Shoureshi P, Guerre M, Seideman CA et al: Addressing burnout in urology: a qualitative assessment of interventions. Urol Pract 2021; 9: 101.

Urologist burnout has been well documented over the last several years.^1,2 Stressors are numerous and vary from increased nondirect patient care to decreased work-life balance.^2–6 The effects of depersonalization, low personal accomplishment and emotional exhaustion affect both patient care (eg medical errors) and the longevity of a urologist’s career.⁵ With a shortage of urologists and a growing number of patients seeking urological care, understanding effective burnout interventions and organizational/institutional involvement in this process is key. Unfortunately, very little has been published in this area. Our study in the January 2022 issue of Urology Practice^® helps to understand this important issue.⁷

A 29-question, general workforce survey was sent electronically to practicing and retired urologists who were members of the Western Section of the American Urological Association (WSAUA). Of note, this was distributed during the COVID-19 pandemic. A portion of this survey focused on the level of physician burnout, burnout interventions and workplace sponsorship. In regards to interventions, only those who tried 1 (or more) were included in the data collection and analysis.

Of the 1,700 urologists who were eligible to participate, 400 responses were received (25.9% response rate). Of the responders 82.2% were male, and the most common practice types were private practice, single-specialty group/network (124) and employee of a teaching hospital/academic medical center (79). While the majority of urologists noted some level of burnout (noted as “mild, moderate, severe;” 349/439, 79.5%), only 31% noted moderate to severe levels (136).

Table 1 demonstrates the various interventions utilized by urologists to prevent or reduce burnout and if they were work sponsored. Fewer than half of the responders noted these were work-sponsored interventions (185/440, 42.5%). The figure shows the interventions that were rated “very effective” and table 2 notes “very effective” interventions by gender. There was no statistically significant difference by gender.

Figure. Percentage and 95% confidence intervals of responders who noted “very effective” for interventions. APP, advanced practice provider.

In this study, levels of physician burnout were similar to what has been previously reported (38.8%–78%).^1,2 The interventions cited most often as “very effective” were hiring a scribe (30/48, 62.5%), regular exercise (189/337, 56.1%), participating in one-on-one gatherings with colleagues outside of work (58/130, 44.6%) and decreased or modified work hours (104/233, 44.6%). In regards to scribe use, any intervention to increase electronic health record efficiency has been shown to be beneficial.⁸ In addition, a recent urology publication also found exercise and socializing to be protective against burnout in practicing urologists.⁹

As for reducing or modifying work hours, only 1.3% noted it was work sponsored (3/233). As of 2019, the AUA census noted that approximately a third of urologists work more than 60 hours/week, with 44% spending at least 5 hours/week at home performing nonclinical work.¹⁰ Shanafelt et al has noted that increasing emotional exhaustion and/or decreased satisfaction increased the odds of decreasing one’s full-time employment status.¹¹ With a large patient population to take care of and a relatively small workforce, decreasing work hours due to burnout will exacerbate our existing patient care issues.

Burnout/stress management seminars and meditation/mindfulness interventions were cited the least as being “very effective” (26.9% and 11.5%, respectively). These are often typical offerings by practices/organizations. Unfortunately, reasons that these were less effective were not elucidated in our study. One possible reason may be the belief that each physician should be in charge of their own professional satisfaction and burnout.¹² Another may be that these types of interventions do not directly address the underlying practice issues contributing to burnout.

A systematic review of controlled interventions found improved effects for organization-directed interventions.¹³ However, all organization-directed interventions are not equal and usually fall into one of 2 categories: 1) organizational interventions that alter the current work environment in order to make it a better place to work and 2) interventions that put the onus on the physician to change their work environment. At this time, our study showed that less than 50% of interventions tried by urologists in the WSAUA were work-sponsored. It is unknown if more urologists would have participated in these options if they were work-sponsored and/or if they would have been more effective with organizational support. Our data show that both institutional and personal interventions can be effective. We believe that practices should consider both in tandem when creating a multipronged effort to decrease burnout, as it is not a “one-size-fits-all” issue.