Editorial Comment

Abstract

I commend Drs. Marchalik et al on their manuscript and work to help define contributors and mitigators to burnout among urology trainees. Their findings are consistent with a similar study by Elmore et al (2014) that demonstrated a 69% rate of burnout among general surgery trainees. 1 Elmore LC Jeffe DB Jin L et al. National survey of burnout among US general surgery residents. J Am Coll Surg. 2016; 223: 440-450 Abstract Full Text Full Text PDF PubMed Scopus (258) Google Scholar It is both curious and worrisome that rates of burnout are consistently this high, despite ACGME efforts to reduce resident work hours, improve learning: service ratios, and build programmatic supports into our training programs. Why is this so alarming? Burnout has been consistently linked to medical errors, suicidal ideation and attempts, and substance abuse and thus poses a great risk to our patients and our trainees. 2 Shanafelt TD Balch CM Dyrbye LN et al. Special report: suicidal ideation among American surgeons. Arch Surg. 2011; 146: 54-62 Crossref PubMed Scopus (509) Google Scholar , 3 Balch CM Oreskovich MR Dyrbye LN et al. Personal consequences of malpractice lawsuits on American surgeons. J Am Coll Surg. 2011; 213: 657-667 Abstract Full Text Full Text PDF PubMed Scopus (173) Google Scholar , 4 Fridner A Belkic K Minucci D et al. Work environment and recent suicidal thoughts among male university hospital physicians in Sweden and Italy: the health and organization among university hospital physicians in Europe (HOUPE) study. Gend Med. 2011; 8: 269-279 Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar , 5 Oreskovich MR Shanafelt T Dyrbye LN et al. The prevalence of substance use disorders in American physicians. Am J Addict. 2015; 24: 30-38 Crossref PubMed Scopus (193) Google Scholar In a review of the role of healthcare leadership on physician burnout, Shanafelt and Noseworthy 6 Shanafelt TD Noseworthy JH Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc. 2017; 92: 129-146 Abstract Full Text Full Text PDF PubMed Scopus (756) Google Scholar point out that the burden of prevention or treatment for burnout is often placed on the individual, with interventions like stress-reduction activities and coaching. However, in reality an integrated approach that focuses on treatment and prevention at all levels (individual, work unit, organization, National) is more effective. Two organizational programs noted here—access to mental health and structured mentoring programs—were shown to be important to reducing burnout. All trainees should have access to mental health treatments and be provided confidential opportunities to seek care. We need to work hard to reduce the stigma and shame surrounding mental health treatment by normalizing mental health as a part of self-care. Structured mentoring programs mitigated burnout in both this study and in the Elmore study. In an era of ever-increasing pressures for clinical productivity on faculty, demonstrating the value of faculty participation in mentoring and finding ways to protect these programs will be critical. In addition to programmatic supports like mentoring and mental health, the most important thing faculty can do is role model the primacy of self-care, seek meaning in joy in work, and build collegiality and community at work so that our future doctors can learn and hone their own resiliency skills.