What is the biggest stressor in your office?

Three urologists discuss what causes them the most angst and the ways they try to reduce the pressure.

Dr. Albertsen“My biggest stressor is getting through clinic on a daily basis. It feels like we’re on a treadmill when we know we need to give a little more time to a patient, but there are three or four more patients lined up waiting and there’s no break during the day to catch up. Either you shortchange someone who needs more time, or you run late for the next patient. It’s the pressure of staying on time in clinic I find the biggest stressor: keeping the pace up, getting through a day, seeing everybody-virtually on time-and still feeling that you’ve adequately addressed the concerns they raised.

I’ve been doing this for 33 years; eventually I’ll retire. In the meantime I’ve developed a couple of strategies to reduce the pressure. I try not to have clinic days all lined up in a row. I make sure that an OR day follows a clinic day and that I don’t have patients piled on top of each other.

I find the operating room a more relaxed environment, particularly when cases are easier. ORs can run late, but there aren’t as many patients. OR usually ends around 3 o’clock, so even if it runs late, you only go to 5 or so. Tougher cases can be a little more stressful, but I think most surgeons agree it’s less stressful than a busy clinic day when you’re trying to crank out a lot of patients. Clinic days lined up Monday through Friday-that would wear me out.”

Peter Albertsen, MD

Farmington, CT

Next: "When that kind of stress comes up, I usually just tell the parents to get a new insurance company."

“The biggest stressor in my office is dealing with insurance companies because of the time employees spend trying to get procedures and tests covered. That carries over and is also stressful for me, secondarily. Let me give you an example. I’m a pediatric urologist, and say I have a one-year-old who needs a circumcision. There’s a certain insurance company that won’t cover it.

Then that stress falls on me because to appeal it takes a peer-to-peer review, which takes time and effort to schedule a phone call to consult with their physician, then the actual conversation with their people. And the company still doesn’t usually go for it. It’s even worse because parents are caught in the middle and they just want the child circumcised. It’s not that expensive a procedure but I’m spending time trying to get it done for them. Then it’s a stress for me because I can’t do it.

When that kind of stress comes up, I usually just tell the parents to get a new insurance company. It’s very simple. I don’t know if that works because I do so many circumcisions that I can’t tell you whether or not they change insurance companies or if they just pay out of pocket for the circumcision. But fighting with insurance companies is just too aggravating.”

Richard Mazo, MD

Savannah, GA

Next: "I would say the biggest stressor in my practice is when patients have complications."

Dr. Villanueva“I would say the biggest stressor in my practice is when patients have complications. Any time complications happen that aren’t expected, I would say that’s the big stressor. I’ve only been in practice 3 ½ years and the first year or two that’s when it’s really bad. Then you start learning to accept to some degree a certain amount of complications. I would say lately they have not been as stressful.

To cope with the stress, you learn that when you’re done with surgery to make sure you leave the OR knowing you’ve done everything you could in the best way, that you did not take any shortcuts or didn’t do anything just because you wanted to save time. Make sure you leave the OR knowing that you’ve done everything you could possibly have done. Then if something happens, it’s just going to happen, and you have to live with it.”

Carlos Villanueva, MD

Omaha, NE