Appendix C

Job Burnout: Consequences for Individuals, Organizations, and Equity

Alden Yuanhong Lai, Kenneth Z. Wee, Erin E. Sullivan, Amber L. Stephenson, Mark Linzer

This paper was commissioned by National Academies of Sciences, Engineering, and Medicine’s Committee on Women in Science, Engineering, and Medicine. Opinions and statements included in the paper are solely those of the individual authors, and are not necessarily adopted, endorsed, or verified as accurate by the committee or the National Academies of Sciences, Engineering, and Medicine.

INTRODUCTION

Burnout is generally defined as “a state of exhaustion in which one is cynical about the value of one’s occupation and doubtful of one’s capacity to perform” (Maslach et al., 1997, p. 20). Maslach and Leiter (2022; p. 72) cautioned that when the mismatches between what organizations require of workers and what workers need to perform their jobs are not addressed, workers experience a “lack of control, insufficient rewards, breakdown of community, absence of fairness and value conflicts” at work, which can in turn lead to burnout. At a time when more than half of workers in certain occupations (e.g., physicians, applied psychologists) are reporting some form of burnout (Shanafelt et al., 2022; McCormack et al., 2018),

understanding the range of consequences and the implications of this occupational phenomenon is long overdue.

As part of the program by the National Academies of Sciences, Engineering, and Medicine’s Committee on Women in Science, Engineering, and Medicine (SEM), this paper seeks to highlight the consequences of burnout among the SEM occupations and their implications for equity. We conducted systematic literature searches across all three SEM occupations to synthesize evidence for the paper. It is organized into the following sections to reflect the consequences of burnout at multiple levels of workers’ lives and our society. First, we highlight the individual consequences of burnout on health and quality of life, including mental health, cognitive function, and substance use, showing the array of consequences that burnout produces among SEM workers as individuals. Second, we highlight the occupational consequences, including decreased job satisfaction and increased turnover. Third, we highlight the consequences for organizations, showing how most attention has been paid to the impact of burnout on service quality. Fourth, although the literature here is comparatively scanter, we highlight the consequences of burnout for society at large, including greater use of, and spending on, healthcare. Finally, we highlight the implications of our findings for equity, including how burnout affects groups disproportionately by sex, age, race, job tenure, and job roles.

Overall, this paper shows that the consequences of burnout are pervasive among SEM occupations, with important implications for equity. It provides several recommendations. First, future research seeking to understand the impact of burnout should focus more on the consequences of burnout for organizations and society at large. Second, because burnout disproportionately affects women SEM workers and workers who are early in their careers, those groups deserve additional, and targeted, support from both leaders and institutions. Third, more attention is needed to understand how burnout affects the lived experiences of workers in underrepresented racial and ethnic groups, including the prevalence, consequences, and measures (i.e., how and when these groups choose to report burnout at work). Fourth, because most of the literature on burnout has concentrated on its effects on those working in medicine and healthcare, more research on the effects of burnout on those in the fields of science and engineering is both needed and warranted. Finally, despite some research gaps, we know enough about burnout to take action to ameliorate its consequences, including the conduct of high-quality interventions, especially for women SEM workers and those who are early in their careers.

