On-call work is an integral part of urological practice in the United Kingdom, yet its effects on urologists’ lifestyles, well-being and stress remain underexplored. Identifying factors that contribute to this stress may help prolong careers and improve professional quality of life.
Materials and Methods:
An anonymised online survey of BAUS members assessed the impact of out-of-hours duties on lifestyle, well-being and stress. Variables included age, gender, hospital type, clinical experience, rota design and call frequency between midnight and 8 a.m. Lifestyle and well-being were measured using linear evaluation scales, while stress was assessed with a validated perceived stress scoring system.
Results:
Complete responses were obtained from 132 mid-grade urologists and 289 consultants engaged in on-call rotas. Overall, out-of-hours work moderately impaired quality of life. Lifestyle disruption increased with consultant age, whereas younger and less experienced colleagues reported higher stress, particularly related to childcare responsibilities and sleep deprivation.
Conclusion:
Although the impact of on-call work on UK urologists appears less severe than for other medical specialties, significant challenges persist. Ageing, childcare demands and sleep deprivation remain key stressors associated with out-of-hours activity, underscoring the need for strategies to support well-being across career stages.
PayneSR.Provision of on-call urology services in the UK: A national survey of current practice. J Clin Urol2025 (published online ahead of print). https://doi.org/10.1177/20514158251379761
2.
NicolAMBotterillJS.On-call work and health: A review. Environ Health2004; 3(1): 15.
3.
CooperCLRoutUFaragherB.Mental health, job satisfaction, and job stress among general practitioners. BMJ1989; 298: 366–370.
4.
SutherlandVJCooperCL.Job stress, satisfaction and mental health among general practitioners before and after introduction of new contract. BMJ1999; 304: 1545–1548.
5.
ReidNMossPJ.The impact of the new deal: Doctors’ stress levels and their views. Stress Med1999; 15: 9–15.
6.
SibbaldBEnzerICooperC, et al. GP job satisfaction in 1990 and 1998: lessons for the future?Fam Pract2000; 17: 364–371.
7.
RoutU.Stress among general practitioners their spouses: a qualitative study. Br J Gen Pract1996; 46: 157–160.
8.
BrownMTuckerPRapportF, et al. The impact of shift patterns on junior doctors’ perceptions of fatigue, training, work/life balance and the role of social support. Qual Safety Health Care2010; 19: e36.
9.
BalchCMShanafeltTDDyrbyeL, et al. Surgeon distress as calibrated by hours worked and nights on call. J Am Coll Surg2010; 211(5): 609–619.
10.
TattersallAJBennettPPughS.Stress and coping in hospital doctors. Stress Med1999; 15(2): 109–113.
11.
LeBlancVR.The effects of acute stress on performance: implications for health professions education. Acad Med2009; 84(10 Suppl.): S25–S33.
12.
RinkLCOyesanyaTOAdairKC, et al. Stressors among healthcare workers: A summative content analysis. Glob Qual Nurs Res2023; 10: 23333936231161127.
13.
BrahmeAKakulteA.Sources and coping mechanisms of anxiety and stress among surgeons – A qualitative study. Mind Soc2022; 11(1): 23–31.
14.
PayneSRKaneAThomasK, et al. Stress among UK consultant urologists and factors influencing when they leave full-time NHS practice. J Clin Urol2023; 18(3): 221–230.
15.
DyrbyeLNBurkeSEHardemanRR, et al. Association of clinical specialty with symptoms of burnout and career choice regret among US resident physicians. JAMA2018; 320(11): 1114–1130.
16.
PanagiotiMGeraghtyKJohnsonJ, et al. Association between physician burnout and patient safety, professionalism, and patient satisfaction: A systematic review and meta-analysis. JAMA Intern Med2018; 178(10): 1317–1331.
17.
O’KellyFManeckshaRPQuinlanDM, et al. Rates of self-reported ‘burnout’ and causative factors amongst urologists in Ireland and the UK: A comparative cross-sectional study. BJU Int2016; 117(2): 363–372.
18.
Franc-GuimondJMcneilBSchlossbergSM, et al. Urologist burnout: Frequency, causes, and potential solutions to an unspoken entity. Can Urol Assoc J2018; 12(4): 137–142.
19.
PercyDBStreithLWongH.Mental toughness in surgeons: Is there room for improvement?Can J Surg2019; 62(6): 482–487.
20.
SuhCPunnettL.High emotional demands at work and poor mental health in client-facing workers. Int J Environ Res Public Health2022; 19(12): 7530.
21.
