Reply to “Burnout in Program Directors: We Still Need More Answers”

We appreciate the thoughtful letter by Dr Kendall in response to our study examining burnout and resiliency in family medicine program directors.¹ We agree burnout and resiliency are very important topics in graduate medical education and overall physician practice.

As with our study, many evaluations of burnout focused on emotional exhaustion and depersonalization as the foundation of burnout among medical professionals.^2-4 The study referenced by Dr Kendall found a lower rate of personal accomplishments in studies of surgeons experiencing burnout compared to emotional exhaustion and depersonalization.⁵ In review of this paper, we did not interpret the results in the same manner as Dr Kendall, as we did not find a result or conclusion that personal accomplishment was protective against burnout in the professionals studied. Further, burnout is defined as a high rate of response in any of the three areas (emotional exhaustion, depersonalization, or personal accomplishment) and we believe this meta-analysis found a low rate in this one area.

Dr Kendall also noted our response rate and expressed concerns about response bias. For our study, the characteristics of nonrespondents were not available. In review of the literature examining burnout in physicians, response rates vary from 19.2% to 75% in studies we cited.^6-8 This marked variation in response rates does raise concerns in numerous studies addressing the prevalence of physician burnout as a response bias may be affecting the results. For instance, a widely cited study by Shanafelt distributed 89,831 email invitations for physician participation, had 27,276 physicians open at least one invitation email, and had 7,288 physicians complete the survey.6 While the reported response rate was 26.7%, one could argue for a much lower rate of response (8.1%). This issue is significant if the true prevalence of physician burnout is to be known.

Finally, our study noted that program characteristics were not associated with program director burnout. We did not study job or personal characteristics of burnout. Including these variables in future studies may be interesting and useful.