Letters to the Editor
To the Editor:
We read the recent report, “Burnout in Medical School Deans: An Uncommon Problem” by Gabbe et al1 with great interest. We appreciated the very clear presentation of burnout data, but we believe the conclusions drawn from those data are incorrect.
The authors concluded that, according to their criteria, only 2% of medical school deans exhibited high levels of burnout. Their criteria required high levels of burnout in all three domains of the Maslach Burnout Inventory (MBI): depersonalization, emotional exhaustion, and low personal accomplishment. However, the MBI manual2 does not report any validity evidence on a single “high burnout” outcome but rather reports correlations with high burnout in each subscale separately. This means that to define high burnout, each subscale must be considered separately. Although an alternative definition requiring a high subscore in emotional exhaustion or depersonalization has been suggested as indicative of clinically significant burnout and has been widely used,3 we were unable to find support in the literature for a summative definition of burnout requiring high burnout in all three MBI subscales.
From the authors’ Figure 2, 24% of medical school deans exhibited high depersonalization, 40% high emotional exhaustion, and 18% low personal accomplishment. These individual high burnout rates are similar to those reported elsewhere in the literature among medical students and physicians.3 A total of 56% of responding deans exhibited high burnout on at least one subscale, and 47% had either high emotional exhaustion or depersonalization, providing a vastly different interpretation of the frequency of burnout than the 2% suggested by the authors. In summary, then, we conclude that high levels of burnout are actually very common among medical school deans. This adds to the existing body of evidence pointing to burnout as prevalent at all stages of medical careers.
Colin P. West, MD, PhD
Assistant professor of medicine and biostatistics, Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota; (firstname.lastname@example.org).
Liselotte N. Dyrbye, MD
Assistant professor of medicine, Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Tait D. Shanafelt, MD
Assistant professor of medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota.
1Gabbe SG, Webb LE, Moore DE, Harrell FE Jr, Spickard WA Jr, Powell R Jr. Burnout in medical school deans: An uncommon problem. Acad Med. 2008;83:476–482.
2Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. 3rd ed. Palo Alto, Calif: Consulting Psychologists Press; 1996.
3Thomas NK. Resident burnout. JAMA. 2004;292:2880–2889.