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Dr. North on burnout among urology residents and practicing gratitude


"It's been pretty consistent that our second-year urology residents are really suffering," says Amanda C. North, MD.

In this installment of “Begin Your Journey,” urologist Amanda C. North, MD, talks with host Scott A. MacDiarmid, MD, FRCPSC, about burnout among urology residents as well as the benefits of practicing gratitude. North is an associate professor of urology at Montefiore Medical Center in Bronx, New York. MacDiarmid is a urologist with Alliance Urology Specialists in Greensboro, North Carolina.


MacDiarmid: From your census work, and also as faculty, can you share any thoughts about residents? Do they think they've chosen a good path?

North: It's interesting. It's been pretty consistent that our second-year urology residents are really suffering. [PGY2] residents, in almost every program, have a disproportionate amount of "scut" work relative to rewarding work. And those are the residents that have the highest rates of burnout and the highest rates of career decision regret. And so supporting our PGY2 residents in urology is vital for anyone who works with residents. We're also starting to think about generational differences in learning and training. I'm a Gen X-er, and our residents are millennials coming into Gen Zers soon, and the way that they learn and the way that they want to be taught is different. And I think it's important for us to adapt how we train residents to what their learning styles are. That's a challenge for us old people. But I think it's something that's really important in order to keep them engaged. By the time they get to be chiefs, they're almost all happy that they chose urology, so we have to get them over that hump of the PGY2 year. As you know, the match has been very competitive the past couple of years. There was some worry that the reported high rates of burnout among urologists would discourage medical students from going into urology. But I think the match the past 2 years has been phenomenal, and we are getting many of the best and the brightest. I think we're doing a better job of looking into diversifying the urologic work force. I'm optimistic about the future of our specialty based on the residents alone.

MacDiarmid: Being grateful really is something, I must say. There have been some things in my personal life lately in which I remind myself how grateful I am many times a day. And even my wife said in the past month, "the last couple of times you've been on call, you seem to be okay." And I just know that's why. That's my take-home point; there's lots [of reasons to be] grateful. Just look at some of the patients you saw today, and you'll realize how grateful you should be to be a physician. What would you finish up with as a tip?

North: I think the idea of practicing gratitude has gotten a bad name. Because I think for so many doctors, their hospital administrations are saying, "Well, here are our strategies for you to not be burned out. It's not to fix the problems in the health care system. It's to tell you to go home and do yoga and meditation and gratitude, and you're going to be just fine." And I know that hearing that from people of authority can make it a real turnoff to those of us in the trenches. But what I would say is, practicing gratitude is not going to change the nursing shortage at your hospital; it's not going to change the frustrations with the inefficient electronic medical record system. I get it. But it will make you deal with the stresses in your life better and more successfully. And it will make you a happier person because it will remind you why you've made the choices you have. It is not the only solution to burnout. It doesn't fix the broken health care system. But it does make you able to appreciate what you have and what you do. And that's worth it. And so even if you're annoyed that somebody else is telling you to do it, I still suggest you give it a try.

MacDiarmid: The last time I spoke about burnout, 2 gentlemen got up and they were basically saying, "Scott, we need to change the system." I'm in full agreement. In the meantime, we are practicing medicine and there's no question that I've learned from others much, much smarter than I that the more resilient you are—maybe that's through gratefulness and better balance—your burnout rates and severity are lower. You can self-help yourself. You can make it better. I want to thank you so much for coming on today. I want to remind our audience that with these little short snippets, we're really just trying to encourage you, whether it's this video today or a book, a song, a video, once you make a decision that you're going to begin your journey to be joyful and fulfilled as a provider, that you're going to start living and working differently, [and realizing that] it's a life journey. That's really our goal. And I encourage you all to consider that. So thank you very much, Amanda.

North: Thank you for your time.

This transcript was edited for clarity.

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