As with most other healthcare specialties, substantial disruptions in neurology care occurred through the early element of the COVID-19 pandemic. Many routine visits and healthcare procedures have been delayed, and overall health care personnel had to adapt to a variety of new security protocols and adjustments in workflow.1 Nearly 2 years later, even though patient care has largely resumed, neurology practices face a shifting set of challenges like employees shortages and ever-escalating levels of experienced burnout.
Practice Changes and Current Demands
“I suspect that one of the main ongoing issues right now is patient access to neurologic care,” says Barney J. Stern, MD, professor, healthcare director of the neurology services at the Johns Hopkins Outpatient Center, and vice-chair for strategic organizing in the division of neurology at Johns Hopkins University School of Medicine in Baltimore. “There is an ongoing endemic demand for neurologic services,” with earlier findings projecting a 19% shortfall of neurologists in the United States by 2025.2
Many neurologists are nevertheless working by means of the delayed demand that occurred early on in the pandemic. “There has been a significant deferral of care, with some patients avoiding hospitals and emergency rooms, and an increase in patients who want their acute issues treated in [an] outpatient office setting,” explains Andrew Russman, DO, head of the Stroke Program and healthcare director of the Comprehensive Stroke Center at the Cleveland Clinic in Ohio. “Patients have done harm to themselves by deferring their care.”
In addition, there has been an influx of patients with symptoms of “long-haul COVID” and symptoms associated to COVID-19 vaccinations.3-5 Although the literature describing neurologic symptoms linked with the vaccines is restricted, some patients have told Dr Stern that their earlier neurologic symptoms have substantially worsened due to the fact they received the vaccine, even though other people have reported new-onset symptoms such as numbness, headache, fatigue, tingling, and brain fog following vaccination.
However, final results of neurologic testing are normally unremarkable in these patients. “I don’t think we know how to handle these cases other than symptomatic management, which may well be the correct approach,” says Dr Stern. Most patients look to enhance more than weeks or months, while other people look to have persistent symptoms.
Changes in access to telemedicine due to the fact the early element of the pandemic represent yet another current element of practice interruptions. “Many of us pivoted to telemedicine, and patients for the most part were very thankful for that, but now many of the reciprocal agreements between states have been rolled back, even in the middle of another surge,” Dr Stern notes. This has placed additional strain on patients’ access to care.
While post-COVID adjustments in doctor employment have been reported, these challenges have not substantially impacted Cleveland Clinic.6 “We haven’t had a lot of physician turnover; we have actually seen less movement of clinicians and we’ve hired more people than before the pandemic,” says Dr Russman. “In other places, there may be physicians nearing the end of their careers, and these new COVID-related demands may hasten their retirement.”
At their facilities, on the other hand, the shortage of nursing personnel probably represents the greatest interruption. Nurses are getting into the workforce in fewer numbers and leaving in higher numbers.7
As such, there have been challenges with staffing challenges in the clinic, with a dearth of nurses as properly as lab technicians and computed tomography (CT) technicians, for instance, along with employees absences due to illness. “For the most part we haven’t had to cancel clinics but are running ‘leaner,’ and this has shifted some of the burden to physicians,” according to Dr Russman.
Dr Stern added that healthcare residents are also undergoing anxiety, with numerous becoming pulled from elective rotations to support handle the inpatient crush, and they are exhausted and at danger of becoming COVID-positive. “This is falling very hard on residents as well as medical students, who have experienced major interruptions to their academic year. Everyone’s expectations have been altered.”
Additionally, with neurologists contracting COVID and experiencing burnout, and employees shortages putting more demand on healthcare personnel who are also experiencing burnout, the complete program is below anxiety. This is on major of the general shortage of neurologists.
Dr Russman and his colleagues are working to address burnout in element by striving for a fair distribution of the workload and an sufficient quantity of days off. “It’s important to understand that people working in high-volume settings need downtime,” he says.
