Why do you think this is happening, specifically to urologists?
There are attributes in all surgical specialties that may contribute to burnout. We have an unwritten code: Come in early, stay late, meet multiple deadlines, keep emotional problems at home, never complain, never show weakness.
It begins with our training. We work long hours and don’t have a lot of control over our schedules, and I think this contributes to life imbalance beginning in residency. There are data suggesting that when students enter medical school, the depression and burnout rates are the same or slightly lower than the general population. Sadly, we put them through our educational system and then they come out with burnout rates that are two- or three-fold higher. There is something in our process, obviously, that contributes to that.
We delay gratification in residency. We have the feeling that, well, this is residency and when we get through residency, it’s all going to get better. I think the habits formed in residency persist for many people and they don’t regain their work/life balance and some of their personal pursuits. The thinking becomes: I’ve got to establish my practice or I need to become promoted to associate professor or I need to be on this committee or I need to secure this grant in order to get my funding. It never ends, and after a while it becomes habit-forming to put life on hold, which can be a negative.
When I saw the 64% burnout figure, I thought, why in urology, when studies done by the American College of Surgeons showed that burnout rates for neurosurgery and transplant/vascular were much lower? It made me wonder if in urology, we take the external environment stressors that have come along in medicine—less autonomy, administrative tasks—more severely. Expectations in our field are very high. Our medical students are the best and the brightest, and what they like about urology is the ability to make a big clinical impact. We also look at it as a surgical specialty that provides a little bit of balance; you can have it all. When some of those external burdens are put upon us, it disrupts that balance. Again, maybe we’ve taken the external burdens more severely.