METHODS

Evidence synthesis was conducted from July to September 2024. Our literature search took on a three-stage process to gather and synthesize the evidence. Because burnout has been so extensively studied, the first stage involved a review-of-reviews approach, where we focused on identifying review articles (e.g., systematic, narrative, meta-analysis) on burnout and its consequences across SEM fields. A reference librarian searched the databases of PsycINFO, MedLine, Web of Science, and IEEE Xplore using relevant search terms. We screened the resulting 6,459 articles and, from them, identified 98 articles for full-text review during this stage. Our exclusion criteria were nonresearch articles (e.g., opinion editorials); articles that did not investigate burnout; articles that did not investigate the consequences of burnout; and articles that did not focus on workers in SEM. An overwhelming portion of the articles produced in this first stage were based in medicine or healthcare, in comparison to science and engineering. We therefore conducted a second search for articles studying burnout in the fields of science or engineering specifically, but without restricting our search to review articles. This second search produced an additional 1,090 articles, from which we identified 35 articles for full-text review. We applied the same set of exclusion criteria at this stage. For this paper, we focused primarily on evidence from SEM workers based in the United States, although we cite studies conducted elsewhere if and where relevant. When reviewing articles in full text, we sought to extract the following information: research question/aim; whether the article was based in the field of science, engineering, or medicine; whether the article focused on individual and/or organizational outcomes; the type and number of participants; the measures of burnout being used; the consequences of burnout studied; and whether particular groups or subgroups at higher risk of experiencing consequences of burnout (i.e., equity issues) were described. In the third and final stage, we also performed backward and forward reference searches for 15 key articles (e.g., Schaufeli et al., 2009).

RESULTS

We make two notes about the results section. First, because the majority of studies used variants of the Maslach Burnout Inventory to measure and analyze burnout, the findings are occasionally specific to one or all of the subscales of the instrument (i.e., emotional exhaustion, depersonalization or

cynicism, and reduced professional accomplishment or reduced professional efficacy).¹ In this paper, we distinguish among the three subscales of the Maslach Burnout Inventory, where relevant to the reporting of our findings. These distinctions, in turn, facilitate a more nuanced understanding of the consequences of burnout. Second, because most of the studies are neither longitudinal nor randomized in design, our discussions of their results are necessarily limited to describing associations. We suggest causation only in certain instances, such as when there is a dose-response relationship.

UNPACKING BURNOUT CONSEQUENCES

Individual Health and Quality of Life Consequences

The individual consequences of burnout refer to indicators of individual functioning, health, and well-being. Studies across physicians, nurses, dentists, and healthcare workers in general show that burnout is associated with reduced levels of physical health, of mental health, and of the quality-of-life for individual workers (see Box C-1). Workers experiencing burnout also report higher levels of anxiety and depression. The evidence of links between burnout and substance use and suicide ideation are, however, more mixed. Research has also documented an association between burnout and poorer cognitive function, especially the impact of burnout on memory. Finally, some studies have positioned burnout as a cumulative process in which individual-level consequences accumulate and become increasingly severe over time.

Mental Health

The relationship among burnout, anxiety, and depression as the individual manifestations of burnout has been the consequence documented most frequently in the literature (e.g., Ryan et al., 2023; Kratkze et al., 2022; Johnson et al., 2022). In a review of physicians, Ryan et al.’s (2023) review reported that 45 studies that examined the relationship between burnout and depression found a significant association, with correlations

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¹ Broadly, emotional exhaustion refers to the depletion of emotional resources, cynicism refers to the distancing of oneself from work and developing negative attitudes toward work, and reduced professional efficacy refers to the tendency to evaluate one’s work as negative. For a discussion on the terms and subscales, see Bakker et al. (2002) and Leiter and Schaufeli (1996).

between r = 0.41 and r = 0.74. Additionally, all 12 studies that examined the relationship between burnout and anxiety found a significant association, with correlations of approximately r = 0.46. Similar results were found among trainees (Kratzke et al., 2022; Johnson et al., 2022). Mukherjee et al. (2022) found that burnout was the second-best predictor of post-traumatic stress syndrome, after depression. Yang and Hayes (2020) reviewed the literature on burnout among psychotherapists and reported that burnout is related to physical well-being as well as their psychological well-being, including anxiety, depression, secondary traumatic stress, and psychological distress. Overall, workers who experience burnout, including physicians and nurses, also report poorer health, chronic fatigue, and lower levels of general quality-of-life and professional quality-of-life (Williams et al., 2020; Friganovic et al., 2017).

