To the Editor I read with great interest the article of Porter et al in a recent issue of the journal.1 The authors performed a cross-sectional study to examine burnout and resiliency among family medicine residency directors and concluded that levels of emotional exhaustion, depersonalization, and resiliency are significantly related to personal characteristics of program directors rather than characteristics of their program. The authors should be congratulated for performing a well-designed study on an important topic in graduate medical education and overall physician practice.2,3 Moreover, the need to identify specific areas for potential interventions is an innovative concept that needs to be further explored.4,5 Although the study was well conducted, there are some aspectes that need to be clarified by the authors. First, the authors have excluded the personal accomplishment component of the Maslach Burnout Inventory. The personal accomplishment element of the instrument has been shown to be protective against burnout among high achiever professionals.6 Secondly, the authors reported a 53.7% response rate for the survey. It would be important to exclude response bias by evaluating the characteristics of nonrespondents of the survey. Lastly, the authors concluded that program characteristics were not associated with burnout, but they did not investigate the important job characteristics of program directors (eg, working hours and control over professional life). I would welcome some comments to help further confirm the findings of this important study.
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