Re: Burnout in Young Family Physicians: Variation Across States

I read with great interest the article of Hansen et al¹ in a recent issue of the journal. The authors performed a cross-sectional study to determine the rates of emotional exhaustion and depersonalization and symptoms of burnout in family physicians 3 years out of training. They report high rates of burnout, with considerable variation between states. The authors should be congratulated for performing a study in an important topic in medical practice.^2,3 Moreover, the need to identify specific geographical locations associated with high burnout rates in physicians is an innovative concept that needs to be further explored.^4,5

Although the study of Hansen et al¹ was well conducted, there are some questions regarding the study that need to be clarified. The authors have chosen to exclude the personal accomplishment components of the Maslach burnout survey. The personal accomplishment assessment has been shown to be protective against burnout among high-achiever professionals. In addition, several confounding factors associated with burnout (eg, control over professional life, working hours) were not investigated by the authors and could confound the variance observed by the authors across states. Lastly, it would be important to evaluate response bias particularly in states with less than 60% response rate to determine the generalizability of the study results.

I would welcome some comments to address the aforementioned issues, as they were not discussed by the authors. This would further support the findings of this important study.