Substance Use

The evidence is mixed as to substance use among those experiencing burnout at work (Johnson et al., 2022; Ryan et al., 2023; Kratze et al., 2022; Williams et al., 2020). The majority of reviews report that workers experiencing burnout are more likely to engage in substance use, including psychiatric medications and alcohol. Ryan et al.’s (2023) review of physicians found that, of 16 studies that examined the relationship between burnout and substance use, only 1 found a significant association. The authors suggested the mixed findings to be a function of two factors. First, studies examining substance use often employ different measurement tools, making it challenging to draw consistent conclusions across studies. Second, substance use is often a comorbid outcome of both burnout and other mental health conditions (e.g., depression) and results differ depending on whether such confounding factors have been sufficiently considered (Ryan et al., 2023).

Suicide Ideation

A small number of papers have described higher levels of suicidal ideation among physicians, veterinarians, and trainees who experience burnout (e.g., Ryan et al., 2023; Ishak et al., 2013). Ishak et al.’s (2013) review of nine papers found that 45 to 71 percent of medical students experienced burnout and that those experiencing burnout are 2–3 times more likely to have experienced suicidal ideation in the past. Additionally, the authors observed that, although emotional exhaustion, depersonalization, and

reduced professional efficacy all significantly predicted suicidal ideation, depersonalization had the strongest effect, even after controlling for depression. Ryan et al.’s (2023) review showed a significant association between burnout and suicidal ideation among physicians, with Ishak et al. (2013) showing similar findings among medical students.

Cognitive Function

Some reviews have evaluated the effect of burnout on workers and trainees’ cognitive function—comprising executive functioning, attention, and memory (Renaud & Lacroix, 2023; Deligkaris et al., 2014; Gavelin et al., 2022). For example, Saxena (2024) concluded that among 513 science, technology, engineering, and mathematics students, burnout was associated with mind-wandering (i.e., not focusing on tasks on hand). However, certain methodological challenges, such as not controlling for confounding factors or not including more severe cases of burnout in the subject pool, have prevented researchers from drawing more definitive conclusions about the effect of burnout on cognitive functioning (Deligkaris et al., 2014). The strongest evidence to date is the effect of burnout on memory. Renaud and Lacroix’s (2023) review reported that burnout had a strong association with memory performance, with workers experiencing burnout exhibiting both poorer prospective memory and delayed memory. Gavelin et al. (2022) noted that burnout had a small but significant effect on working memory. On the other hand, evidence of the effect of burnout on executive functioning (with the subcomponents of inhibiting, switching, and updating), and the effect of burnout on attention, are more mixed. Inhibition is the ability to control one’s attention, behavior, or thinking by preventing distraction or the use of learned reflexes; switching is the ability to change perspectives when needed; and updating is the ability to refresh information that is relevant to the goal at hand (Renaud & Lacroix, 2023). For example, although Renaud and Lacroix’s (2023) review found that burnout had a medium effect on switching and updating, Gavelin et al.’s (2022) review found that burnout affected both switching and inhibiting but not updating.

Viewing Individual Consequences of Burnout as a Cumulative Process

Some studies have conceptualized burnout as a cumulative process in which individual-level consequences become increasingly severe (Peck & Porter, 2022; Williams et al., 2020). These studies used the

Burnout Cascade Framework, which first emerged from occupational studies (Weber & Jaekel-Reinhard, 2000). Based on this framework, workers initially experience a burst of activity, but once this hyperactivity subsides, both activity and productivity decline. This pattern of decreased activity resonates with findings reported by existing reviews of how workers who experience the onset of burnout often seek to conserve resources, and therefore, reduce participation in professional growth or develop intentions to leave their job (e.g., Williams et al., 2020). In the later stages of the Burnout Cascade Framework, the consequences become more severe: workers begin to experience emotional, social, and psychosomatic malaise. The final stage of the framework points to diseases and harm to self. Specifically, Williams et al.’s (2020) work has highlighted the eight stages of burnout and their consequences as follows:

