SummaryThis study among a sample of 207 general practitioners (GPs) uses a ®ve-year longitudinal design to test a process model of burnout. On the basis of social exchange and equity theory, it is hypothesized and found that demanding patient contacts produce a lack of reciprocity in the GP±patient relationship, which, in turn, depletes GPs' emotional resources and initiates the burnout syndrome. More speci®cally, structural equation analyses con®rmed thatÐboth at T1 and T2Ðlack of reciprocity mediates the impact of patient demands on emotional exhaustion. Emotional exhaustion, in turn, evokes negative attitudes toward patients (depersonalization), and toward oneself in relation to the job (reduced personal accomplishment). Moreover, this process model of burnout was con®rmed at T2, even after controlling for T1-scores on each of the model components. Finally, T1 depersonalization predicted the intensity and frequency of T2 patient demands, after controlling for T1 patient demands. This major ®nding suggests that GPs who attempt to gain emotional distance from their patients as a way of coping with their exhaustion, evoke demanding and threatening patient behaviors themselves. The theoretical and practical implications of these ®ndings are discussed.

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