Stress and burnout – why are urologists so stressed?

Ben ChallacombeThis 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.

Ben Challacombe
Consultant Urological Surgeon and Honorary Senior Lecturer
Guy’s and St Thomas’ Hospitals NHS Foundation Trust and Kings College London

Comments (9) Add yours ↓
  1. Roger Kirby

    The reasons for the current prevalence of stress and burnout, not just among urologists, but in many specialties as well as in general practice, are multifactorial. Here are a few of my suggested causes:

    1. Rising patient and public expectations and intolerance of complications and/or unsatisfactory outcomes.
    2. The prospect of seven day working, proposed by politicians without consultation or costing.
    3. The current junior doctors strike action, which in itself is a symptom of unease and anxiety among clinicians.
    4. Fear of litigation, investigation by the GMC or, worse, prosecution for “gross negligence manslaughter”.
    5. An NHS which is overstretched, with GPs unhappy and difficult to recruit, hospitals in deficit and managers demanding ever more “efficiencies” from doctors with no extra resources.

    Not surprisingly anxiety and demoralisation are becoming widespread among doctors, both junior and senior, with many reporting stress and burn-out, and not a few looking for early retirement or employment overseas.
    What are your views? Does this description of “stress” at work reflect your experiences? Please do add your comment to Ben’s blog.

    January 12, 2016 Reply
  2. Matthew Bultitude

    Feel depressed reading Roger’s comment. Sadly a lot of it is true though.

    I am not sure I (or anyone) actually believes that urology is the most stressful job – many jobs have high stress levels. However I agree that increasing demands clinically with fewer resources combined with multiple other activities as Ben lists clearly does not help. Then juggling that with reduced (or at least enforced) limits on study/ professional leave and linking all that in with holiday and family time becomes increasingly complex.

    Ultimately I suspect we will all reach the point where we just have to say No.

    PS Ben – You don’t look too stressed in the photo!

    January 12, 2016 Reply
  3. culley carson

    In the US, there is growing research and publication about physician burnout. indeed there is a great study published recently in Mayo Proceedings. Their data showed that burnout actually increased significantly from 2011 to 2014. Urology was especially prone to burnout in their study. In the US as elsewhere, there are many theories about this increasing burnout. Loss of physician autonomy, diminishing income, constant oversight by government and third party carriers, medico legal issues, changes in the expectations of physicians are all contributors to the burnout. In the US where private practice is in decline as large institutions take over practices and the feeling of being on the assembly line is increasing and the electronic medical record is more important that patient care, makes the practice of medicine less and less attractive. Many more physicians are going into industry, administration and other endeavors as practice is ever more stressful and ever less rewarding.

    While this Assessment of US medicine sounds bleak, it is. I would encourage all to read the Mayo Proceedings paper and editorial for a very unsettling perspective.

    January 13, 2016 Reply
  4. Ben Eddy

    I’d question the validity of a survey that doesn’t include the most recognised stressful jobs in society such as air traffic controllers, or our serving military. Do phlebotomists, or dancers and costume attendants really have more stressful jobs than bomb disposal experts? That aside its interesting to see majority on the list are medical. Surgery, including Urology can be a stressful occupation as the responsibility for your actions lies solely with yourself and no others, and with that, during complex cases theatres can at times be a lonely place. Seeking advice from colleagues can aid stress(and protect patients) however medical culture must continue to change to allow surgeons to do this and not feel as though you are swallowing your pride. Stress is brought on by time pressure yet this will only increase in an NHS trying to milk consultants by increasing clinical activity and forcing more patients into overbooked clinics and stretched theatre lists while also reducing staffing. Other areas of stress or anxiety include working with difficult staff, operating through the learning curve which is increasingly common with junior consultants that are not fully trained to deal with all eventualities and taking on roles without support or adequate training. Should our registrars be taught how to handle stress? I certainly feel we should be supporting our new Consultants in their first year or two.
    As a family man I must include the most stressful job… being a mum, salary $0!!
    So if you need some stress relief then consider exercise, join us on BIKE to BAUS 2016 to Liverpool to raise money for the Urology foundation!!