1. Hyperactivity: an initial period of high levels of activity, as evidenced by putting more effort into work to address increasing demands
2. Exhaustion: once hyperactivity subsides, a period of exhaustion in the form of fatigue and loss of energy
3. Reduced activity: a period of reduced capability and productivity in the form of disengagement
4. Emotional reactions: experiences of anxiety and fear
5. Breakdowns: experiences of impaired cognition, lack of motivation, and depression
6. Degradation: social isolation and physical withdrawal
7. Psychosomatic: psychosomatic symptoms including insomnia, headaches, gastro-intestinal disorders
8. Despair: chronic physical disorders, serious illnesses, or suicide

OCCUPATIONAL CONSEQUENCES

The occupational consequences of burnout are twofold: one, they refer to how one feels about their job and work environment; two, they refer to aspects of one’s job performance in an organization or career advancement in their field (see Box C-1). A majority of studies in this area document that burnout predicts one’s willingness to leave their job. Comparatively fewer studies have looked at how burnout predicts one’s willingness to leave their profession or field entirely (c.f. Dall’Ora et al., 2020); we located two studies that show burnout is related to nurses’ plans to leave the nursing profession entirely.

Overall, research highlights several occupational consequences of burnout, including lower job satisfaction, absenteeism, and reduced professionalism, productivity, and commitment to the organization.

Intention to Leave

Research has most commonly documented a relationship between burnout and SEM workers’ plans to leave their job (e.g., Kratzke et al., 2022; Williams et al., 2020; Dewa et al., 2014). Ford et al. (2013) studied 287 information technology professionals employed by a university and found that emotional exhaustion and disengagement together explained approximately 53 percent of the variance in their turnover plans. A study of 360 engineers in India investigated the effect of emotional exhaustion on plans to leave and reported that emotional exhaustion mediates the relationship between role stress (i.e., stress from work stemming from role ambiguity, role conflict, and role overload) and plans to leave (Hazeen & Umarani, 2022). Indeed, a systematic review of 92 articles on information technology professionals, including software engineers, reported that planning to leave is the most studied and frequent consequence of burnout in the field (Tulili et al., 2023), citing studies conducted both in and outside the United States (e.g., Moore, 2000; Shropshire & Kadlec, 2012; Shih et al., 2013). In medicine, Hodkinson et al.’s (2022) meta-analysis of approximately 240,000 physicians found those who are burned out are 3 times more likely to plan to leave their jobs or regret their career choice. In a recent systematic review and meta-analysis, de Vries et al. (2024) reported that burnout was a primary determinant of nurses and physicians’ plans to leave their job and profession during the COVID-19 pandemic. Specifically, the meta-analysis revealed that 38 percent of nurses intended to leave their jobs (pooled prevalence across 18 studies) and that 28 percent of nurses intended to leave the profession entirely (pooled prevalence across 16 studies). Fewer studies have examined the intention to leave the job and profession among physicians—de Vries et al. (2024) found only three and two studies, respectively—but those studies reported that 29 percent of physicians planned to leave their job and 24 percent planned to leave the profession entirely. Kratzke et al.’s (2022) review of surgical residents found that residents experiencing burnout are more likely to consider leaving residency, while Skillman and Tom’s (2022) study showed that acute care nurses experiencing burnout are likely to leave the nursing profession altogether, with effort-reward imbalance as the strongest predictor. Ishak et al. (2013)

noted that medical students who are experiencing burnout are more likely to drop out of medical school. Locatelli et al. (2015) studied healthcare workers and found that employee voice, or the degree to which participants felt that they were included in decision-making or that their opinions were heard, may make them less likely to leave. The study found that healthcare workers with lower burnout scores and lower intention to leave their jobs tend to report that employees’ concerns were more represented in organizational decision-making.

