Urologist burnout rates not declining overall and increasing in women

In this interview, Andrew M. Harris, MD, discusses the findings and implications of the study, “Burnout: A call to action from the AUA Workforce Workgroup.”¹ Harris is a urologist at the Lexington VA Medical Center and an assistant professor of urology at the University of Kentucky Medical Center in Lexington.

Andrew M. Harris, MD

Could you describe the background for this study?

2016 is really when the discussion of burnout became more mainstream. That was from a study showing that urologists were among the most burnt out physicians in the country. We really started studying burnout from that time. Dr. Amanda North has done a tremendous job in putting this focus in the urology workforce. We've continued to study this since 2016 and generate a lot of discussion on how we can improve burnout. That's how this study got started. This is a natural build off of the previous work that's been done in this area in urology.

What were some of your notable findings? Were any of those surprising to you and your coauthors?

There were several interesting findings from the most recent AUA census results considering burnout. Some of them we didn't really see coming. Some of them are really, really concerning. The overall burnout rate really didn't change a lot between the 2016 and 2021 AUA annual census; both were about 36% of urologists were experiencing burnout. We still have too high of a rate. 36% is still too high. Even though it's the same in 2016, it's still not good.

However, when we start to break that down a little bit, we really see some differences that have panned out since 2016. Some are really concerning. When we look at the gender discrepancy, this vastly widened since 2016, then actually decreased a little bit from about 36% to 35%. But very concerningly, the burnout that women are experiencing has increased from 35% to 49%. That is a dramatic increase over the past several years.

Also, when we look at it by age, those experiencing burnout under 45 years old have increased from 38% to 45%, and those 45 to 54 years old, from 43% to almost 45%. So, we see that our younger urologists, for those in their early to mid-career, are experiencing burnout, and it's getting worse since 2016. This is very concerning.

What might be some of the reasons for burnout among urologists?

Considering burnout from a broad perspective in the urology population, increasing regulation, excess bureaucracy, decreasing autonomy, declining reimbursement, and increased administrative burdens are all increasing the risk of burnout. When we discuss what some of these burdens may be, there is a large amount of urologists that are really worried about the electronic health record, and the increased administrative burden and non-clinical tasks that is placed on them that are likely contributing to burnout. Also, when we asked about barriers to professional success through the census, we find many of our urologists don't feel they have enough time, or they have little control over their schedule or scheduling decisions. This is also likely contributing to burnout.

When we think about some of the contributors that may be leading to the discrepancies that we see in different genders and by age of those experiencing burnout in urology, debt really comes into mind. There are previous studies looking at the AUA census and debt, and we know that debt is more common or more significant in our younger urology population and also in our women urology population. This could be one of the significant contributors to why there may be more burnout.

However, I think it's really important for us to step back and learn. We need to listen to our colleagues about why they're experiencing more burnout. That discrepancy between men and women since 2016 is significant. We have more women in the workforce now, which is phenomenal and something we really need to help us provide more balanced care. We really need to step back and listen to what is it that our women colleagues are experiencing so that we can help advocate and so that they have the opportunity to advocate to bring these burnout rates down.

Could you touch on some of the impacts or implications of these findings?

When we think about what burnout does to our workforce, it's important to consider what it does to us as individuals and also what happens to our patients. When we think about what burnout does to our workforce, the ramifications are significant. Those who are experiencing burnout are much more likely to have substance abuse, or substance dependence, drugs or alcohol, are more likely to have depression. You're much more likely to have suicidal thoughts or even [die by] suicide.

We don't need our workforce to be feeling those kinds of issues or struggling with those kinds of conditions. That is absolutely heartbreaking, from a workforce perspective. We also know that burnout, for those who are experiencing burnout, are more likely to have diabetes [and] also heart disease. That's also not good for our population. Being a physician is difficult enough without having those other conditions placed on top of burnout. So really concerning of what these conditions can do to us and what burnout can do to us as a workforce.

When you think about what happens to the patient, it also reflects the value we provide to the patient, because those physicians who are experiencing burnout, are also likely to have worse quality scores, more likely to provide poor quality care, more expensive care, they're also more likely to have adverse events or patient safety events that contribute to our patient. Nobody is winning in the situation where we have more burnout. It's very concerning about what's happening to us as providers, and also what may be happening to our patients as a result of our workforce being burnt out.

Is any further research on this topic planned? If so, what might that cover?

Concerning further research on this topic, we are really trying to understand more from our work. We need a better understanding what is contributing or causing a lot of burnout, especially in some of the gender discrepancy, and especially in some of the younger workforce. Some of our research going forward will be to further question how we can help [and] what is contributing to the burnout.

We're also going to be strongly considering and trying to examine how much of our workforce is struggling from the ramifications we talked about previously. How much substance abuse do our members feel like they are being subject to, or depression? Who's having suicidal thoughts? And how can we help? How can we be there for our members when they're really struggling, so they feel they have somewhere to turn? These are a lot of avenues we're going to be examining in the future.

Also legislatively, the American Urological Association is going to be looking at how can they help. How can we help advocate for our members to get rid of some of the regulatory burdens that they're feeling every day? It's really making it hard for them to do their job, and really contributing burnout. Those are the next plans of action.

What is the take-home message for urologists?

When we think about the most important messages from this work on burnout, as we continue to build over the last several years in examining burnout in our workforce, I think we’ve got to think about 2 different avenues. One is the people. Burnout is not getting better for our workforce. It's as stable today as it is 2016. We've done a lot of focus on burnout in the past 6 years, how do we continue to get better? There has not been much change in burnout in the last 5 years, even though we've been focusing on it tremendously. So I think we need to consider how do we get this needle to move in the right direction for the health of our workforce?

The other take-home message is for our members who are struggling: We are here to help. There are people all around you that want you to be successful, that want you to enjoy your work, wake up in the morning, not thinking "Oh, another day," but "I can't wait to go to work today." If our members are not feeling that, how do we help? Please reach out for help. Please look for those in your department if you're struggling with substance abuse, alcohol, depression, having suicidal thoughts. Please reach out to all those around you. We are all here to help and we want to be there for you so that we can prevent some of those things from ongoing.

Is there anything else that you'd like to add?

Please feel free to reach out if you have ideas about burnout, things you're experiencing, [and] those things that you want the Workforce Workgroup to know. We're here to help and try to strive to make the workforce better and so please, if you'd like to get involved, reach out.

If you have ideas about addressing burnout that you would like to share with Dr. Harris, please reach out to him at Andrew.harrisMD@uky.edu.

Reference

1. Harris AM, Teplitsky S, Kraft KH, Fang R, Meeks W, North A. Burnout: A call to action from the AUA Workforce Workgroup. Journal of Urology. 2023 Mar;209(3):573-579. doi: 10.1097/JU.0000000000003108