Joy in Work: Burnout as a Threat to Quality in Urologic Care

Published 2026

Panel Members

Andrew Harris, MD, MBA (Co-chair); Amanda North, MD (Co-chair); Max Bowman, MD; John S. Lam, MD, MBA, FACS; Kevin Koo, MD, MPH, MPhil; Kate H. Kraft, MD, MHPE, FACS, FAAP

Staff

Emily Calvert, MSN, RN, CPHQ; Karen Johnson, PhD, CPHQ

Physician Burnout in Urology

Joy in medicine, or the loss of it, is a popular topic of conversation, even more so since the COVID-19 pandemic. Safe, effective, and patient-centered care requires adequate resources and an engaged workforce. However, more than half of all physicians in the United States report a troubling constellation of symptoms including emotional exhaustion, depersonalization, dissatisfaction, distress, and a sense of failure or reduced personal accomplishment.^{1, 2}This is nearly twice the rate of the general working population and results in many physicians experiencing an increased risk of cardiovascular disease, depression, anxiety, or suicidal ideation.² These physical and psychological issues have been labelled “burnout.” Burnout rates are reaching near epidemic levels and urologists are at particularly high risk, approaching rates of 63.6%.^{3, 4} This critical issue threatens urologist wellness and their satisfaction of practicing medicine. Moreover, the ramifications of burnout produce a serious set of negative consequences for physicians and patients as well as healthcare organizations and systems.

Beyond the adverse impact to individuals, physician burnout also poses a significant public health threat, affecting the quality of patient care and the quantity of physicians available to provide it. Similarly, nurses, advanced care providers, pharmacists, and other clinical team members experience alarming rates of burnout. Studies show burnout negatively impacts patient care and care delivery systems in the form of decreased job performance,⁵ lower patient satisfaction,⁶ increased medical errors,^{7, 8} interpersonal conflicts,⁹ and increased number of physicians changing jobs or sometimes abandoning medicine altogether, which further exacerbates issues concerning access to care.¹⁰ The impact on patient care is particularly worrisome, as lower levels of staff engagement are linked with lower-quality patient care as well as concerns for safety. Further, burnout limits provider empathy, which is a crucial component of effective and person-centered care.^11-13 This quality improvement issue brief, which focuses specifically on the unique implications of physician burnout in urology, aims to illustrate burnout as a quality issue, argue increasing joy in work is a more effective intervention than traditional wellness approaches, and provide recommendations for practicing urologists who are experiencing burnout.

Physician Burnout as a Patient Safety and Quality Issue

Burnout not only threatens the well-being and career longevity of individual clinicians but also compromises the foremost mission of health care organizations: to deliver safe, high-quality care. Recognizing, addressing, and sustaining physician well-being is vital to ensuring patients and their families receive safe, high-quality care.

Yet physician well-being has long been overlooked as a quality indicator.¹⁴ Ample evidence suggests physician well-being directly impacts performance, clinical outcomes, teamwork, and patient-centered care—but unlike these performance goals, physician well-being is rarely measured and is challenging to prioritize. Burnout contributes to the cumulative burden of life, which is associated with a cascade of immune and neuroendocrine derailments called allostasis accommodation. These responses are known to deteriorate total health and cognitive dysfunction and to accelerate aging through epigenetic means as well as being linked to the development of chronic diseases, such as hypertension, metabolic syndromes, diabetes, and cancers.¹⁵ Furthermore, chronic psychological stress of any form is associated with a 22% higher mortality rate for all causes and a 31% higher mortality rate for cardiovascular events.¹⁶

Burnout and Patient Safety. Physician burnout is strongly associated with patient safety incidents and adverse outcomes. Evidence from diverse specialties and practice settings confirms those suffering from burnout are more prone to medical errors, delayed diagnoses, and suboptimal care. For instance, physicians who experience burnout are 2.2 times more likely to report medical errors^{7, 8} and burnout among surgeons is associated with a significantly higher likelihood of self-reported recent medical errors.¹⁷ Physician burnout can double the risk of patient safety events¹⁸ and contribute to up to 7% to 10.6% of serious medical mistakes.¹⁹ Burnout in healthcare workers has also been associated with increased rates of catheter-associated urinary tract infections (CAUTI) and surgical site infections (SSI). Researchers found a 10% increase in a hospital’s employee burnout to be associated with an increase of one UTI and two SSIs per 1,000 patients. Furthermore, burnout is associated with a twofold increase in adverse patient safety events and a decline in patient satisfaction.⁶

