The urological workforce harbors one of the highest rates of burnout among all physicians with the worst severity score.¹ While burnout is prevalent in medicine, 48% of urologists describe experiencing burnout, with persistent burnout reported by 54% when compared to other surgical subspecialties.^2-4 Burnout is common among women surgeons, especially in women urologists, who report the highest burnout at 67%.^1,5,6

Burnout, often defined as prolonged mental, physical, or emotional exhaustion from workplace stress, continues to be a focus in medicine as data show higher levels of burnout can compromise patient safety. Burnout can also impact levels of satisfaction in practice, leading to physicians leaving medical practice. As women in urology demonstrate significant vulnerability to burnout, this can exacerbate the existing gender disparity, with only 10% of the practicing workforce being women.⁷ This can impact the urological workforce, which is already anticipating a severe shortage in the next 5 years.^8,9 With more women entering the field of urology, addressing factors that contribute to burnout among women in urology is necessary to avoid this concerning trend and prevent workforce attrition.¹⁰ The purpose of this study is to understand the patterns and impact of burnout among women in urology.

An electronic census survey was distributed to residents, fellows, and practicing urologists in the United States and its territories by the Society of Women in Urology between February and May 2022. This survey was disseminated via email communication and social media. The responses to questions addressing burnout were analyzed in this study. Participant demographics, personal characteristics, professional characteristics, practice environment, and compensation patterns were assessed with respect to burnout. Statistical analyses were performed with descriptive x ² and t-tests, and a multivariable logistic regression was done to assess burnout in Stata.

There were 379 survey participants with an average age of 42 years (SD 10). A majority identified as cisgender heterosexual females (96%). Most participants were practicing urologists (282, 74%), in fellowship (37, 10%), or in residency (57, 15%). The average reported time in practice was 9 years (SD 9). A majority of respondents identified as White (269, 71%). Most were married (307, 81%) or divorced (64, 17%), and had children (259, 68%).

The most common practice setting was urban (240, 63%). A majority were employed full time (250, 66%). Practice environments included academic institutions for 55% (210) of participants, private practice for 17% (64), public institution for 3% (11), Veterans Affairs for 3% (11), and hospital employment for 17% (63). Most respondents felt being female is a disadvantage for career advancement (252, 66%), though a majority (296, 78%) believe they are valued by their practice, chairman, or manager.

All geographic sections of the AUA were represented in the survey. Fellowship training was completed by 178 respondents (47%), specifically in urologic oncology by 18 (5%), pediatrics by 50 (13%), endourology by 14 (4%), minimally invasive surgery by 13 (3%), infertility/men’s health by 13 (3%), reconstruction and trauma by 9(2%), and female pelvic medicine and reconstructive surgery by 66 (17%).

Most women reported burnout (273, 72%), with 330 (87%) agreeing COVID-19 worsened burnout. The Table demonstrates personal and professional characteristics for participants who did and did not report burnout. Burnout was significantly associated with training level, pay structure and transparency, increased hours/week, and not feeling valued in a practice setting. Participants with burnout had an increased desire to leave their current practice or medicine, or transition to teaching roles, with a desired retirement age of <60 years. On a multivariable logistic regression analysis, increased hours worked per week (OR 1.03, P = .002), relative value unit pay vs salary (OR 4.4, P = .007) and feeling personal income was not comparable to peers (OR 0.4, P = 0.003) were correlated with burnout.

Table. Characteristics and Perceptions Among Those Who Did and Did Not Report Burnout

Despite the high rates of burnout among participants, a majority (318, 84%) would choose a career in urology again and 91% (345) felt satisfied with their career choice. Common shared experiences include lack of staffing, reduced operating room time, lack of administrative support, predominance of nonoperative referrals, gender and racial inequity/microaggressions, electronic health records with increased documentation demands, increased administrative duties, and lack of financial advancement.

This 2022 survey of women in urology indicates a high prevalence of burnout at 72%, and is similar to previously reported rates of burnout of 67% for women in urology.¹ Burnout correlated with a greater desire to leave medical practice or retire at a younger age, which will impact the urological workforce and exacerbate the existing gender gap.

Respondents who worked an average of 49 h/wk reported no burnout compared to those who worked an average of 58 h/wk. There was a 4-fold increase in likelihood of burnout among individuals with relative value unit−based pay compared to a salary structure. The perception of a comparable income to peers was protective. These factors associated with burnout should prompt a paradigm shift for income transparency, pay structure, and the clinical and nonclinical demands on urologists’ weekly work hours.

Interestingly, while a majority of burned-out participants indicated a perceived lack of compensation equality, 29% of respondents did not disclose their income. Given the relationship between compensation and burnout noted in these responses, we hypothesize there may be insecurity in disclosing compensation while also experiencing burnout from a lack of income transparency. With an increase in pay transparency laws and disclosures in other economic sectors, medicine, and specifically urology, can be an early adopter in efforts to preserve and promote a diverse workforce.^11,12

The high rate of burnout among women in urology is multifactorial, but compensation inequity and transparency as well as work hours have a significant impact. Nuanced concerns raised in this study, such as lack of support staff, racial and gender inequity, and poor referral patterns, require additional study to determine a comprehensive plan to reduce burnout and retain practicing urologists.