Urology residency – a demographic cross‐sectional study by the Swiss Society of Residents in Urology

The working conditions for residents in Switzerland have garnered increasing scrutiny in recent years. A 2023 survey of 4500 residents in Switzerland shed light on the demanding schedules many endure, with a significant number working beyond the legally permitted 50-h workweek [1, 2]. Among residents, this issue is particularly acute, contributing to ~10% of Swiss doctors leaving the profession, with half departing within just a few years of graduation [3]. Changing social expectations, notably among Generation Y and Z, alongside a growing number of female doctors balancing work and childcare responsibilities, have intensified the call for more flexible and sustainable working models. Simultaneously, Switzerland faces a growing demand for medical specialists, projected to rise by 16–32% by 2032, a trend exacerbated by the anticipated retirement of 25% of currently active doctors within the next 5 years [4]. Addressing these challenges will require not only retaining more young doctors but also ensuring that training programmes meet their needs and aspirations. Becoming a urology specialist in Switzerland involves a 6-year programme. It includes a standard 50-h workweek, including 8 h allocated for training activities such as structured educational sessions, multidisciplinary meetings, and surgical training to meet procedural quotas. Certification requires evidence of conference participation, publication authorship, and successful completion of a surgical catalogue. Following certification, residents may choose further subspecialisation in fields like operative urology, neuro-urology, or female urology. This study, initiated by the Swiss Residents in Urology (SRU) association, provides a comprehensive evaluation of urology residents’ experiences in 2023. By identifying key challenges and proposing actionable solutions, it aims to help shape the future of Swiss urological training. A cross-sectional web-based survey was designed and distributed via Google Forms (Google LCC, Mountain View, CA, USA). The survey was available in German, French, and Italian—ensuring inclusivity. The finalized survey comprised 64 questions spanning eight domains, including demographic data, education, work–life balance, research engagement, and future career aspirations (Appendix S1: Questionnaire). The target group comprised urology residents in programmes accredited by the Swiss Institute of Medical Education (SIWF/ISFM). Invitations were sent via e-mail, with additional outreach through social media platforms and the SRU website. The survey period ran from April to May 2023, with incomplete responses excluded from analysis. Data were analysed using the Statistical Package for the Social Sciences (SPSS), version 28 (IBM Corp., Armonk, NY, USA). Categorical variables were expressed as percentages, while continuous variables were reported as means, medians, and interquartile ranges (IQRs). Pearson's chi-square and Mann–Whitney U tests were used to compare baseline characteristics, with significance set at P < 0.05. Participant Demographics: of 147 eligible residents, 63 completed the survey, yielding a 43% response rate. Most participants (95%) were employed in public hospitals, with 84% completing the survey in German. Respondents’ median (IQR) age was 30 (29–33) years, and their median (IQR) postgraduate year was 4 (3–6). Males comprised 65% of participants, while females accounted for 35%. A total of 16% reported having children or living in a household with children (Table 1). Educational Opportunities: training quality was mixed. While 57% of residents had access to mentoring programmes, a notable 36% reported no access at all. Although 79% deemed conference participation essential for their development, only 40% could attend conferences during work hours. Of the remainder, some had to use personal time, and only 60% received full financial coverage for attendance. Mandatory weekly training, set at 4 h of structured education, was rarely met. Only 22% of respondents reported receiving the full amount, while 71% received <2 h. Informal training predominated, accounting for 56% of the total training time, whereas structured educational sessions were reported by 42% of respondents. Surgical Training Gaps: surgical training, a cornerstone of urology education, revealed significant shortcomings in its current implementation. While the Swiss surgical catalogue establishes minimum quotas for various procedures, 65% of residents found these requirements to be outdated and insufficiently aligned with contemporary practice. On average, residents reported a median (IQR) monthly exposure of 15 (10–20) cases, which often proved inadequate to meet the established quotas in several critical areas. For instance, 66% of trainees struggled to fulfil the requirements for urethral procedures, while 43% faced difficulties with transurethral bladder or prostate resections, and 36% encountered challenges in achieving sufficient experience with retroperitoneal surgeries. Despite these obstacles, 57% of residents expressed overall satisfaction with their surgical training experiences. Work–Life Balance/Working Conditions: work–life balance remains a pressing concern, with 54% of residents dissatisfied. The median workweek spanned 60 h, well above the official 50-h limit. Moreover, 22% reported receiving no compensation for overtime hours worked. Nearly half (49%) of residents are