Job and career turnover can be challenging to assess in research, especially in cross-sectional studies, because participants are often lost to follow-up. Longitudinal research designs can therefore be helpful in better understanding the impact of burnout on one’s job or career trajectories, although such studies are rare. Barthauer et al. (2020) studied German academic scientists (Ph.D. candidates and postdoctoral fellows) who took part in a time-lagged online survey at three points of time (1-year intervals from 2014 to 2016). The study examined the relationship between burnout and career turnover plans among German scientists from fields such as economics, engineering, information technology, natural sciences, mathematics, social sciences, and humanities. The results indicated that burnout is positively related to career turnover plans, but this relationship is mediated by perceived internal marketability and career satisfaction. In particular, academic scientists in science and mathematics were more likely to consider leaving their careers (r = 0.11, p < 0.05), while those in economics, engineering, and information technology were less likely (r = −0.15, p < 0.01). Additionally, those who had completed their Ph.D. and those with long-term contracts reported lower burnout and turnover plans, with significant negative correlations (r = −0.11, p < 0.05 for Ph.D. status, r = −0.20, p < 0.01 for contract status). Additionally, we located one longitudinal mixed-methods study that offered counterintuitive results on burnout and career change. Cherniss (1992) studied human service professionals (i.e., public health nursing, public law, mental health, teaching) over a period of 12 years, and found that professionals who experienced burnout within the first year of their career were less likely to experience a career change over the next decade. The author provided two possible explanations: that professionals who experience burnout earlier in their careers may be more reluctant to switch careers later to avoid having to go through a similar, negative experience again, or that experiencing burnout in the early stage of one’s career can lead to greater investment in and commitment to their profession. Although this study yielded contrasting results, it had a small sample

size (only 25 human service professionals) and was conducted between the 1970s and the 1980s.

Professionalism, Productivity, and Commitment

Burnout among workers has been linked to decreased professionalism and productivity at work. Hodkinson et al.’s (2022) meta-analysis showed that physicians experiencing burnout are twice as likely to show decreased professionalism at work. To illustrate examples of reduced professionalism, Zheng et al.’s (2018) study of a group of surgeons in China, for example, showed that they were prone to displaying irritability at work. Separately, Williams et al.’s (2020) review noted that physicians are less likely to engage in professional development when burned out. Dewa et al.’s (2014) review further showed that burnout among physicians was significantly associated with reduced ability to work, defined as “the degree to which a worker is physically and mentally able to cope with the demands at work” (Ruitenberg et al., 2012, p. 2), a finding that was echoed by Hodkinson et al. (2022). Studies among nurses document similar trends: Jun et al.’s (2021) review reported that burnout among nurses, especially emotional exhaustion, is negatively associated with both commitment to the organization and productivity. These findings are supported by other studies (Edwards & Burnard, 2003; Friganovic et al., 2017; Torlak et al., 2021). Separately, a study of 824 human service workers (which included hospital and homecare workers) in Denmark observed that workers who were in the highest quartile for burnout scores were absent from work due to sickness an average of 13.6 days a year, compared with an average of 5.4 days for workers with the lowest quartile of burnout scores, even after adjusting for socioeconomic, family, health, and lifestyle factors (Borritz et al., 2006).

Beyond medicine, we located a 2003 study focused on burnout among Australian civil engineers, 92 percent of whom were men. Although the study highlighted that engineers derived a sense of accomplishment from the social value of their work, it also noted that cynicism was linked to dissatisfaction with pay and promotion and that both cynicism and emotional exhaustion were significant predictors of turnover plans (Lingard, 2003). However, many engineers experiencing burnout remained in their jobs due to a perceived lack of better alternatives, raising concerns about underperformance in the construction industry. Additionally, we located two studies that examined the effects of burnout on organizational

commitment among information services directors in the United States (Sethi et al., 1999) and software developers in India (Singh et al., 2012). In a sample of 312 information services directors in the United States, burnout was positively correlated with role stressors, with emotional exhaustion negatively impacting affective commitment (emotional attachment to the organization) but increasing continuance commitment (staying due to economic and social costs) (Sethi et al., 1999). Meanwhile, an Indian study of 372 software developers found that burnout decreased commitment to both the organization and to interpersonal relationships but, paradoxically, improved job performance (Singh et al., 2012); thus, software developers experiencing high burnout may perform better. Burnout among software developers was also associated with frequent job-hopping (average professional experience among software developers in their past job(s) is less than 2 years), work-family conflicts, and lower quality of life (Singh et al., 2012).

