Burnout Remains an Important Issue in Urology, Despite Decreased Occurrence

Amanda C. North, MD

Amanda C. North, MD

Based on results from Maslach Burnout Inventory (MBI) questions included as part of the 2016 American Urological Association (AUA) Census, burnout rates among urologists are lower than previously reported, but the issue still remains important. While many physicians and urologists can experience burnout, it is more likely to occur in urologic oncologists, who often see patients with aggressive and even incurable disease.

Physician burnout is linked to decreased job performance, increased medical errors, interpersonal conflicts, and depression, according to a presentation by Amanda C. North, MD, an assistant professor of pediatric urology at Montefiore Medical Center.¹There have been more pointed concerns about the work force in urology practices. She pointed out that there is even an ICD 10 code for burnout, defined as a state of vital exhaustion.

“There are 3 components to burnout in MBI. The first is emotional exhaustion, the feeling of being overextended, fatigued, and a loss of enthusiasm for their work. The second is depersonalization, objectification of patients, and being less caring toward your patients. The third is a decreased sense of personal accomplishment, loss of meaning in your work,” North explained in her presentation at the AUA Annual Meeting. Notably, a decreased sense of personal accomplishment is not used as a criterion for most studies on burnout, according to North.

A recent multispecialty study demonstrated that urologists had the highest rate of burnout among specialties and that rate was rising, with the burnout rate in 2011 reported at 41.2% and the burnout rate in 2014 at 63.6%.²“This made urologists the most burnt-out specialty of medicine,” North commented. The studies were limited, however, due to the small sample size for urologists. Thus, the study led by North sought to determine the prevalence of urologist burnout and determine factors associated with it.

In the study, the MBI questions were randomly distributed to about half of the respondents to the AUA Census. The matrix sampling included 1126 practicing urologists, representing the total 2301 who responded to the Census. Ultimately, 38.8% of the urologists met the criteria for burnout, with a rate of 41.3% in urologists aged 29 to 65. In terms of emotional exhaustion, 17.2% scored high, and 37.1% scored high for depersonalization.¹

There were no differences reported between male and female urologists, but there are several risk factors for burnout. Major work-related stressors are administrative duties and work hours, which are related to early retirement and job changes. Urologists seeing a greater number of patient visits per week, or with a greater number of work hours in a particular week are at risk for burnout. Other risk factors include being in a younger age group, practicing in a subspecialty other than pediatric or oncology, being part of an independent or multispecialty practice, and having a practice size greater than 2 urologists.

Although burnout rates for urologists are lower than previously reported, burnout is still an important issue, and North recommends making burnout mitigation a priority. Understanding the causes of burnout helps guide future intervention, and it is important to keep all urologists in the workforce to lessen projected shortages. North also recommends creating and evaluating resourced to address physician burnout, such as the American Medical Association STEPS Forward program, or working with the Centers for Medicare and Medicaid Services Office of Clinician Engagement.

“Although physician burnout in urology is less than previously reported, it is still a serious issue that impacts work force issues,” North said. “There are projected physician shortages in all areas of medicine; urology had one of the largest projected shortages and we cannot lose more urologists to burnout.”

References:

1. North AC, McKenna PH, Fang R, et al. Burnout in urology: findings from the 2016 AUA Annual Census. Abstract presented at: 2017 AUA Annual Meeting; May 12-16, 2017; Boston, MA. Abstract MP76-10.
2. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014.Mayo Clin Proc. 2015;90(12):1600-1613. doi: 10.1016/j.mayocp.2015.08.023.