Burnout in urology has drawn media attention since 2014 when a Mayo Clinic study suggested that urologists were among the most burned out physicians in the United States.¹ Since that time, the Medscape annual report of physician burnout has put urology in the top spot for most burned out twice—in both 2019 and 2020. Interestingly, in the 2023 report, urology was ranked as one of the least burned out specialties.² Both of these data sources included a small percentage of urologists—approximately 1% of the total sample size—with just over 100 urologists participating. In December 2022 the Occupational Information Network published data suggesting that the most stressful occupation in the United States is urologist. Urologist now ranks fifth on the list of most stressful occupations.³ Is urology really that stressful that we rank among the worst specialties when it comes to burnout?

The 2 largest studies of burnout in urology come from the AUA Census. The most widely used, validated questionnaire for burnout, the Maslach Burnout Inventory, was first included on the 2016 AUA Census. In 2016, 38.8% of practicing urologists experienced burnout. There were no gender, racial, or ethnic differences in burnout rates in this study. Working harder—whether measured by clinical hours worked per week, total hours worked per week, or increased number of patients seen per week—led to more burnout.⁴ Five years later, the Maslach Burnout Inventory was again included on the AUA Census and overall burnout rates were pretty stable. However, this time there were important gender and generational differences in burnout rates. Burnout among women urologists increased from 35.3% in 2016 to 49.2% while burnout among men urologists actually decreased during the same time period. In terms of generational changes, urologists younger than 45 years of age saw the largest increase in burnout from 37.9% in 2016 to 44.8%.⁵

Burnout doesn’t only impact practicing urologists. It also affects our trainees and our advanced practice providers (APPs). One study of 415 urology residents found an overall burnout rate of 47% with postgraduate year (PGY)–2 residents demonstrating the highest amount of burnout at 65%.⁶ APPs in urology also experience burnout, although at a lower rate than practicing urologists; 26.1% of APPs experienced burnout, with women APPs at a higher risk of burnout than men.⁷ Urologists in academic medicine need to be aware of the high rates of burnout during residency and work with residents, especially PGY-2 residents, to mitigate burnout. Practicing urologists should realize that our APPs are also at risk and may need coaching and support to prevent burnout.

The causes of burnout are complex and multifactorial, which makes preventing and treating burnout challenging. Most institutional approaches to burnout have focused on physicians learning self-care techniques such as mindfulness meditation, healthy eating, increasing exercise, and getting enough sleep. When these burnout-related seminars are offered by institutions, they are rated as very ineffective in addressing burnout.⁸ One reason may be that physicians see this as an attempt to make fixing burnout the problem of the individual physician rather than attempting to fix underlying structural issues. Addressing structural causes of burnout such as prior authorization burdens, staffing shortages (including physician shortages), and frustrations with electronic medical records are much harder to address. These require more complicated solutions, which may include political advocacy for governmental regulation–related burdens and creative approaches to improving workflow in the clinic, such as implementing Lean methodology.⁹

In summary, burnout continues to be a problem for urologists, with women urologists experiencing an alarming increase in burnout since 2016. Because working more contributes to burnout, APPs may play an important role in supporting urologists; however, APPs also experience burnout. Urology residents—especially PGY-2 residents—have high rates of burnout and should be monitored closely. Although many organizations offer wellness programs that emphasize self-care to combat burnout, strategies that focus on systemic issues in health care are more likely to have beneficial results for practicing physicians. The urologic community needs to work together to find sustainable solutions to burnout.