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Dear Editors,

We appreciate both the expertise and the passion that Zsenits and colleagues bring to the conversation about electronic health records (EHRs) and clinician burnout. We hope that by responding to some of the points in their letter that we can provide clarification and perhaps some reassurance.

First, this was not a case-control study, nor did we test for correlation. The Department of Health samples all of the physicians in the state for public reporting purposes. Our study population was not generated by identifying cases and controls; rather, we categorized physicians’ responses into relevant groups for the planned analysis. We used multivariable regression to identify which covariates were independently associated with burnout symptoms among respondents. The term “predictor” can be used in cross-sectional studies in the biomedical sciences without implying causation; in this context, it serves as a synonym for an independent variable.1,2 Fortunately, we were able to include many clinician and practice characteristics in the model; as with any observational study, we were not able to include unmeasured factors, nor would we attempt to determine causation. Dr Guyatt's evidence-based papers3 are superb, but the comparison studies the authors speak of are not comparable to the study design in our paper. They would apply more to longitudinal cohorts or randomized trials.

Issue Section:
Correspondence
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