The practice of medicine is an honor and privilege and should bring us joy as a return on the investment of energy and time.

For various systemic and personal reasons, the joy may be eclipsed by burden. Medicine has always been a demanding field with great responsibility. The needs of others always come first. That has not changed, but the metrics with which we are publicly measured by the hospital and government and the lens with which we are viewed by the public are quite different. In many parts of the country, the doctor not only needs to prove expertise, but they must appear to bring their best every day. Patient satisfaction scores and web-based grades do not comprehensively sample our work or represent our worth. Comparing oneself to others on social media or ranking systems is exhausting and may be misguided. The weight of imperfect outcomes, expectations to see more patients, messages and requests coming via numerous mechanisms, incomplete charts, looming deadlines, family stressors, or medical issues can be heavy.

Despite all the conversation and statistics about physician burnout and physician suicide, it does not appear that a real solution is imminent. Talking about it without actionable and achievable steps is insulting. Raising awareness and taking the stigma and barriers away from getting help for mental health issues is a very positive step that is being pursued at the national and state level by the Dr Lorna Breen Heroes’ Foundation.¹ Removing barriers to seeking treatment will save lives, and it will likely allow many others the capacity to continue serving children and families.

Although surrounded by people daily, relationships may not exist wherein we can safely share the things that only other surgeons understand. Perhaps showing doubt or “weakness” within one’s practice or health system is feared too risky. Reputation and livelihood are at risk.

What if we could create a space where people can come together and share about pressure points, personal and professional challenges, difficult cases, and complications? What if we could reveal vulnerability and find resolutions without fear of exposure of perceived weakness?

Last summer a group of pediatric urologists answered a call to step forward and build a different model for mentorship and support. Our small field had just lost a talented colleague to suicide. The responses to this call clearly recognized a deep preexisting need to reinvent support and community among pediatric urologists of all ages. One may not perceive this need for themself and may be completely unaware of the neighbor in need.

The group brainstormed about what size communities might function best and what needs they would serve. How would confidentiality be addressed? Should members span the career cycle or be comprised of similar age? Connection with those outside the local area was deemed important to allow sharing without exposure, and it would also expand the personal and professional networks. Virtual connections across time zones were noted to present challenges as well. The ENCOMPUS (ENgagement and COMmunity in Pediatric Urology Societies) initiative was presented at the Pediatric Urology Fall Congress in October 2022, along with plans for an annual wellness event or topic to be identified by a Wellness (Task) Force.

Approximately 175 pediatric urologists and fellows from the private, managed care, and academic arenas submitted information about their practice and interests, and disclosed what they can give and hope to receive within these small groups.

The process of forming the groups based upon these preferences proved challenging, but it was time for ENCOMPUS to launch. The groups are in the early stages of getting to know each other, acknowledging some awkwardness, but creating a nonjudgmental space. Questions were offered to learn more about shared experiences and memorable challenges without full exposure. Each group will set a schedule of virtual meetings to suit their needs and will establish a check-in chain or other regular communication. Groups with similar interests but more distant time zones will be paired to meet up at the Fall Congress and future meetings.

Many thanks to the development team volunteers (Tony Casale, MD, Yvonne Chan, MD, Christina Ching, MD, Chris Cooper, MD, Hillary Copp, MD, Tanya Davis, MD, Dave Ewalt, MD, Candace Granberg, MD, Kate Hubert, MD, Chris Kimber, MD, John Makari, MD, Max Maizels, MD, Leslie McQuiston, MD, Adam Rensing, MD, Michaella Prasad, MD, Vijaya Vemulakonda, MD, Patience Wildenfels, MD, Jennifer Yang, MD) for their engagement in creating ENCOMPUS. We acknowledge that there is no model that will suit everyone, and adjustments will certainly be needed over time. ENCOMPUS is one opportunity to build a foundation for a stronger community.