Burnout and Medical Malpractice. Physicians experiencing burnout are more likely to face malpractice claims. Surgeons experiencing burnout are more likely to face legal action, and physicians involved in malpractice lawsuits report increased levels of emotional distress and burnout, further perpetuating the aforementioned ramifications to quality.²⁰ This cyclical dynamic creates a “second victim” phenomenon, where the emotional toll of adverse events further compounds burnout symptoms,²¹ escalating the risk of future errors and potential litigation.²²

Access to Care and Financial Impact. The financial burden of burnout to physicians, patients, employers, and health care organizations is significant. A 2019 report estimates physician burnout costs the U.S. healthcare system approximately $4.6 billion annually.²³ The primary drivers of this cost include physician turnover and reduced clinical hours when physicians cut back their work hours or leave medicine altogether due to burnout. A longitudinal study of 2500 physicians at Mayo Clinic found for each one-point increase in burnout (on a seven-point scale), or a one-point drop in professional satisfaction (on a five-point scale), there is a 30–50% higher chance that a physician will reduce their work effort (i.e., part-time employment) within the next two years, which may worsen patient access to care.¹⁰

When physicians leave their practices, the cost of replacing them is staggering, with costs estimated at two to three times the physician’s annual salary.^{24, 25} These costs include lost productivity and recruitment and onboarding of replacement staff, which may lead some systems to forgo replacing the departing physician. Health care organizations may attempt to combat physician attrition by hiring advanced practice providers, but this may not fully restore the clinical capacity or continuity of care lost with the departure of experienced physicians. Burnout-related early retirement and reductions in clinical hours may also contribute to significant service gaps and strain on the health care system as a whole, possibly contributing to more access issues for patients.²⁶

Systemic Consequences and Workforce Shortages. The downstream consequences of burnout include increased absenteeism,²⁷ reduced productivity,²⁶ and loss of accumulated expertise—all of which negatively affect patient care, team dynamics, and organizational performance. The annual productivity loss due to burnout has been estimated as the equivalent of the graduating classes of seven medical schools each year in the U.S. alone.¹⁰

Physicians reducing work hours or leaving the workforce altogether will only worsen the existing workforce shortage. United States Health Resources & Services Administration (HRSA) data suggest that by 2037 there will be enough practicing urologists to meet 82% of overall demand, but only 32% of demand in non-metropolitan areas.²⁸ American Urological Association (AUA) Census data suggest that 61.5% of counties in the United States lack any practicing urologists. As the urologic workforce shortages worsen, patients will face longer wait times and longer travel times to seek care.

Recommendations to Address Burnout

Nearly all physicians in the United States agree on the source of the problem when asked about the causes of their professional dissatisfaction. In a 2020 survey, physicians pointed at “too many bureaucratic tasks,” “too many hours at work,” “increasing computerization,” and “insufficient compensation” as the leading causes of their distress.²⁹ Burnout is a complex framework resulting from many factors, including high workloads, insufficient support, and lack of autonomy.³ It is increasingly recognized that traditional wellness interventions such as mindfulness or exercise focus on the symptoms of burnout rather than attacking the systemic causes. Accordingly, these approaches have proven insufficient in addressing burnout, which ultimately requires organizational and systemic solutions.^{30, 31}Ultimately, the lack of fulfillment among physicians in general, and urologists in particular, cannot be solved until physicians understand and are willing to address all the factors contributing to their discontent.³² Shifting the focus to fostering joy in work, rather than improving personal wellness, offers a more sustainable solution. The Institute for Healthcare Improvement (IHI) emphasizes joy in work is not merely the absence of burnout, but is created by organizational factors improving performance, patient care, and staff satisfaction.³³ Addressing burnout—focused on improving the work environment and fostering joy in medicine—is crucial for ensuring the well-being of healthcare workers and the quality-of-care provided.^{34, 35}

Process Improvement. To increase joy in work, the IHI recommends identifying and then addressing the “pebbles in your shoe,” those small daily frustrations decreasing work satisfaction. There is a focus on identifying those small daily frustrations that decrease work satisfaction. Fixing these hinderances requires good team communication and mutual respect. The AUA Quality Improvement and Patient Safety Committee has developed a Quality Improvement Project Guide illustrating how to work on changing processes. Some potential processes to be targeted could be clinic efficiency and delays in the operating room.^36-38 Other examples of effective interventions include hiring scribes, reducing work hours, and encouraging regular connection with coworkers.^{30, 34} The adoption of the electronic medical record (EMR) and the emergence of physicians’ email “in-basket” management, have also been recognized among the key drivers leading to physician burnout in recent years, thus attention to technology that can reduce the burden of the EMR, digital messages, and nuisance alerts are of importance.

