Advocacy in Neurology: A Tool to Serve and Find Fulfillment

NeurologyLiveOctober 2022
Volume 5
Issue 5

Acting as an advocate is meaningful to neurologists because it speaks to their inner core—or their “why.” Neurologists have the agency to make this world a better place while working as a neurologist and an advocate at many levels.

Mary Rensel, MD, FAAN, ABIHM, Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine Director, Pediatric Multiple Sclerosis and Wellness, Mellen Center, Cleveland Clinic Founder, Brain Fresh™ LLC

Mary Rensel, MD, FAAN, ABIHM

I WAS RECENTLY FORTUNATE ENOUGH to serve as an adviser at the Palatucci Advocacy Leadership Forum (PALF) per the American Academy of Neurology. This PALF training has been impactful in my career. I initially attended to learn the skills of advocating over a decade ago and have returned to advise groups of passionate neurologists honing their individual advocacy skills to create a better day for our patients and their families. On the last day of PALF training, we had the opportunity to recognize the graduating group of advocates and quite a surprise occurred. Advisers shared the successes and talents of their advocates, and many were brought to tears because the missions they are working on are so meaningful and the bonds of the team became so deep. Multiple physicians mentioned how they were frustrated with medicine and now were reenergized and will stay in the profession to work on their advocacy projects. The power of advocacy was felt by all in the room.

Where else in medicine are we allowed to share our deepest wishes and take specific action to right a wrong we see in society? Acting as an advocate is meaningful to us as neurologists because it speaks to our inner core—or our “why.” We all have days when we step back and ask ourselves, “Why are we in this profession?” Why did we not sell T-shirts on the beach? Why did we place ourselves in a profession that demands so much energy and emotion each day?” I can tell you that after 30 years of being a physician, I realize the honor in our daily work and the potential toll it can take. However, acting as an advocate can remind us to sharpen our “why,” to be intentional about taking the time to find what our core reason is for doing what we do and realizing that we have agency to make this world a better place while working as a neurologist and advocate at many levels.

Although it may seem counterintuitive, we first need to start advocating for ourselves, personally and professionally, to ensure that we remain well and balanced so that we can remain active and fulfilled in our professions.1 Burnout has been described since 1974, yet it remains at high levels in neurology and other professions.2-4 Unfortunately, the risk of burnout—due to systemic challenges in health care—is high, and the consequences are grave.4 We need to set clear boundaries about our “nonnegotiables,” the actions that keep us healthy and balanced.1 Finding meaning at work is associated with less burnout in neurology residents and fellows, and taking time to realize your “why” and intentionally staying active in what brings meaning to your work may lessen one’s risk of burnout and subsequent depressive symptoms.5

I am pleased to see the Accreditation Council for Graduate Medical Education has required a professional well-being plan for neurology residents to build a vitally important professional well-being tool kit because studies have revealed potential barriers to humanistic curriculum for residents, faculty support, and time and perception, as these are not typically prioritized.6,7 May we, as their faculty, be shining examples of the challenges and realities of professional well-being. Many studies suggest the level of burnout today is due to the whole health care organization rather than the individual; therefore, advocating to adjust and influence the organization may indeed result in less burnout for our colleagues and ourselves.8

Focusing on these advocacy efforts can help sharpen our long-term goals toward generativity. Giving of our time and energy toward the next generations and “righting a wrong” are long-term, fulfilling goals that advocacy can help meet. When we are active in pursuing these goals, we can find more meaning in our work and make new connections with those that also find this type of work meaningful, thereby increasing our social networks. Belonging and feeling productive are basic human needs that advocacy can help us attain. Ultimately, advocacy can help us feel deep meaning at work, serve and support others, and feel fulfulled while working towards a brighter tomorrow.

1. Shanafelt TD. Physician well-being 2.0: where are we and where are we going? Mayo Clin Proc. 2021;96(10):2682-2693. doi:10.1016/j.mayocp.2021.06.005
2. Freudenberger HJ. Staff burn-out. J Soc Issues. 1974;30(1):159-165. doi:10.1111/j.1540- 4560.1974.tb00706.x
3. Levin KH, Shanafelt TD, Keran CM, et al. Burnout, career satisfaction, and well-being among US neurology residents and fellows in 2016. Neurology. 2017;89(5):492-501. doi:10.1212/ WNL.0000000000004135
4. Shanafelt TD, Mungo M, Schmitgen J, et al. Longitudinal study evaluating the association between physician burnout and changes in professional work effort. Mayo Clin Proc. 2016;91(4):422-431. doi:10.1016/j.mayocp.2016.02.001
5. Hakanen JJ, Schaufeli WB. Do burnout and work engagement predict depressive symptoms and life satisfaction? a three-wave seven-year prospective study. J Affect Disord. 2012;141(2-3):415-424. doi:10.1016/j.jad.2012.02.043
6. Antonio A, Morgan C, Johnson E, Anderson T. The journey with our evolving neurology residency curriculum in molding humanistic neurology graduates (P9-6.002). Neurology. 2022;98(suppl 18):1366.
7. Dewey JJ, Chiota-McCollum N, Barratt D, et al. Introducing the Neurology Milestones 2.0. Neurology. 2022;98(9):366-372. doi:10.1212/WNL.0000000000013312
8. Panagioti M, Panagopoulou E, Bower P, et al. Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis. JAMA Intern Med. 2017;177(2):195-205. doi:10.1001/ jamainternmed.2016.7674
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