ORGANIZATIONAL CONSEQUENCES

Organizational consequences related to burnout refer to constructs that are linked to an organization’s performance or attainment of valued goals. Most research on burnout and its impact on organizations has centered on healthcare organizations and their service delivery performance (see Box C-1).

Service Quality

A body of literature has focused on examining the quality of healthcare as an organizational consequence of burnout among medical providers (Mossburg & Dennison Himmelfarb, 2021; Rathert et al., 2018; Salyers et al., 2017; Johnson et al., 2022; Mangory et al., 2021; Rabatin et al., 2016; Tawfik et al., 2019; NASEM, 2019). A 2019 report on clinician burnout from the National Academies noted that the combination of the many consequences of burnout, including absenteeism, sub-optimal performance, and reduced effort have “a major impact on the ability of healthcare organizations to maintain an adequate professional workforce” (NASEM, 2019; pg. 71). However, higher-quality studies, including randomized trials and the use of a standardized and consistent set of outcomes, are needed to more accurately determine the magnitude of the relationship between worker burnout and service quality. Tawfik et al.’s (2019) review of the literature over a 25-year period with more than 240,000 healthcare

professionals, for example, concluded that burnout was related to decreased quality of care in 58 studies, although they did not find this relationship in 50 studies. Rathert et al.’s (2018) review found that the association between physician burnout and medical errors was significant only in studies that measured physicians’ perceptions, with no associations found in studies that used objective measures of medical errors, such as chart reviews or clinical records. Rabatin et al. (2016) could not confirm a correlation between burnout and the quality of healthcare outcomes when objective measures were used. However, numerous studies have documented associations between worker burnout and a range of quality-of-care indicators, including unsolicited patient complaints, patient dissatisfaction, hospital-acquired infections, and post-discharge recovery time, suggesting that it is important to consider the quality of care as an important potential consequence of burnout (Cimiotti et al., 2012; Halbesleben & Rathert, 2008; Trockel et al., 2022; Welle et al., 2020). Scholars have offered two perspectives in light of the mixed findings. First, our inability to draw more definitive conclusions is in part because of the variability with which the quality of care is defined (e.g., medical errors, safety culture, patient outcomes, patient satisfaction) and measured (e.g., clinical records, self-perceptions) (Dewa et al., 2017; Hall et al., 2016; Humphries et al., 2014). Second, an overly strong focus on the relationship between burnout among healthcare workers and quality of care can mislead stakeholders at-large into thinking that burnout is causing decreases in service quality, when healthcare workers are using their personal resources against organizational pressures to prevent harm to patients or decreases in the quality of care. Indeed, scholars have suggested that healthcare professionals act as buffers between adverse work conditions and patient care (Linzer et al., 2009; Wallace & Lemaire, 2009).

Nevertheless, there is consensus that burnout in workers affects service quality generally, especially when subjective or self-reported measures are used (e.g., Salyers et al., 2016; Owoc et al., 2022; Steffey et al., 2023). In a meta-analysis, Owoc et al. (2022) reported that 34 to 77 percent of physicians experience burnout and that these physicians are approximately 3 times more likely to make self-perceived errors, findings similar to a study of veterinarians (Steffey et al., 2023). Reviews have also found significant negative associations between burnout among healthcare professionals and perceptions of the culture of patient safety (e.g., Garcia et al., 2019; Mossburg & Dennison Himmelfarb, 2021). Garcia et al.’s (2019) systematic review and meta-analysis found that burnout among healthcare professionals reduces the incidence of actions taken to promote patient

safety. Hall et al. (2016), in their review, concluded that the majority of studies show that clinician burnout is associated with medical errors, and they cautioned that objective measures, like chart reviews or clinical records, may not be sensitive enough to capture the extent to which burnout is affecting the quality of care. Indeed, Humphries et al. (2014) suggested that the quality of care should be divided into two components when evaluating the effect by burnout: technical (e.g., clinical elements such as diagnosis and treatment) and interpersonal (e.g., communication, respect, and time spent with patients). The authors suggested that healthcare professionals experiencing burnout are more likely to neglect the interpersonal dimension than the technical dimension (Khazen et al., 2022).