Dr Stern emphasized the have to have for physicians to have a tendency to their mental and physical overall health for their personal wellbeing as properly as to optimize patient care. This is specifically crucial provided that there is presently no finish in sight for the pandemic.
Regarding strategies to lower burnout on the person level, “I think it’s very individualized, and different people find relief in different ways – it could be meditation, exercise, time with family and friends,” says Dr. Stern. “We have to find ways to sign out to one another and step back for a day or a week during this time. Each physician group should be proactive in making sure each clinician has some off time.”
Compared to other specialties, numerous neurology practices have a fairly modest margin and lack the capacity to employ midlevel providers. “Having the funds and mechanisms to develop a team approach to neurologic care, coupled with telemedicine, would go a long way to improving patient access,” says Dr Stern. “A new patient visit with me is currently booking out 6 months, which is inappropriate – and I’m the first to say it.”
While experienced organizations such as the American Academy of Neurology have been proactive in advocating revolutionary approaches to group-primarily based care, sources stay restricted.
Patient Education Needs
Dr Russman encourages colleagues to continue to educate patients at every single pay a visit to on the value of not deferring their care, as this creates unfavorable outcomes for patients and locations an further strain on the overall health care program as it accommodates the eventual demand.
He also emphasized the value of educating patients in a non-confrontational way about the have to have for vaccination. “We are finding that many people are not vaccine rejecters but are vaccine hesitant, and we can use our expertise to dispel myths about vaccination,” Dr Russman notes, such as the myth about a higher danger of contracting COVID in hospitals. He adds: “That’s not what we’ve seen; what we’re seeing is that around 90% of patients hospitalized with COVID are unvaccinated.”
In discussing the advantages of vaccination with patients, Dr Russman suggests shifting the emphasis from prevention of infection to a focus on milder symptoms and lowered danger of hospitalization. “Don’t be afraid to discuss the importance of vaccination and dispel myths,” he advises.
The Importance of Adaptation
While COVID-associated stressors have absolutely taken a toll, Dr Stern says, “We should be very proud of ourselves for all the adaptation we have gone through over the past 2-plus years.”
In that vein, Dr Russman adds that “these challenges have taught us to be very efficient about distribution of care across facilities and prioritizing resources for the highest-risk patients, so we have not seen any compromise in care for acute patients. We’ve learned how to adapt and become more efficient overall.”
1. Leira EC, Russman AN, Biller J, et al. Preserving stroke care during the COVID-19 pandemic: potential issues and solutions. Neurology. Published on the net May 8, 2020. doi:10.1212/WNL.0000000000009713
2. Dall TM, Storm MV, Chakrabarti R, et al. Supply and demand analysis of the current and future US neurology workforce. Neurology. Published on the net April 17, 2013. doi:10.1212/WNL.0b013e318294b1cf
3. Patone M, Handunnetthi L, Saatci D, et al. Neurological complications after first dose of COVID-19 vaccines and SARS-CoV-2 infection. Nat Med. Published on the net October 25, 2021. doi:10.1038/s41591-021-01556-7
4. Garg RK, Paliwal VK. Spectrum of neurological complications following COVID-19 vaccination. Neurol Sci. Published on the net October 31, 2021. doi:10.1007/s10072-021-05662-9
5. Finsterer J. Neurological side effects of SARS-CoV-2 vaccinations. Acta Neurol Scand. Published on the net November 8, 2021. doi:10.1111/ane.13550
6. Neprash HT, Chernew ME. Physician practice interruptions in the treatment of medicare patients during the COVID-19 pandemic. JAMA. September 20, 2021. doi:10.1001/jama.2021.16324
7. Shah MK, Gandrakota N, Cimiotti JP, Ghose N, Moore M, Ali MK. Prevalence of and factors associated with nurse burnout in the US. JAMA Netw Open. Published on the net February 4, 2021. doi:10.1001/jamanetworkopen.2020.36469
This write-up initially appeared on Neurology Advisor