Country doctors of America’s rural past are mythic symbols of a simpler time in medicine. They were called upon by their neighbors to practice their vocation with little more than their education, empathy and learned experience. They represented the essence of self-sacrificial commitment and were essential and trusted members of the community. The currency they were paid was not always in dollars. Their time was spent interacting with patients and family, not screens, paperwork or codes. Their patients weren’t referred to as stakeholders. Burnout, a term not coined until the 1970s, wasn’t measured back then, but it would be safe to assume that it wasn’t as pervasive as it is today.

The Problem

Figure 1. Dr. Ron Hrebinko teaching the fine points of nerve-sparing radical prostatectomy, Dakar Senegal.

Figure 2. Pediatric urologist Dr. Rich Grady training on site, Lusaka, Zambia.

Figure 3. Dr. Mark Bellinger making rounds, Lusaka, Zambia.

Figure 4. Author’s daughter in recovery room, Dakar, Senegal

No physician is surprised to learn that burnout, “the mental, emotional or physical exhaustion caused by excessive demands in the workplace,” is getting worse and having a profoundly negative effect on our profession.^1,2 This comes as a surprise to many, except physicians. Stress and fatigue among doctors have been mounting for years, even decades. In recent times, the ever-rising tide of administrative work has competed for time with patient care and the foundation of what physicians strove to become has been devalued. We are seeing physicians becoming more disengaged and retiring early, and because of the economic effects of this, a heightened interest in “treating” burnout has emerged.³ While hospital systems across the U.S. are presenting solutions to help cope with stress and fatigue, none quite address the root of the problem—an erosion of meaningful life work. Practicing medicine is a sacred trust between the physician and the patient. This delicate relationship has been jeopardized.

I would argue, however, that in addition to the common causes of burnout, the exhaustion physicians are contending with should include a spiritual one as well. The distractions physicians face in medicine today minimize meaningful interaction with patients, and other colleagues for that matter. Making a difference in people’s lives validates a physician’s vocation throughout the rigors of medical school, residency training and their career in practice. Did the country doctor of the past see this coming, and what are we to do about it today?

A Solution

International Volunteers in Urology (IVU) has been a source for hundreds of urologists, including myself, to re-establish a meaningful connection with patients and patient care, and a reinvigorating means of professional renewal. Sixteen years ago I joined an IVU workshop to Kumasi, Ghana. It was an intense and exhausting trip that paradoxically was one of the most uplifting and vitalizing experiences of my life. I have heard many volunteer surgeons on IVU trips describe their experience as what they sought when they first entered medical school.

IVU is a nonprofit organization whose mission is to address the global shortage of urological care and training in medically underserved areas of the world. For over 25 years, IVU has provided onsite medical outreach, and more recently virtual education, to more than 3,000 doctors in 40 countries, changing the lives of thousands.

Training local doctors to care for urological conditions in their own community is the most sustainable and scalable solution to address surgical access in low- and middle-income countries. It is estimated that 5 billion people lack access to surgical care, and urological surgery in low- and middle-income countries is one of the most difficult to access.^4,5 Consider Uganda, which has approximately 15 urologists for over 30 million people.⁶ Common urological conditions when left untreated result in debilitating health issues that significantly impact the quality of life of not only the affected individual but their entire family. Women and children are disproportionately affected and often ostracized due to the stigma surrounding untreated urological conditions, spiraling families into poverty.

Figure 5. Mother and child, Bahir Dar, Ethiopia.

Figure 6. Ready for surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana.

Figure 7. Patiently waiting their turn. University Teaching Hospital, Lusaka, Zambia.

Figure 8. Dr. Mark Bellinger taking Dr. Madina Ndoye through a hypospadias repair. Hôpital Général de Grand Yoff, Dakar, Senegal.

As I learned more about the African countries I traveled to I was surprised that there were no pediatric urologists in the entire Saharan subcontinent at the time. Since then, hundreds of urologists in Africa have participated in IVU workshops focused on pediatric urology. In addition, now there are 2 full-time fellowship trained pediatric urologists with 1 in training, all supported by IVU. While this is a far cry from what would be remotely considered adequate, it’s an important start, and IVU has increased its training presence within all urological subspecialties including general, female, reconstruction, oncology and endourology and stones (Figs. 1–8).

While I believe there is genuine interest in turning around the escalating trend in physician burnout, the ailment is too deep to repair in 1 generation. The fundamental issue that needs to be addressed at present is the reestablishment of the same sense of purpose and joy that led us into medicine in the first place. The pathway to “spiritual rehab” can begin immediately through humanitarian outreach. I have participated in over 30 IVU workshops since I began volunteering. Like most IVU volunteers, despite the physical demands, humid operating rooms, unfamiliar food and jetlag, the consolation is collegial camaraderie, professional rejuvenation and fulfilment and a yearning to sign up and do it all over again.

Dr. Schneck is a pediatric urologist at UPMC–Children’s Hospital of Pittsburgh, and Chairman of the Board of IVU. Correspondence: schneckf@upmc.edu