The following represents work fostering joy in work or ridding the work environment of “pebbles in the shoe.” Physicians, patients, and staff are often frustrated by long wait times in the clinic. A study examining implementation of efficiency principles was able to decrease wait times by 63%, decrease rework by 48%, and decrease visit times by an average of 6 minutes.³⁶ This allows for more patients to be seen, thus, increasing clinic access as well as allow clinic to run and finish more timely. Another clinic found they needed more clinic access for new patients, and this was being limited by the number of post-operative checks occupying the clinic. The clinic attempted to offer patients telehealth visits to patients who preferred them. This change gave patients more choices and opened additional clinic appointment slots for new patients. However, the process didn’t work well. After applying quality improvement methodology, the clinic was able to increase telehealth scheduling from 32% to 95%, increasing access to postoperative surgical care as well as availability for new patients.³⁷ Another group examined surgical delays the day of surgery. These delays lead to patient satisfaction issues, potential patient safety issues, and provider frustration. The team launched a quality improvement project to study and mitigate delays. They found paperwork was the main reason for delays at this particular institution and were able to decrease delays by nearly 40% by fixing paperwork issues.³⁸ These are a few examples of systems issues causing physician frustration and potential quality issues for the patient.

Work-Life Integration. In urology, specific populations may be more susceptible to burnout. While the proportion of female urologists is on the rise and now at more than 12%, women remain underrepresented in our field compared to the proportion of female patients seeking urologic care. In a recent study investigating work-life integration between male and female urologists, analysis of AUA Census data found that women in urology are more likely to be younger, have young children, and to have a personal partner who is employed. Women in urology are also less likely to have a personal partner who serves as the primary caretaker of family. Overall, urologists with children < 18 years old are 35% less likely to report work-life satisfaction.³⁹ Recognizing opportunities to support urologists with young children, particularly female urologists, is crucial to optimizing work-life integration and mitigating burnout in one’s early career. This is best achieved by individualized discussions and initiatives at the local level as work-life integration is person dependent.

Burnout and Mental Health. Further data potentially affecting delivered quality is found in the 2023 AUA Census where data was collected on coping mechanisms and willingness to seek professional help and reasons/barriers for seeking help. Seventy percent of urologists reported experiencing burnout, with 39% utilizing unhealthy coping mechanisms such as drinking alcohol or eating junk food. Younger urologists aged 34-44 years were more likely to utilize unhealthy coping mechanisms and more likely to seek professional help. Forty-three percent of respondents stated they would seek help if professional services were not included in records for state licensure. Policy changes in state licensure are imperative to protect the health of our current workforce and further destigmatize utilization of mental health resources, particularly for older generations of urologists who are less likely to seek professional counseling.⁴⁰ Further, popularizing programs as those from the Dr. Lorna Breen Heroes’ Foundation and congressional advocacy initiatives such as the Dr. Lorna Breen Act are important to ensure access to mental health treatment without fear of professional reprisals.⁴¹

Artificial Intelligence. A promising tool for burnout mitigation lies in artificial intelligence (AI), though implementation should be approached with caution. While much of the burden of bureaucratic tasks may be alleviated with AI, there is good reason to be thoughtful about how AI is implemented and in what capacity. For instance, with the increased productivity made possible by AI, there may be a push by administrators to increase the patient load for physicians, thus obviating potential burnout mitigation. Moreover, as discussed above, increased computerization and diminished autonomy have previously been shown to exacerbate feelings of physician burnout, and AI threatens not to ameliorate but to enhance these concerns.⁴² This will only serve to make physicians feel less valued, and perhaps may encourage physicians to feel as if their role as a practitioner of medicine is dwindling and being outsourced to AI.⁴³ The overarching concern is that further alienation of the physician-patient relationship and replacing (rather than enhancing) physician work or skill, may only increase burnout. Despite the risks, the potential benefits of AI are wide-ranging and hold much promise in this arena.⁴⁴ While this is a rapidly evolving landscape, AI has clear applications to directly address burnout, perhaps in ways that are yet to be conceived. The main focus of intervention should be thoughtful reduction of administrative burden by serving as digital scribes, automating billing, assisting with patient messages, and reducing burdens of data and system management in clinical practice. Put differently, the primary benefit of AI in medicine lies in systems that re-humanize medicine, restore a sense of fulfilment, and reestablish a sense of purpose and joy in work while reducing work hours and increasing productivity in ways that do not add additional burden. Certainly, a cautious and balanced approach between these potential benefits and risks must be taken to maximize this burgeoning tool for reducing burnout and enhancing joy.

