In Reply We agree with Gregory and Menser that interventions in any research field should be grounded in an understanding of the causes of the outcomes in question. A number of contributors to burnout and physician distress in general have been proposed in the literature, including workload as noted by Gregory and Menser in their letter. Additional contributors cited in the literature include inadequate work support, work inefficiency, loss of workplace autonomy, challenges to work-life balance, and loss of meaning in work.1- 3 Based on this understanding of proposed factors contributing to burnout, our intervention was designed to promote meaning in work and improve work support by encouraging collegiality among participants as they engaged in the structured facilitated small-group curriculum. In addition, the time to participate in our study was institutionally provided rather than further taxing personal time, so these domains could be addressed without a cost to work-life balance. We certainly endorse the need for future studies to similarly base their designs on intentionally targeted contributors to burnout, and we support further efforts to more fully understand the causal pathways leading to burnout.
West CP, Dyrbye LN, Shanafelt TD. Improving Physician Well-Being—Reply. JAMA Intern Med. 2015;175(4):649-650. doi:10.1001/jamainternmed.2014.7865