J Healthc Manag. 2026 Mar-Apr 01;71(2):109-121. doi: 10.1097/JHM-D-24-00244.
ABSTRACT
GOAL: Burnout in healthcare remains a significant problem, with implications not only for physicians and advanced practice providers but also for the entire US healthcare system, including patients and payers. Significant work has been done to understand the antecedents of burnout and develop successful intervention strategies. Much of the attention has focused on either improving the work environment or enhancing individual resilience, with suboptimal results. Consequently, we examined individual fortitude-including resilience and other attributes-and its interaction with organizational support to extend the research into both individual- and workplace-level antecedent factors in burnout.
METHODS: Physicians and advanced practice providers from six healthcare systems were invited to participate in this study, with 753 completing the survey. The survey included valid and reliable instruments for burnout, fortitude, and perceived organizational support. Multiple methods of assessment were used to triangulate the interactive effects of fortitude (i.e., individual attributes or factors) and organizational support (i.e., workplace-related factors) on burnout. First, correlation analyses were performed to identify statistically significant relationships between individual- and workplace-related factors. Next, stepwise regression modeling was used to test the simultaneous impact of individual- and workplace-related factors by examining the interaction between fortitude and organizational support on burnout. Finally, a path model was developed to test for the mediating effect of fortitude on the relationship between organizational support and burnout.
PRINCIPAL FINDINGS: Significant negative correlations between both individual fortitude and perceived organizational support in the workplace on burnout were evident. Similarly, there was a positive association between fortitude and organizational support. Stepwise regression showed that the interaction of individual attributes and organizational support had the highest degree of significance (β = -.67, p < .01), with an adjusted R2 of .44. Fortitude was added in the second step (β = -.37, p < .01) and provided significant improvement over the previous model, consisting of the interaction variable. The adjusted R2 increased to .52 (X2 = 11.18, p < .01, Δ adj R2 = .08). While organizational support was significantly related to burnout, the addition of this variable to the model showed no significant improvement in explained variance (X2 = 0.18, ns, Δ adj R2 = .00). Subsequent path modeling showed that fortitude can partially mediate the relationship between organizational support and burnout. Empirically, this demonstrates that fortitude significantly affects the relationship between organizational support and reduced burnout.
PRACTICAL APPLICATIONS: The causes of burnout are multifaceted and unique to individuals. Organizational attempts to improve the work environment or increase individual resilience have been suboptimal, as burnout rates have remained stubbornly elevated. By considering the interaction of individual fortitude and organizational support, leaders can develop more effective intervention strategies to support healthcare providers.
PMID:41817540 | DOI:10.1097/JHM-D-24-00244
