Letters to the Editor
- Occupational burnout is a highly prevalent manifestation of work-related distress among physicians, with important personal and professional consequences.1 Several recent studies have suggested that professional coaching is one strategy to help individual physicians navigate personal and professional challenges and reduce occupational burnout.2,3 Other studies report that although physicians have higher levels of personal resilience than US workers in other fields,4 they often have perfectionistic tendencies and low self-valuation levels.
- Medicine is a demanding profession with a long and arduous training process. Once physicians complete training, they engage in meaningful and professionally fulfilling work. They also typically work long hours and deal with a number of profession-specific challenges (eg, dealing with medical errors, risk of malpractice suits, frequent exposure to human suffering, and a rigorous maintenance of the certification process). In recent years, a host of regulatory changes and the more widespread use of electronic health records have increased clerical burden and changed the nature of the physician’s workday.
- We appreciate Lawson’s interest in our article1 and his commitment both to scholarly integrity and to inclusivity. However, we feel compelled to correct misconceptions apparent in his reply, as they may be common among the scientific community.
- We appreciate the interest in our articles1,2 calling for systemic action to reduce physician burnout. We also are grateful for the opportunity to respond to the letters from Bianchi and Schonfeld3 and from Schears.4 Following their recent studies reporting overlap between burnout and depression in schoolteachers,5,6 Bianchi and Schonfeld have authored a barrage of correspondence calling for classification of burnout as a depressive condition. Both they and Schears call for clarification of the diagnostic criteria for burnout and imply that burnout cannot be reliably measured.
- The US Department of Health and Human Services projects a shortfall of 45,000 to 90,000 physicians by 2025.1,2 The magnitude of this shortage may be more acute in specialties such as the primary care disciplines and general surgery.1 One underrecognized factor that may influence the supply of physicians is professional burnout. Based on a prospective, longitudinal analysis of burnout and payroll records, we recently reported that higher emotional exhaustion (EE) (a dimension of burnout) is associated with an increased likelihood that physicians will reduce their professional work effort.
- Response bias is a concern with survey studies. We do not know if depressed students are more apathetic and less likely to fill out surveys on QOL and depression or if, on the other hand, they are more likely to complete such surveys because the survey content is more relevant to their circumstances. As pointed out by Drs Khoo and Tan, there may be other factors as well that impede minority students from filling out survey forms. As we pointed out in the discussion, minority students may feel that their anonymity is threatened because there are few minority students like them.
- In reply: We agree, in general, with Dr Mikhail's comments. The results of the Women's Health Initiative led to the conclusion that long-term HRT should not be recom mended for women at this time because of the increased risk of strokes, cardiovascular disease, venous thromboembolic disease, and breast cancer.1 As noted in our article, the Women's Health Initiative investigators specified that the trial did not address the short-term risks and benefits of hormones given for the treatment of menopausal symptoms.