The Hidden Struggle
Burnout is often a hidden struggle or a concealed challenge because people may not recognize that they are experiencing it and may not feel comfortable speaking up about their symptoms. Burnout can build up slowly over time as people experience chronic stress, high levels of work demands, long hours, poor work-life balance and lack of support from colleagues and supervisors [3,4]. People who are experiencing burnout may feel ashamed or embarrassed to admit it, thinking that it is a sign of weakness or a failure on their part. Additionally, there may be stigma attached to mental health issues in the workplace that prevent people from seeking help or disclosure of their struggles [3].
According to a study by Kiehl et al, burnout rates among urology residents are higher than those in other medical specialties, with a prevalence of around 58%. The study also indicates that these rates may continue to increase [3,4]. A systematic review and meta-analysis by Avery et al, found that urology residents experience high levels of burnout, which can go unnoticed and lead to negative outcomes for both the resident and patient care [4,5,6].
Moreover, the pressure to appear competent and productive at work can make it challenging for individuals to speak out about burnout, as they may fear it could affect their job security or reputation. All these factors can contribute to burnout being a hidden struggle, with many individuals suffering in silence [3,4,5,7].
It is important to recognize that burnout can be hidden in many ways. A study conducted by Demerouti et al, as well as another one carried out by Bordin et al, highlight the concept of ”masking” as a mechanism used by people to conceal their burnout symptoms. This creates a discrepancy between the level of burnout they experience and how others perceive it. To cope with this struggle, affected professionals often put on a ”professional mask” and portray a facade of coping and well-being [8,9]. Furthermore, the study by Bordin et al delves into withdrawal behaviors, such as emotional distancing or reduced participation, as tools individuals use to deal with burnout [8]. The article also discusses how burnout can lead to absenteeism and disengagement, which are commonly seen as causes for decreased job performance and increased turnover intentions. Absenteeism is often misunderstood as laziness, rather than a symptom of a larger issue, while disengagement can result in mistakes, lack of motivation, and poor performance, sometimes misinterpreted as a lack of ambition or dedication [8]. Burnout can also manifest itself in physical symptoms such as headaches, stomachaches, and exhaustion, which can be attributed to other causes, making the underlying burnout difficult to detect [10].
A systematic review conducted by Dyrbye et al. revealed that physicians and advanced practice clinicians frequently conceal their burnout by resorting to certain behaviors. These behaviors may include avoiding situations, distancing themselves from colleagues, or exerting extra efforts to mask their distress. Furthermore, they may also attempt to hide their burnout by self-medicating with drugs or alcohol [11].