Public Policy & Advocacy. Finally, advocacy for public policy solutions that strengthen and protect the well-being of the urology workforce can help sustain joy in work. The AUA’s federal legislative priorities, which guide the organization’s advocacy efforts and political contributions, include reducing physician burnout and protecting career longevity to ensure workforce stability.⁴⁵ Recent federal efforts include the Dr. Lorna Breen Health Care Provider Protection Act, which was first passed in 2022 and allocated $100 million for mental health and peer-support programs for physicians and healthcare workers. The law also supports burnout reduction, suicide prevention training, and evidence-based awareness campaigns to protect workforce health. State-level legislative successes include a 24/7 confidential mental health support program for physicians in Virginia, qualified immunity provisions for physicians who participate in wellness programs in South Dakota and Indiana, and removal or narrowing of mental-health questions on state medical licensure applications in 21 states to reduce stigma and fear of seeking care. Recent AUA advocacy has also focused on Medicare payment reform to reverse cuts to Medicare physician reimbursement, expansion of federally funded graduate medical education positions to expand the urology residency training pipeline, educational loan repayment incentives for specialty physicians who practice in rural and underserved communities, and deferral of educational loan interest accrual during residency. These efforts aim to ensure economic stabilization of urology practices, encourage urologists to practice where they are most needed, and ensure a healthy pipeline of trainees to preserve and expand the urology workforce. All urologists can be involved in advocacy by participating in the Annual Urology Advocacy Summit, contributing to the AUA Political Action Committee, and supporting AUA advocacy campaigns at federal and state levels.

Ineffective Strategies to Address Burnout. Many, especially institutionally driven, “cures” for physician burnout address resilience. Resilience has been defined as “the personal qualities that enable one to thrive in the face of adversity.”⁴⁶ The focus on physician resilience raises two important questions: Do physicians lack resilience and does improving resilience improve clinician well-being? One large study comparing resilience in physicians vs. non-physicians found that physicians are significantly more resilient than non-physicians. The study also found that higher resilience was associated with lower burnout scores, but that even highly resilient physicians had high burnout scores.⁴⁷ This suggests that improving resilience is beneficial, but not powerful enough to compensate for systems-based problems in healthcare.

The problem with institutional wellness programs focusing on individual strategies for mitigating burnout – such as resiliency training or classes in mindfulness meditation – is they suggest physician burnout is both the fault of, and the problem of, the individual physicians. One study looking at interventions for burnout in urologists found workplace strategies such as stress or burnout seminars and training in mindfulness/meditation were not helpful, but practice improvement strategies such as hiring scribes were effective.³⁰

Addressing burnout in urology is not simply a matter of improving physician resilience and wellness because burnout is a systemic issue that directly impacts the quality, safety, and accessibility of patient care. Reframing the conversation from mitigating burnout via improving physician resilience to promoting joy in work provides a more sustainable path forward. Solutions must prioritize reducing administrative burden, improving workplace efficiency, supporting work-life integration, protecting mental health, and leveraging technology and public policy to restore joy in work in urology practice.

Summary Statements

Physician burnout, particularly among urologists, threatens individual well-being, but also healthcare quality, patient safety, and workforce stability.
Physician burnout contributes to increased medical errors and malpractice claims, reduces patient access to care, and imposes a financial burden on the healthcare system.
Programs that focus solely on individual’s wellness are ineffective at addressing physician burnout. Sustainable solutions must focus on the system’s inefficiencies and organizational culture. Improving joy in work by addressing the “pebbles in the shoe” is a more effective approach to tackling burnout.
AI, quality improvement initiatives, and public policy and advocacy are promising tools to help mitigate burnout within individuals’ practices and across the healthcare system.

Additional Resources

References

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