Stress and burnout – why are urologists so stressed?
This week the Independent newspaper reported that urology was the number one most stressed occupation. This initially seemed surprising to me and many other urological colleagues and surgeons of other specialties. Surely those who practise trauma surgery and vascular or transplantation must be more stressed than us who have the reputation of being ‘the nice guys of surgery?’ Then I began to think of reasons why this could actually be true. While all of us can cope with a few busy weeks, it is the unrelenting nature of urological pressure that probably produces the overall stress. Urologists are getting busier and busier as the population ages and people become more demanding and less tolerant of benign conditions such as BPH/LUTS, erectile dysfunction, recurrent infections as well as incontinence and andrological conditions. As a result the workload of general urology is ever increasing, and patients ever more demanding.
Cancer targets are becoming more and more of a headache for all those urologists involved in the diagnosis and treatment of malignancy. Over 40% of all two-week wait referrals come through urology and, certainly in my hospital, cancer treatment targets in urology have the capacity to downgrade the whole hospital’s CQC grading if they are missed. The pressure is on more and more to deliver diagnostics and major surgery every week of the year with 31/62-day targets always on my mind. We are also in a climate of increasing public expectation and our surgical results are now available online for all our key procedures. Just this week I have had two referrals to operate on patients who were regarded as too ‘high risk’ to have their procedures locally. This must be a result of this increased scrutiny of our outcomes, with others wishing to minimise their risk of poor figures.
Urologists are fundamentally nice people and this is why I chose it as a career, but this strength is also a weakness when it comes to stress. We just can’t say no to things: surgical tutor, audit lead, FY1/2 supervisor, ARCPs and CT selection, a talk to GPs, a grand round and medical student teaching, to name just a few. The extracurricular list just piles on and on to overburden the already packed week. Why don’t orthopaedic and general surgery colleagues have this to the same extent? Well many of them are sensible enough to just say NO! As a physically fit person, but having already had two medical scares that are arguably stress-related, perhaps we urologists need to look after ourselves a little more to avoid burnout and ensure we are there for our patients for many more productive years.
Consultant Urological Surgeon and Honorary Senior Lecturer
Guy’s and St Thomas’ Hospitals NHS Foundation Trust and Kings College London