Researchers have also examined the differential effects of the three subscales of the Maslach Burnout Inventory on service quality. Overall, depersonalization and emotional exhaustion among physicians predict more self-reported medical errors, whereas professional accomplishment serves as a protective factor (Dewa et al., 2017; Salyers et al., 2016). For example, Shanafelt et al. (2010) reported that physicians experiencing higher depersonalization and emotional exhaustion are significantly more likely to report higher odds of a major medical error in the past 3 months, but those with higher professional accomplishment report lower odds. Rathert et al. (2018) documented similar findings for patient-reported care satisfaction, where patients were less satisfied with their care and experienced longer postdischarge recovery times when their physicians were experiencing higher levels of depersonalization (see also Hall et al., 2016). The effect of the magnitude of depersonalization versus emotional exhaustion on service quality has generated mixed findings. While Owoc et al.’s (2022) meta-analysis and Dewa et al.’s (2017) review found that depersonalization had a stronger impact than emotional exhaustion on self-perceived errors, Salyers et al.’s (2016) review reached a contrary conclusion: that emotional exhaustion is the stronger predictor. Jun et al. (2021) demonstrated that emotional exhaustion among nurses is the best predictor of decreased quality of care, patient safety, and patient satisfaction. Researchers have suggested that, because of reduced levels of empathy, feelings of depersonalization and emotional exhaustion are likely not allowing healthcare professionals to be attentive to patients’ needs and to be patient centered in their communication, therefore affecting service quality (Garcia et al., 2019; Rathert et al., 2018; Wilkinson et al., 2017).

Interestingly, some studies reveal a cyclical effect between burnout and medical errors. West et al. (2006, 2009) documented, for example,

that burnout leads to errors, which can in turn exacerbate burnout among medical residents. Studies that examine such cyclical effects remain rare, but they should be pursued to expand our understanding in this area.

Financial Costs

Several studies have sought to document the financial costs of burnout. For example, Han et al. (2019) provided a conservative cost-estimate of the impact of physician burnout, which was $7,600 per employed physician at the organizational level, and $4.6 billion at the national level annually, largely due to turnover and reduced clinical hours. Separately, Muir et al. (2022) estimated that hospitals that do not have burnout reduction programs in place for nurses incur burnout-related costs that amount to $16,736 per nurse per year, while hospitals with burnout reduction programs in place incur lower costs of $11,592—savings that approximate $5,000 per nurse per year. Muir et al.’s (2023) study highlights the “business case” of burnout reduction programs for workers, where efforts to reduce burnout are not only beneficial for employees, but also financially beneficial (among other dimensions) for organizations. Indeed, Cunningham et al. (2024) highlight that because the high cost and scale of turnover among nurses—existing studies suggest a range of $46,100–$88,000 per nurse, with approximately 19 percent of nurses planning to leave their jobs within 6 months—are much more significant than the cost of reducing burnout, there is a strong business case for organizations and leaders to protect workers from burnout.

Leader Burnout and Its Impact on Others

Within an organization, burnout among leaders can affect those who report to them, indicating a trickle-down effect among leaders and workers. Huang et al.’s (2016) study found that burnout among software developer leaders is negatively associated with changes in workers’ resources at work, including decreases in autonomy, social support, performance feedback, professional development, self-efficacy, self-esteem, and optimism. The authors documented such changes over a 6-month period and that these changes were in turn associated with burnout among the workforce. A study of an academic medical center documented that approximately 10 percent of the variation in leadership behavior was associated with physician leaders’ own levels of burnout (Shanafelt et al., 2020). While not focused on SEM workers, a multilevel analysis of 442 workers in 68 teams in child daycare

centers in Germany demonstrated similar findings: That is, when leaders’ workload was high, workers perceived lower levels of support from their leaders, which in turn correlated with higher levels of emotional exhaustion among the workers (Stein et al., 2020).

