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].