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    Burnout: How can it be prevented?

    Raj S. Pruthi, MDRaj S. Pruthi, MDAre you burned out? If not, you may know someone who is; 40% of respondents to the 2016 AUA ­Annual Census reported burnout. In this interview, Raj S. Pruthi, MD, discusses the factors behind burnout and steps that can be taken to address and prevent it. Dr. Pruthi is Rhodes Distinguished Professor and chair of urology at the University of North Carolina, Chapel Hill. Dr. Pruthi was interviewed by Urology Times Editorial Consultant Stephen Y. Nakada, MD, the ­­Uehling Professor and founding chairman of urology at the University of Wisconsin, Madison.


    Please describe the problem of physician burnout.

    Burnout in medicine is a national, complex, and systemic issue whose effects go far beyond physicians themselves, impacting our patients and even having far-reaching societal implications. Sadly, across the world, I believe that physician burnout is becoming the norm within our career path.

    The term “burnout” was first used in 1974 to describe stress related to one’s occupation. It can affect anybody but seems to have a disproportionate effect on health care providers, police officers, and teachers—those whose work involves constant demands and intense interactions with people with high levels of physical and emotional needs. I think we all realize physicians are often part of or at the top of that short list of those with burnout.


    Does burnout affect urologists differently than other physicians?

    I think it affects all physicians, as we share common internal characteristics: drive and determination, motivation, and perfectionism, which paradoxically can actually contribute to burnout by giving one’s self until there’s nothing left to give. Other elements shared by all physicians are external stressors that have worsened recently: government regulations, bureaucratic burdens of providing health care, electronic health records, and so forth.

    Read - Burnout, biopsy, BPH, and more: Post-AUA review

    A group at the Mayo Clinic led by Dr. Tait Shanafelt looked at burnout in 2011 (JAMA 2011; 306:952-60). Despite burnout being described for 40-50 years, it was not until this paper that it was really addressed in a broad way in the physician work force. In a subsequent paper, his group broke down burnout rates by specialty (Mayo Clin Proc 2015; 90:1600-13). The rate in urology was 64% and was the highest of the specialties evaluated, which many of us in the field found rather surprising. It is not what we expected; when we went into urology, we had a perception of it being a specialty of very fulfilled, happy, relaxed surgeons who can make a difference.

    Subsequent surveys have suggested different numbers. A 2017 Medscape survey suggested a 52% rate for urologists, which is right in the middle of the specialists surveyed. The AUA Annual Census embedded Maslach Burnout Inventory questions in the survey and showed a rate of about 40%. (Also see, “Burnout rate lower than believed, but still too high") That might be a more accurate number than the Mayo Clinic number as it had a larger sample size than the 2015 Mayo Clinic study. Still, 40% is a high number. It’s something that deserves attention by our field.

    Next: Why do you think this is happening, specifically to urologists?

    Stephen Y. Nakada, MD
    Stephen Y. Nakada, MD, a Urology Times editorial consultant, is professor and chairman of urology at the University of Wisconsin, Madison.


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