Post-Pandemic Primary Care Burnout Drivers: Interplay of Organizational Constraints, Values (Mis)alignment, and...

Burnout has been exacerbated by post-pandemic woes, and research has examined burnout drivers; however, limited attention has been given to how values alignment with leadership, organizational constraints, psychological safety, and supervisor support simultaneously shape burnout outcomes. This study aimed to identify workplace factors most strongly associated with emotional exhaustion, depersonalization, and personal accomplishment to inform leadership strategies for improving clinician well-being.

Cross-sectional survey of 338 employees across 12 primary care clinics in a healthcare system in Portland, Oregon, from January to August 2023 (response rate: 63.5%). Eligible respondents included clinicians and support staff. Burnout was assessed using the Maslach Burnout Inventory (MBI-HSS). Independent variables included organizational constraints, values alignment with leadership, psychological safety, and two forms of supervisor support (general support and family-supportive supervisor behaviors [FSSB]). Structural Equation Modeling (SEM) was employed to examine the simultaneous relationships between workplace factors and burnout dimensions, while controlling for demographic and occupational characteristics.

Lower values alignment with leaders was the strongest predictor of emotional exhaustion (β = -0.15, p < 0.001). Organizational constraints were associated with both emotional exhaustion (β = 0.08, p < 0.001) and depersonalization (β = 0.05, p < 0.001). Lower psychological safety was also linked to greater emotional exhaustion (β = -0.04, p < 0.001). For personal accomplishment, higher values alignment (β = 0.10, p < 0.05) and fewer organizational constraints (β = -0.03, p < 0.001) were positive predictors. General supervisor support was associated with greater personal accomplishment, while higher FSSB was unexpectedly associated with lower accomplishment (β = -0.06, p < 0.001).

These findings underscore the importance of aligning values with leadership and promoting psychological safety as crucial levers for mitigating emotional exhaustion. Although general supervisor support enhances personal accomplishment, the negative association with FSSB suggests more complex supervisory dynamics.