HuYYFixMLHeveloneND, et al. Surgeons’ emotional responses to adverse events: a qualitative study. JAMA Surg2012; 147(12): 1126–1132.
22.
BumpsteadHKovacKFergusonSA, et al. How should we manage fatigue in on-call workers? A review of guidance materials and a systematic review of the evidence-base. Sleep Med Rev2025; 79: 102012.
23.
SonnentagSZijlstraFR.Job characteristics and off-job activities as predictors of need for recovery, well-being, and fatigue. J Appl Psychol2006; 91(2): 330–350.
24.
WilliamsSMichieSPattaniS.Improving the Health of the NHS Workforce: Report of the Partnership on the Health of the NHS Workforce. Nuffield Trust1998.
25.
Provision of On-Call Urology Services in the UK: Teamworking confidence in providing an emergency service. J Clin Urol2025 (published online ahead of print). https://doi.org/10.1177/20514158251379775
26.
MizrahiT.Managing medical mistakes: ideology, insularity and accountability among internists-in-training. Soc Sci Med1984; 19(2): 135–146.
27.
ZiebertzCMvan HooffMLBeckersDG, et al. The relationship of on-call work with fatigue, work-home interference, and perceived performance difficulties. Biomed Res Int2015; 2015: 643413.
28.
CharlesSCWilbertJRFrankeKJ.Sued and non-sued physicians’ self-reported reactions to malpractice litigation. Am J Psychiatry1985; 142(4): 437–440.
29.
SloanFAMergenhagenPMBurfieldWB, et al. Effects of medical malpractice on physicians: a review of the evidence. J Health Polit Policy Law1989; 14(3): 591–606.
30.
CohenSKamarckTMermelsteinR.A global measure of perceived stress. J Health Soc Behav1983; 24(4): 385–396.
KodzJDavisSLainD, et al. Working long hours: a review of the evidence. Volume 1–main report. Employment Relations Research Series2003; 16: 1–260.
33.
SatoKKurodaSOwanH.Mental health effects of long work hours, night and weekend work, and short rest periods. Soc Sci Med2020; 246: 112774.
34.
ShanafeltTDHasanODyrbyeLN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clinic Proceedings2015; 90(12): 1600–1613.
SmithLJeppesenHJBøggildH.Internal locus of control and choice in health service shift workers. Ergonomics2007; 50(9): 1485–1502.
38.
SaksvikIBBjorvatnBHetlandH, et al. Individual differences in tolerance to shift work–a systematic review. Sleep Med Rev2011; 15(4): 221–235.
39.
KunzeFBoehmSBruchH.Age, resistance to change, and job performance. J Manag Psychol2013; 28(7/8): 741–760.
40.
HarrisECD’AngeloSSyddallHE, et al. Relationships between informal caregiving, health and work in the Health and Employment After Fifty study, England. Europ J Public Health2020; 30(4): 799–806.
ColemanJJRobinsonCKvon HippelW, et al. Home is not always where the sleep is: the effect of home call on sleep, burnout, and surgeon well-being. J Am Coll Surg2024; 238(4): 417–422.
47.
MalmbergBKecklundGKarlsonB, et al. Sleep and recovery in physicians on night call: a longitudinal field study. BMC Health Services Research2010; 10(1): 239.
48.
GanderPHMerryAMillarMM, et al. Hours of work and fatigue-related error: a survey of New Zealand anaesthetists. Anaesth Intensive Care2000; 28(2): 178–183.
49.
HowardSK.Sleep deprivation and physician performance: why should I care. Proc (Bayl Univ Med Cent)2005; 18(2): 108–112; discussion112.
50.
MeerloPSgoifoASucheckiD.Restricted and disrupted sleep: effects on autonomic function, neuroendocrine stress systems and stress responsivity. Sleep Med Rev2008; 12(3): 197–210.
51.
NolletMWisdenWFranksNP.Sleep deprivation and stress: a reciprocal relationship. Interface Focus2020; 10(3): 20190092.
52.
BalendranBBathMFAwopetuAI, et al. Burnout within UK surgical specialties: a systematic review. Ann R Coll Surg Engl2021; 103(7): 464–470.
53.
WhitakerM.The surgical personality: does it exist?Ann R Coll Surg Engl2018; Jan100(1): 72–77.
PepperJRCoonarAS.High-risk surgery: the courage to fail. J R Soc Med2015; 108(2): 44–46.
56.
OsterAWikingENilssonGH, et al. Patients’ expectations of primary health care from both patients’ and physicians’ perspectives: a questionnaire study with a qualitative approach. BMC Prim Care2024; 25(1): 128.
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