Have you ever experienced burnout as a urologist? How do you cope?

"I've never seriously come close to quitting, but I've become disgruntled with all the paperwork and regulations we have to get through with insurance companies, Medicare, and Medicaid.

When that happens, basically, I just say, 'I'm not doing it anymore.'

One example is when insurance companies change formularies and stop covering a drug your patients have been using for years. We don't chase down patients and the covered drugs anymore. We have the patient do it and have them come in to discuss whether they want to change or not. Otherwise, we spend hours on the phone with no reimbursement, trying to get this settled.

I may take a vacation, a long weekend, or a week and get refreshed. We go to a secluded camp on the river. It's almost impossible to stay home, because people call me. I really have to get out of town. Maybe we visit one of my kids. But I always come back. I still like the practice of medicine."

Charles Bowie, MD Eunice, LA

"Sometimes, I know I need to take some time off. But I've never felt like hanging it up and going into gardening. Sometimes work, phone calls, and trying to make decisions seems a little bit much.

I'll go skiing, usually in Utah, or I go visit my family in other parts of the country. Once a year I go back to India-those are the kinds of breaks I take.

I have family in San Francisco, and a daughter and sister are in this area. Two grandchildren are the light of our lives. My family is really the way I get away from it all."

Krishna P. Jayaraman, MD Mechanicsville, MD

"I've certainly felt burned out. The time and the constant questions; after a while, it takes a toll.

Now that I've been practicing longer, I'm better at taking more frequent breaks to recoup than I used to be. I used to think I had to work through it.

It's like anything else; as you learn more about yourself and your environment, you learn to be more preventative.

I usually take time every 2 to 3 months. Sometimes, it's only a couple of days if my daughter has a long weekend. I'll take a day or a week off. It doesn't have to be a lot of time or even leaving town, just enough to break the monotony. Sometimes, it's getting things done around the house that have been on your mind.

Some people do well with one 3-week vacation a year, but I find a need to step back and take a day periodically."

Scott Troxel, MD Roseville, CA

"I've never been professionally exhausted to the point where I don't like what I do, but I do get frustrated with certain aspects of what I do and the effort it takes to deal with hospitals and administrators, with insurance companies and pharmacies.

Sometimes I'm just not willing to stand there and fight with some insurance company about whether a drug should be covered or whether surgery is necessary. These things happen in waves, and you just have to back off and let whatever happens happen. Then issues pass and you get back to normal.

My family is a big part of what I do. Medicine is what I do for a living-I don't do it to live. I like being a urologist, but I think of myself as a husband and father first and a urologist after that.

Also, I'm done when I leave the office. I don't do any academics, research, or prepare talks. I don't take it home.

I also exercise a lot. I'm a cyclist and ride my bike 10 to 12 hours a week. I race, go on trips. That burns off a lot of energy. That's a certain mentality-it's not always healthy, but if that's the kind of person you are, you've got to have some draining, time-consuming activity that takes you away from everything."

Stephen Tannenbaum, MD Miami