supported by Advanced Nurse Practitioners, which reduces their average working hours to 56 h compared to 59 h for those without support (P = 0.13). However, 24% remain dissatisfied with their working conditions, citing time-consuming documentation (40%), direct patient care (34%), and administrative tasks as the main contributors. Alarmingly, 32% of respondents stated they would not choose medicine as their profession again if given the chance, and 6% would not choose urology as their specialty. Nevertheless, 62% expressed satisfaction with their chosen field. While 91% worked full-time, 63% expressed interest in transitioning to part-time roles, with an 80% workload emerging as a preferred model for post-certification employment, without a significant difference between male and female residents. Economic Pressures on Clinical Decisions: a notable 17.5% reported daily pressure to adjust clinical decisions based on financial considerations. Similarly, 42.9% felt economic constraints impacted discharge timings. These pressures also affected training, with 63.5% of residents citing reduced teaching time in the operating theatre and insufficient financial support for educational projects as key challenges. Research Involvement: while 48% of respondents engaged in research, dedicating a median of 4 h weekly, 70% expressed dissatisfaction with available opportunities. Barriers included insufficient time (97%), lack of supervisor support (32%), and bureaucratic challenges (23%). Despite these challenges, 30% of residents aspired to pursue academic careers. Career Aspirations: operative urology emerged as the most popular subspecialisation, with 62% of respondents expressing it as their intended career path. In contrast, interest in neuro-urology (2%) and female urology (1%) was notably low. Regarding career preferences after specialisation, 41% favoured roles in regional hospitals, while 25% preferred private practice. Only 11% expressed interest in employment at a university hospital, with a small minority considering careers in the industry (3%) or indicating other/unspecified preferences (3%). This study offers a comprehensive snapshot of the state of urology training in Switzerland, highlighting both strengths and areas for improvement. The survey achieved a 43% response rate, higher than previous studies such as the European Urology Residents Education Programme (EUREP) 2013 (29%) and German Society of Residents in Urology (GeSRU) 2020 (19%) [5, 6]. Most respondents were male, working in public hospitals, and predominantly from the German-speaking region. There was no representation from the Italian-speaking region, which at the time lacked a SIWF-certified training centre, and only 11% of responses came from the French-speaking region, highlighting potential recruitment challenges. Regarding education, 57% of respondents participated in structured mentoring programmes, which are linked to reduced burnout [4] However, only 22% met the mandatory 8-h weekly education requirement, with 71% receiving <2 h of structured education weekly. A significant number of residents engage in informal training discussions, and 65% expressed dissatisfaction with the surgical training curriculum. The median number of surgeries performed of 15/month was higher than the European average of 8.5/month, as reported in Germany in 2021 [5]. Moreover, 61% of residents expressed interest in specialising in operative urology, suggesting a growing interest in advanced surgical techniques. Work–life balance and resident satisfaction were key concerns, with 54% dissatisfied with their balance and 50% considered leaving medicine at least once. These issues, alongside the fact that only 22% of residents are willing to work full-time, may affect the future supply of urologists, especially given the ageing population and upcoming retirements. The median workweek was 60 h, which could negatively impact work–life balance and patient care [7]. Contrary to an often-made argument, reducing working hours to 48 h/week has not been shown to decrease the number of procedures performed by residents [6]. Economic pressures were a significant challenge. In all, 17.5% of residents reported that economic factors influenced their clinical decisions, and 63.5% stated that financial constraints negatively impacted surgical training. These findings emphasise the need for strategies to mitigate the impact of rising healthcare costs on training conditions. Finally, 45% of residents expressed interest in a research career, but lack of time and supervisor support remain barriers, as was the case 20 years ago [8]. While this study only focused on residents’ perspectives, future research should compare these with those of tutors and consider the growing role of virtual platforms in education [9, 10]. The limitations of this study, including selection and recall bias, should be considered when interpreting the results. The findings highlight key areas for improvement in Swiss urology training, including mentorship, surgical requirements, work–life balance, and economic challenges. Addressing these issues might be crucial for retaining talent and ensuring high-quality patient care as demand for urologists is considered to increase in the near future. All authors declare that they have no conflicts of interest. Appendix S1. Questionnaire: cross-sectional study among residents in Urology 2023. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. 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