking, mentorship and informative lectures, these programs are designed to foster a long-term commitment to headache medicine in aspiring medical professionals. The American Headache Society will continue to promote these efforts and many more to benefit the careers of those interested in headache medicine and to improve the lives of our patients.
 Palen T.E., Ross C., Powers J.D., et al. (2012). Association of online patient access to clinicians and medical records with use of clinical services. JAMA, 308(19), 2012-2019. doi: 10.1001/jama.2012.14126.
 Brilla, R. , Woo, K. M. and Seeger, S. K. (2018). Do Headache Patients Require More Care in Between Visits Than Other Neurology Outpatients? Headache: The Journal of Head and Face Pain. doi:10.1111/head.13339