Beating Burnout: Tips

15 Jan 2024

By Dra. Elizabeth Perazza Valentin, FACS

Simplicity is the ultimate sophistication- Leonardo Da Vinci

Greetings esteemed colleagues: 

Surgeons have long experienced a culture of silence when it comes to their personal pain. We have a reputation as stoic, determined, and driven. What can we do to prevent burnout and more importantly if we have suffered it what do we do to recover? How do we heal?

In a field where we dedicate ourselves to caring for others, it’s easy to overlook our own needs. Over the next few moments, I invite you to explore a series of transformative tips designed not only to manage burnout but to invigorate our commitment to exceptional patient care and personal fulfillment. Let’s embark on this journey together, discovering how we can cultivate resilience, restore balance and ultimately enhance the quality of both our professional  lives. Welcome to our discussion that I believe will resonate deeply with each one of us.

Burnout, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, Maslach 20013.It’s not just a personal challenge but a systemic concern. Its relevance extends beyond individual lives, affecting patient care, healthcare systems, and overall quality.

To understand burnout, we need to review the definition as established by psychologist Dr. Maslach in 2001.3 

 Burnout is characterized by 3 dimensions: emotional exhaustion, depersonalization, and reduced personal accomplishment.

1.Exhaustion: this dimension involves feelings of extreme fatigue, both physically and emotionally. Individuals experiencing burnout may find themselves drained, lacking the energy to meet the demands of their work and daily life.

2.Depersonalization is marked by a sense of detachment and cynicism towards others, particularly towards those whom individuals are meant to serve, such as patients or clients. As example is when we name an “elevated PSA” instead of referring to “Mr. Rivera” who will be evaluated for an elevated PSA.

3.Reduced personal accomplishment in this dimension, individuals experiencing burnout perceive a decline in their sense of competence and achievement. They may struggle to see the positive impact of their work and feel a diminished sense of accomplishment.

These alarming numbers were published in the magazine Galenus for the month of August.4 In Puerto Rico, 48% percent of active doctors are exhausted. We must remember the impact of Hurricane María in 2017, followed by earthquakes in the south of the island and three years of pandemic since 2020.

Of this 48% of our colleagues reporting exhaustion :

  1. 26% have clinical depression
  2. 37% present clinical anxiety
  3. 9.4% have considered suicide

When asked about the primary workplace dissatisfier, 29% of urologists chose EHR- the extensive documentation required for each evaluation and management encounter, followed by 17% stating not having enough time for personal/family life, 14% experiencing decreasing reimbursements, and 12% identifying issues with office staffing and complicated requirements. In my experience, I would add receiving nonconstructive feedback from an anonymous source. In other words, workplace gossip could be a contributor to burnout.

The American Urological Association workforce work group has analyzed the annual AUA census data over the past several years. 

Published1 results in March of this year shows that:

Burnout in men decreased from 36.3% to 35.2%, but increased in women from 35.3% to 49.2%. Overall, urologists have higher burnout now when compared to 2016. The gender discrepancy has vastly widened with women experiencing burnout at an increased rate of 14% compared to 2016, while burnout in men decreased by 1%. 

Surpassing the Leviathan

Stress is a perceived threat to the status quo.  Ultimately, stress boils down to your perception of your degree of control. If you believe you have a high degree of control, your stress level will be low. Conversely, if you see life as happening to you without much control, your stress level will be high, as every little thing becomes a potential threat.

It’s noteworthy that job stress alone doesn’t cause burnout, as concluded in the article “The relationship between job stress, burnout, and clinical depression”.2 Despite this conclusion in a peer reviewed journal, the dictionary definition of burnout still includes physical or mental collapse caused by overwork or stress.

These are some of the strategies that we can adopt at an individual level. It’s important to recognize that organizational factors, including high workloads, extended working hours, and time-consuming administrative tasks, are frequently cited as significant contributors to burnout. 

Personally, I have been able to integrate the empathic listening skill into my work time. For example, I can understand as a mother of four now adults, how difficult it was to wait in the doctor’s waiting room when I had to take the children to a sport or ballet practice. Integrating empathic listening has allowed me to increase my social connection that prevents feelings of burnout.

Recognizing the critical importance of maintaining our well-being, surgeons can proactively integrate preventive measures into their daily routines. One key aspect is maintaining a healthy work life balance, allowing time for personal pursuits and relaxation. Equally essential is setting clear boundaries between work and personal life, enabling us to recharge and rejuvenate.

Furthermore, effective task prioritization helps us tackle demanding schedules with greater efficiency, minimizing unnecessary stress. As we navigate the challenges of our profession, embracing these preventive strategies empowers us to not only to enhance our own resilience but also elevate the quality of care we provide our patients.

Fostering a positive and supportive work environment it’s not just a feel-good sentiment but a strategic imperative. When colleagues and leaders collaborate to create an atmosphere of respect, open communication, and empathy, the benefits are manifold. Team members thrive in such an environment, experiencing job satisfaction, improved mental well-being, and a greater sense of belonging. This in turn contributes to higher levels of productivity, enhance patient care and lower turnover rates. By prioritizing the cultivation of a supportive workplace, we invest in the overall health of our team, allowing us to collectively tackle challenges and seize opportunities with greater resilience and enthusiasm. 

By concentrating on preventing and recovering from burnout across all these areas, organizations and individuals can create a more supportive environment that positively impacts productivity and overall satisfaction. 

As surgeons we get to be the leader of our teams most of the time and I encourage you to lead by example.


Dra. Elizabeth Perazza

Assistant Chief of Surgery


Urologic Surgeon


  1. Burnout: A Call to Action From the AUA Workforce Workgroup. Letter. J Urol. 2023;209(3):573-579
  2. Maslach, Christina, Wilmar B. Schaufeli, Michael P. Leiter(2001). Job Burnout. Annu. Rev. Psychol. 52:397–422 , 2001  by Annual Reviews.
  3. Maslach, C.; Jackson, S.; Leiter, M. Maslach Burnout Inventory, 4th ed.; Mind Garden: Menlo Park, CA, USA, 2018; pp. 10–74 
  4. Ortiz Rodríguez , J. A. (n.d.). SÍNDROME de desgaste profesional. Galenus , REVISTA PARA LOS MÉDICOS DE PUERTO RICO

I have been the Assistant Chief of Surgery @ the Veterans Administration Caribbean Healthcare System since 2018.

Staff Urologist with a practice in general urology since 2001.  Have led the implementation of prostate laser, and minimally invasive techniques to manage patients with enlarged prostate since 2010 until present.

Assistant Professor of Urology  Ad Honorem of the Puerto Rico School of Medicines, Universidad Central del Caribe, San Juan Bautista and Ponce Health Science.

Principal Investigator in Prostate cancer Prostatak protocol @ our Facility.

Presented this conference Beating Burnout : Tips at the PR Urological Association last October 2023.

Currently I also lead the initiative Mentoring the Future Puertorrican Surgeon, an initiative promoted by the PR Chapter of the American College of Surgeons designed to mentor our medical students interested in surgical careers.

I have been married to Dr. De Leon ( ENT Surgeon), mother of four children that are preparing one to become Ob -GYn, another in Masters of Health Administration and twins , one pursuing Psychology and the other general science.

Hope this material is of benefit to everyone who has been “burned out “ , as I was from 2008-2016.

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