What was your reaction when you heard urology was considered the most stressful job in the United States?

Aaron Bayne, MD

“I didn’t believe it, and I’m still not quite there. An [individual’s] perspective on what’s stressful depends entirely on the [individual] themself. So 2 [individuals] can do the same job, and one might find it stressful, whereas another finds it easy to manage.

It’s hard for me to believe urology’s the most stressful job, although it’s very stressful. You’re dealing with sensitive topics. A lot of [the] time, [patients’] expectations cannot be met, even when you deliver that up front.

I don’t put much stock in the report, but I can’t dismiss it either. Most jobs that deal with intimate issues of patient health will cause stress both for the patient and the provider. I can easily say it’s stressful, but not necessarily more stressful than an obstetrician delivering [newborns] every hour of the day or a cardiac surgeon where your patients are always [at high risk] of death. I don’t think it’s fair to say which [job] is most stressful.

I only have the perspective of seeing pediatric urologists every day, and for one of my partners, I see the stress on a regular basis. It’s a taxing job for that doctor, but they’re also very good at what they do. I can see how someone could easily respond that way within our group, but if you surveyed me, I would not say that.

[In] the past few years, burnout is incredibly prevalent at all levels of medicine, not just [in] urology. Part of the stress is caused by external factors that have made it harder to practice [in] the past few years.”

Aaron Bayne, MD

Portland, Oregon

Joseph Pazona, MD

“It’s a great question. At first, I was surprised for 2 reasons: first, [because of] our training, physicians tend to normalize stress. Medicine attracts [individuals] who are drawn to that sort of demand on themselves.

Second, although I only know urology, many medical fields deal with patients [with more disease] and acute medical issues. Very few things are considered urologic emergencies. We don’t [see] patients dying all the time; we deal with a lot of quality-of-life issues.

You could argue that a cardiac surgery isn’t stressful because that attracts a certain person. If you go into cardiac surgery, you know what you’re getting into.

The older generation of urologists had it pretty good for a number of years. Then they [experienced] declining reimbursement, difficulty recruiting new partners, and more administrative burdens. That ties in with burnout.

Younger [physicians] come in expecting to earn all this money, [thinking] life will be great. And the next thing they know, they’re taking 10 days [on] call and are running between [emergency departments], ORs [operating rooms], and [the] clinic. I hypothesize there’s a misalignment between the urologists’ mindset going in and reality.

I buy that declining income could be stressful. Urology is the second oldest specialty, so if we’re talking about a urologist in practice for 25 or 30 years, they see the real effect every single year of working harder to make less money.

When I was hospital employed, I felt that stress [and] the lack of autonomy. I’m not as stressed now because I’m creating a practice. It’s exceeding my expectations, and I’m doing exactly what I want to do as a solo, private practitioner.”

Joseph Pazona, MD

Nashville, Tennessee

Bevan Choate, MD

“I was a little taken aback by that. At some points, I can completely relate. Other days, I [think], ‘Aw, come on. It can’t be worse than being an airline pilot right now.’

[But] I believe it. I’m only 37 years old, and I had a stroke about 2 years ago, not necessarily because of stress. It was a total fluke, but I wonder sometimes.

[I think about] the increasing demand that falls on the physician from regulation, insurance companies, [and] growing hospital administration staff. The expectations are much higher, and for urologists, when it comes to dealing with those very specific issues that require a lot of tact—when you’re dealing with male and female genitalia—expectations are certainly high as well. And in that regard, expectations are not always realistic. We’re constantly fighting about other [individuals’] expectations, and I think that may be why.

But there are those rare days when everything goes well, and every patient you see in the office has 0 complications and no issues whatsoever. Then it seems a pure joy. They seem a little less frequent, but I couldn’t see myself doing anything else.”

Bevan Choate, MD

Albuquerque, New Mexico

Kevin Krughoff, MD

“I was surprised. My mentality is [that] if you think about anything too much, you manifest it. You have to stay positive. If you focus on this as stressful, you’ll stress yourself out. You’ve got [to] try to see the upside.

I don’t think the urologists I know are more stressed than a lot of other [physicians]. It depends on who they ask. If I had to guess, a lot of stress stems from a staffing squeeze, but everybody’s dealing with it.

When I was a student, urology fell into one of those categories allowing for a better lifestyle. But I don’t know [whether] that promise was delivered, and maybe that’s where that response is coming from.

There are more stressful jobs out there. Being a line worker [is] more stressful.

Maybe it’s my fresh-out bias, but there are a lot of possibilities and opportunities in urology. There’s a lot of stress, but do I think it’s the most stressful job you could have? Not even close.

It is very difficult, and there are some very difficult days. But there are more days when there’s that payoff that you’re doing important work. You’re helping [patients] get to a better place in their life. Those are the important things to remember.”

Kevin Krughoff, MD

Springfield, Oregon