"Invalidated, dismissed, or minimized:" sex differences in workplace experiences and burnout among VHA mental health providers: A mixed methods study

Abstract

Burnout negatively affects clinicians nationwide, with elevated levels among mental health providers (MHPs) in the Veterans Health Administration (VHA). Female providers bear a disproportionate burden. We sought to examine contextual circumstances affecting workplace experiences and burnout among MHPs and differences by sex. Employing a convergent mixed methods design, we explored factors contributing to negative workplace experiences among MHPs (psychiatrists, psychologists, and social workers) using 2022 VHA All Employee Survey (AES) data and MHP interviews (2021-2022). Our analysis included 14,265 2022 AES responses from MHPs (72.1 % female) and 51 interviews, (66.7 % female). A higher proportion of females reported burnout (42.71 % of females, 40.18 % of males). Among other AES workplace items, females were less likely to report no supervisor favoritism, fair conflict resolution, supervisors addressing their concerns, and performance recognition (effect estimates ranged from -0.05 to -0.18). Qualitative findings complemented quantitative findings: females were less comfortable advocating for themselves and setting "hard boundaries" regarding workload. Females reported more disrespect from coworkers than their male colleagues, and in some cases reported outright discrimination. Reflecting the broader social context, females reported a variety of ways in which sexism pervaded the organization and contributed to burnout. Our findings highlighted multiple ways in which female MHPs experienced higher levels of burnout, less positive workplace experiences, and more challenges advocating for themselves. These findings identify targets for system-level improvements that could address burnout among all employees and those unique to female employees. Downstream, these opportunities could lead to a healthier, consistent workforce and improved patient care.

Keywords: Burnout; Female; Mental health professionals; Veterans; Work-environment.

Fig. 1.

Work-environment item means by sex, unadjusted, 2022 All Employee Survey. Note: Each point represents the mean score on that item for that sex category based on unadjusted bivariate analyses.

Fig. 2.

Association between female sex and work-environment items, mixed effect linear regression models, 2022 All Employee Survey. Note: Each point represents an estimate from a separate model adjusted for demographic characteristics and facility random intercepts. A negative estimate corresponds to lower mean for each work-environment item in females compared to males.