Leadership Matters: Protective Factors for Burnout in Military Healthcare Workers

Abstract Background Occupational burnout in healthcare workers, especially in military medical settings, poses risks in retention, patient safety, productivity, well-being, and military readiness. Prior research suggests that sex differences exist with burnout, yet limited data exist on how drivers of burnout interact within military contexts, especially during periods of high stress such as a global pandemic. The objective of this study is to examine sex-specific differences in burnout among military healthcare workers, including the influence of demographic factors, pandemic-related stressors, and leadership characteristics. Materials and Methods A cross-sectional survey was administered to 424 healthcare workers employed at military medical treatment facilities between January and May 2023. Participants completed the Maslach Burnout Inventory (MBI) Health Services Survey, Adaptive Leadership with Authority Scale (ALAS), and Pandemic Experiences and Perceptions Survey (PEPS). Descriptive statistics, t-tests, chi-square analysis, Pearson correlations, and ANOVAs were conducted to assess burnout dimensions—emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA)—in relation to leadership, demographics variables, and pandemic stressors. Results Among 424 respondents (308 females, 116 males), overall burnout rates did not differ significantly by sex (25% males, 20% females, P = .28). However, females reported significantly higher EE than males (91.8% vs. 81.6%, P = .015, Cramer’s V = 0.15). There were no differences in the levels of high DP (71.8% males, 64.6% females, P = .86) or low PA (10.5% males, 7.9% females, P = .67). Adaptive and supervisory leadership were protective against EE and DP for both sexes, but these effects were stronger and more consistent for females. Leadership was a protective factor against EE and low PA for females (r = –.34, P < .001; r = –.23, P < .001) and against EE for males (r = –.22, P = .027), though to a lesser extent. For males, tenure at the current position was inversely correlated with depersonalization (r = −.25, P = .01). Pandemic-related stress was more strongly associated with depersonalization in females. Role- and ethnicity-based interactions also revealed sex-specific patterns, with female physicians reporting higher EE and male depersonalization varying by healthcare role and ethnicity. Conclusions This study highlights important sex-based differences in burnout profiles and associated risk and protective factors among military healthcare workers. Findings underscore the critical role of leadership, particularly for female personnel related to EE, although tenure buffered depersonalization in males. These findings highlight the need for tailored burnout prevention strategies, particularly focused on adaptive leadership development and demographic-specific interventions.