Stressors and Coping Mechanisms Related to Burnout Within Urology

Published:February 04, 2020DOI:


      To identify factors and stress coping mechanisms associated with burnout within the field of urology.


      A survey study was completed using the abbreviated Maslach Burnout Inventory to evaluate emotional exhaustion, depersonalization, and low personal achievement. Demographic information, training status, practice setting, work hours, and mechanisms used to cope with stress were evaluated. Participants were also asked to comment on contributors to burnout in an open-ended question. Univariate analysis and multivariate regression identified factors associated with measures of burnout.


      A total of 476 survey responses from 377 practicing urologists and 99 residents/fellows were included. Burnout was identified in 49.6% of all participants. Burnout through high emotional exhaustion was seen in 40.7%, high depersonalization in 30.7%, and low personal achievement in 18.3%. Trainees exhibited higher levels of depersonalization and lower levels of personal achievement. Higher levels of emotional exhaustion were identified in urologists in the middle of their careers and those in private practice. Urologists identified documentation, insurance and reimbursement, government regulations, medical practice expectations, and patient expectations as stressors contributing to burnout. Exercising and socializing were consistently associated with lower measures of burnout whereas stress eating and alcohol use were associated with higher measures of burnout on multivariate analysis.


      Burnout in urology was associated with trainee status, years in practice, and practice setting. Exercising and socializing were protective against burnout whereas stress eating and alcohol consumption were associated with higher rates of burnout.
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        • Shanafelt TD
        • Hasan O
        • Dyrbye LN
        • et al.
        Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014.
        Mayo Clin Proc. 2015; 90: 1600-1613
      1. Kane L. Medscape national physician burnout, depression & suicide report 2019. Available online at: medscape. com/slideshow/2019-lifestyle-burnout-depression-6011056. Accessed 2019.

        • North AC
        • McKenna PH
        • Fang R
        • et al.
        Burnout in urology: findings from the 2016 AUA Annual Census.
        Urol Pract. 2018; 5: 489-494
        • Landon BE
        • Reschovsky JD
        • Pham HH
        • Blumenthal D
        Leaving medicine: the consequences of physician dissatisfaction.
        Med Care. 2006; : 234-242
        • DiMatteo MR
        • Sherbourne CD
        • Hays RD
        • et al.
        Physicians' characteristics influence patients' adherence to medical treatment: results from the Medical Outcomes Study.
        Health Psychol. 1993; 12: 93-102
        • Haas JS
        • Cook EF
        • Puopolo AL
        • et al.
        Is the professional satisfaction of general internists associated with patient satisfaction?.
        J Gen Intern Med. 2000; 15: 122-128
        • Pathman DE
        • Konrad TR
        • Williams ES
        • et al.
        Physician job satisfaction, dissatisfaction, and turnover.
        J Fam Pract. 2002; 51: 593-601
        • American Urological Association
        The State of the Urology Workforce and Practice in the United States 2018.
        • Maslach C
        • Leiter M
        Maslach Burnout Inventory Manual.
        3rd ed. Consulting Psychologists Press, Palo Alto, CA1996
        • McManus IC
        • Winder BC
        • Gordon D
        The causal links between stress and burnout in a longitudinal study of UK doctors.
        Lancet. 2002; 359: 2089-2090
        • Lebares CC
        • Guvva EV
        • Ascher NL
        • et al.
        Burnout and stress among US surgery residents: psychological distress and resilience.
        J Am Coll Surg. 2018; 226: 80-90
        • Pruthi NR
        • Deal A
        • Langston J
        • et al.
        Factors related to job satisfaction in urology.
        Urol Pract. 2016; 3: 169-174
        • Pulcrano M
        • Evans SR
        • Sosin M
        Quality of life and burnout rates across surgical specialties: a systematic review.
        JAMA Surg. 2016; 151: 970-978
        • Böhle A
        • Baumgärtel M
        • Götz ML
        • et al.
        Burn-out of urologists in the county of Schleswig-Holstein, Germany: a comparison of hospital and private practice urologists.
        J Urol. 2001; 165: 1158-1161
        • Roumiguie M
        • Game X
        • Bernhard JC
        • et al.
        Does the urologist in formation have a burnout syndrome? Evaluation by Maslach Burnout Inventory (MBI).
        Prog Urol. 2011; 21: 636-641
        • Cohen JS
        • Patten S.
        Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta.
        BMC Med Educ. 2005; 5: 21-32
        • Shanafelt TD
        • Bradley KA
        • Wipf JE
        • Back AL
        Burnout and self-reported patient care in an internal medicine residency program.
        Ann Intern Med. 2002; 136: 358-367
        • O'Kelly F
        • Manecksha RP
        • Quinlan DM
        • et al.
        Rates of self‐reported ‘burnout'and causative factors amongst urologists in Ireland and the UK: a comparative cross‐sectional study.
        BJU Int. 2016; 117: 363-372
        • Clark A
        • Oswald A
        • Warr P
        Is job satisfaction U‐shaped in age?.
        J Occupat Organ Psychol. 1996; 69: 57-81
        • Balch CM
        • Shanafelt TD
        • Sloan JA
        • et al.
        Distress and career satisfaction among 14 surgical specialties, comparing academic and private practice settings.
        Ann Surg. 2011; 254: 558-568
      2. Grisham S. Medscape urologist lifestyle report 2018. Available online at: Accessed 2019.

      3. Friedberg MW, Chen PG, Van Busum KR, et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Rand Health Q. 2014;3(4).

        • Kahneman D
        • Deaton A.
        High income improves evaluation of life but not emotional well-being.
        Proc Natl Acad Sci USA. 2010; 107: 16489-16493
        • Shanafelt TD
        • Dyrbye LN
        • Sinsky C
        • et al.
        Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction.
        Mayo Clin Proc. 2016; 91: 836-848
        • Tai-Seale M
        • Olson CW
        • Li J
        • et al.
        Electronic health record logs indicate that physicians split time evenly between seeing patients and desktop medicine.
        Health Aff. 2017; 36: 655-662
        • Weight CJ
        • Sellon JL
        • Lessard-Anderson CR
        • et al.
        Physical activity, quality of life, and burnout among physician trainees: the effect of a team-based, incentivized exercise program.
        Mayo Clin Proc. 2013; 88: 1435-1442
        • Nevanperä NJ
        • Hopsu L
        • Kuosma E
        • et al.
        Occupational burnout, eating behavior, and weight among working women.
        Am J Clin Nutr. 2012; 95: 934-943
        • Oreskovich MR
        • Kaups KL
        • Balch CM
        • et al.
        Prevalence of alcohol use disorders among American surgeons.
        Arch Surg. 2012; 147: 168-174
        • Rohland BM
        • Kruse GR
        • Rohrer JE
        Validation of a single‐item measure of burnout against the Maslach Burnout Inventory among physicians.
        Stress and Health. 2004; 20: 75-79
        • West CP
        • Dyrbye LN
        • Sloan JA
        • Shanafelt TD
        Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals.
        J Gen Intern Med. 2009; 24: 1318-1321