Relative importance of senior leaders compared with direct supervisors in clinician burnout

BACKGROUND: Clinician well-being has been linked to leadership assessment, yet the relative impact of satisfaction with direct supervisors versus senior leadership remains underexplored. Understanding these relationships can inform leadership development and organisational strategies to mitigate burnout. METHODS: We administered a well-being survey to all frontline clinicians at a large US health system in Spring 2023 (response rate 24.5%). Independent variables included satisfaction with immediate supervisors and senior leadership, operationalised from five-point Likert items. Burnout was assessed using the Professional Fulfillment Index. Linear probability models estimated the association of leadership satisfaction with burnout, adjusting for clinician type and gender. Stratified analyses examined differences across nurses, advanced practice providers, physician trainees and attending physicians. RESULTS: Among 3707 respondents, 36.3% met criteria for burnout. Satisfaction with senior leadership was associated with an 83.7% lower probability of burnout (B=-0.304, p<0.001), compared with 32.2% for direct supervisors (B=-0.117, p<0.001). Findings were consistent across clinician groups, with senior leadership satisfaction demonstrating the largest effect, particularly among nurses. CONCLUSIONS: Satisfaction with senior leadership exerts a stronger influence on burnout than satisfaction with immediate supervisors. Interventions that support senior leadership development may yield significant benefits for frontline healthcare worker well-being and retention.