    January 14, 2016 Reply
  5. Roger Kirby

    Well said Ben! Another source of stress is the constant stream of emails and messages that arrive via one’s smartphone. One useful maxim for emails is to make a quick decision to do one of the three “D”s: Deal with it, Delegate it or Dump it!
    Eddie Redmayne recently recommended dumping the smartphone all together, or at least downshifting to an old-fashioned handset, minus email and apps. Dr Christine Grant, an occupational pyschologist, says that she sees many people being worn down by technology. She goes on that “people don’t realise that in this constant “at you” culture you have to draw boundaries before your work starts to impinge on your wellbeing and that of those around you. Stress doesn’t happen overnight, it is cumulative. The long-term implication can be burnout.
    One other option of course is to turn your smartphone off – at least during meals!

    January 17, 2016 Reply
  6. Roger Kirby

    A major review of published research in Current Opinion in Psychiatry has concluded that chronic stress can damage the hippocampus and pre-frontal cortex leading to increased risk of developing neuropsychiatric disorders including depression and dementia.
    Moreover, a systematic review and meta-analysis published in the Lancet has shown that people who work 55 hours or more per week have a 33% higher risk of stroke (relative risk 1·33, 95% CI 1·11–1·61; p=0·002), and 13% increase in risk of coronary heart disease (1·13, 1·02–1·26; p=0·02), compared to those who work a standard 35–40-hour week. The study drew on data from over 600 000 patients. The authors say that the findings may relate to higher levels of stress, lack of physical activity and risky alcohol consumption in those who work long hours. That sounds like a typical urologist to me!

    January 25, 2016 Reply
  7. Roger Kirby

    Six tips for preventing burnout buff.ly/1S2q2ht #urology

    January 25, 2016 Reply
  8. Roger Kirby

    It’s not only urologists who are feeling stressed. People are at the busiest time of their lives at the very end of their twenties because of more personal commitments, growing “life admin” and ever-demanding social media, according to a recent survey.

    Twenty-nine has been identified in a study as the most hectic time for adults, challenging the assumption that the middle-aged are the most harassed and time-pressed age group.

    Indeed, while 25-to 34-year-olds were on average the busiest age group, those in their 40s and 50s came fourth – after other younger age groups – for how busy they were.

    Nearly twice as many men as women felt social media made their lives too busy
    Ryan Perera, co-founder of delivery app company Henchman, which ran the survey, said: “Time is the most precious thing we have – yet Brits feel increasingly under more pressure for their time now than ever before.”

    The survey took responses from about 2,000 British adults, with roughly 300 from each age group participating.

    The busiest age groups were:

    1. 25- to 34-year-olds

    2. 35- to 44-year-olds

    3. 18- to 24-year-olds

    4. 45- to 54-year-olds

    5. 55- to 64-year-olds

    6. 65 plus-year-olds

    Social media and our information technology age are stressing everybody out!

    January 31, 2016 Reply
  9. Roger Kirby

    Men are experiencing severe psychological distress caused by economic setbacks; such as being made redundant, unemployed or incurring a significant cut in their income.
    All too often, we fail to see the value of women’s work, which is why they are continually overworked and underpaid. But little attention has been paid to how men suffer under sexist capitalist models that overemphasise the importance of work to their identity.
    In British society, men are socialised to invest more of their self-esteem in the traditional idea of being a ‘breadwinner’ than women are. As a result they experience deeper distress when they consider themselves to be ‘failing’ to fulfil that role.
    There is a growing body of evidence that men can be trapped by sexist stereotypes that promote ‘toxic masculinity’. This destructive version of masculinity not only rests on the shaky foundations of self-worth based upon income and status, it also means that men cannot ask for help when they feel anxiety and depression.

    May 1, 2016 Reply

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