EAU 2019: The Impact of Sleep-Related Impairment on Burnout in Urologists: Results from a National Consortium Study

Barcelona, Spain (UroToday.com) Physician burnout is an increasingly recognized and rapidly growing concern in the medical community, particularly in the United States. Beyond its impact on the system, it has severe consequences for both the physician and the patients they treat – and if not recognized, can have dire consequences. Defined by most sources as a combination of emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment, burnout has reached greater than 50% amongst some specialties.  Indeed, according to the 2019 Medscape “National Physician Burnout, Depression & Suicide Report 2019,” urology tops the list of specialties with burnout! Topping the list of reasons for burnout include: “too many bureaucratic tasks,” such as charting and paperwork, and spending too many hours at work.

Sleep-related impairment and poor self-valuation have been previously linked to increased burnout and decreased professional fulfillment in general physician studies. Unfortunately, no studies have been conducted on the effects of sleep-related impairment and self-valuation on urologists specifically. As a field with leading rates of burnout, it is important to understand what leads to those high burnout rates.

Using data collected through a standardized electronic survey that had been previously administered to 11 academic medical institutions participating in the Physician Wellness Academic Consortium (PWAC) in the United States, the authors looked specifically at the Urology respondents. For the survey, all residents and trainees were eligible to participate along with attending staff. In that PWAC survey, burnout, professional fulfillment, and self-valuation were measured using an extended version of the Professional Fulfillment Index (PFI). Sleep-related impairment was measured using the PROMIS sleep-related impairment scale.

The overall PWAC response rate amongst all specialties was approximately 63%, which is respectable for a survey of this size. From this sample, 39 residents and 60 faculty identified themselves as urologists.

Looking at burnout rates, burnout was present in 40% of faculty and 38.5% of resident urologists; professional fulfillment was present in 45% of faculty and 28.2% of resident urologists. These numbers themselves are quite alarming – 4/10 urologists were burned out and 4/10 residents who had not yet even started their career were burned out. More concerning, <50% of staff and trainees felt fulfilled by their career choice!

Looking at work hours, one of the top reasons for burnout in the Medscape survey, academic faculty reported working an average of 67.4 hours per week – though it is not clear if this was all clinical work or included academic responsibilities. Amongst the faculty, moderate to high intention to leave the current job was observed in 32.7%; amongst residents, with 13.5% of residents reported moderate to high intention to leave current training specialty. In burnout physicians and residents, professional fulfillment was 9% and 15%, respectively.

Lastly, looking at sleep-related impairment, it was present in 44.1% of faculty and 81.6% of resident physicians. These numbers are high, especially among trainees. While we generally accept and tolerate sleep related impairment as a “part of training,” perhaps it is time to reconsider training structure with such high rates of burnout throughout the urologic academic culture. On multivariate analysis controlling for trainee status and self-valuation, the presence of sleep-related impairment was associated with significantly increased likelihood of burnout (OR=11.2; 95%CI 2.55-49.0; p=0.001). Meanwhile, each one unit increase in self-valuation was associated with a 60% lower odds of burnout (OR=0.40; 95%CI 0.20-0.80; p=0.009).

These results, along with the alarming rates of burnout amongst physicians as a whole, highlight the need to re-examine the academic medicine culture in the United States.

Presented by: Daniel Marchalik, MD, MedStar Georgetown University Hospital, Department of Urology, Washington DC

Written by: Thenappan Chandrasekar, MD, Clinical Instructor, Thomas Jefferson University, twitter: @tchandra_uromd, @TjuUrology at the 34th European Association of Urology (EAU 2019) #EAU19, conference in Barcelona, Spain from March 15-19, 2019.
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