My coauthor and I thank Dr. Khan for his thoughtful response to our commentary. Finding meaning in medicine is an approach to reducing burnout that we believe holds great promise, but it is certainly not the only one. Dr. Khan rightly points out that loss of autonomy is a likely driver of physician burnout, and trying to address it through the interventions that he outlines makes great sense.
Other potential targets for reduction of stress and burnout also exist that have been outlined and examined in work by Leiter and Maslach.1 These researchers have identified six main drivers of burnout: (1) workload: not just the amount of work but also the nature of it; (2) control: how much control one has in one’s work environment (i.e., autonomy) and transparency of decision making; (3) rewards: not just financial but, rather, ensuring that employees feel appreciated for their work; (4) community: a sense of belonging in the organization; (5) fairness: whether employees feel like people are treated fairly and equitably; and (6) values: whether the organization lives up to the values that it espouses.
It appears that many organizations are trying to reduce burnout largely through wellness programs focused on individual coping skills. These programs are to be applauded, but they alone are not enough. Leaders must also work to address the root causes that exist in the clinical work environment, including loss of autonomy, rather than simply relying on programs designed to remedy some perceived weakness or deficiency in individual physicians.
Stuart J. Slavin, MD, MEd
Associate dean for curriculum and professor of pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri; [email protected]
1. Leiter MP, Maslach C. Perrewé PL, Ganster DC. Areas of worklife: A structured approach to organizational predictors of job burnout. In: Emotional and Physiological Processes and Positive Intervention Strategies. 2003.Bingley, UK: Emerald Group Publishing Limited.