Gender and Burnout in Health Care Delivery - It's Complicated Cross-Sectional Study

Introduction. Multiple studies have demonstrated that women have a higher individual risk of reporting workplace burnout. In a prior analysis examining religion and burnout, we observed that a higher proportion of women within a healthcare organization was associated with lower aggregate burnout prevalence. Authors of the present study examined the association between gender composition and burnout among health care staff. Methods. We conducted a cross-sectional study using data from the 2021-2024 English National Health Service Staff Survey and followed STROBE guidelines for observational reporting. Random forest regression was used to identify key predictors of burnout. Mediation analyses were then performed to evaluate indirect pathways through which organizational gender composition may be associated with burnout. Results. The analysis included 942 organizational reports comprising 2,681,573 survey responses. In unadjusted analyses, a higher proportion of female staff was associated with lower reported burnout at the organizational level. However, after adjustment for workplace stressors and resources, this association reversed, with higher female representation associated with increased burnout. Mediation analyses suggested that higher proportions of female staff were associated with more favorable workplace characteristics, including increased perceived membership and autonomy, as well as reduced harassment and discrimination. Conclusions. Consistent with prior literature, adjusted analyses support an association between female gender and higher individual-level burnout. However, at the organizational level, unadjusted analyses demonstrated an inverse association, which reversed after adjustment for workplace factors. Mediation findings suggest that gender composition may influence burnout through improvements in workplace culture, particularly increased sense of membership. If replicated, these findings warrant further investigation into mechanisms by which organizational composition shapes burnout and how these pathways may be leveraged for intervention.