SOCIETAL CONSEQUENCES

Comparatively less research has focused on the broader societal consequences of burnout among SEM workers (see Box 1). Some studies outside the United States point to the impact of burnout on greater healthcare spending by society as a whole, such as more referrals to specialists and more hospitalizations. One study of 136 primary care physicians in Israel showed that physician burnout is associated with higher rates of referral for diagnostic imaging, specialist health services, and nurse-sensitive treatments (Kushnir et al., 2014). Nørøxe et al. (2019a) showed that, in a Danish cohort of more than 460,000 patients seen by 392 general practitioners, physician burnout was associated with a 19 percent greater likelihood of hospitalization among patients, due to a lack of appropriate interventions in primary care.

Other studies have sought to document different forms of the societal consequences of burnout. These consequences range from patient-initiated change of primary care physicians (which reflects poorer patient experiences) to greater physician prescription of opioids and antibiotics. For example, Nørøxe et al. (2019b) documented that in a Danish cohort of more than 550,000 patients seen by 409 general practitioners, patients are 24 percent more likely to change their doctors—unrelated to a change of address—when their general practitioners experienced depersonalization and 40 percent more likely to change their doctors when their general practitioners experienced reduced professional accomplishment. The authors explained that when physicians are experiencing burnout, they may exhibit less empathetic concern for patients or have longer waiting times for consultations, which can strain the patient-doctor relationship. Another study in the United Kingdom of a sample of 351 general practitioners showed that increases in emotional exhaustion and depersonalization were associated with 19 percent and 10 percent greater likelihood, respectively, of prescriptions of strong opioids (Hodkinson et al., 2023). The same study also showed that increases in emotional exhaustion and depersonalization among physicians are associated with 19 percent and 24 percent greater likelihood, respectively, of prescriptions of strong antibiotics.

DOSE-RESPONSE RELATIONSHIPS BETWEEN BURNOUT AND CONSEQUENCES

In our review of the literature, we located a handful of studies that have described dose-response relationships between burnout and its consequences. Peterson (2008) concluded that self-rated health, anxiety, and depression among healthcare workers increased in order of the following: workers that were not burned out, disengaged, exhausted, and burned out. Additionally, Kim et al. (2011) showed that higher rates of burnout among social workers are associated with faster deterioration in physical health over a 1-year period. In a study of approximately 1,600 general employees (across technology, academia, and administration), Toker and Biron (2012) found that physical activity attenuates the effect of burnout on depression in a dose-response manner. The authors observed that increases in job burnout and depression were the strongest in workers that did not report engaging in any physical activity, while the correlation was the weakest, to the point of nonsignificance, for workers that reported the highest levels of physical activity.

LONGER-TERM EFFECTS OF BURNOUT

We located at least two studies that described the time periods in which the consequences of burnout occur (or continue to occur). Although most of the studies neglected to use time series designs, thereby limiting the ability to track outcomes over time, they are nonetheless important in understanding how long the consequences of burnout persist. Hillhouse et al. (2000) reported that emotional exhaustion predicted mood disturbance in medical residents over a period of 1 year, and Hakanen and Schaufeli (2012) reported that burnout predicted depressive symptoms and life dissatisfaction among Finnish dentists over a period of 7 years.

BURNOUT CONSEQUENCES AND IMPLICATIONS FOR EQUITY

Differences by Sex

The consequences of burnout differ by factors such as sex, race, age, job tenure, and even job roles (see Box C-2). Most evidence to date on differences by sex has, however, focused on disparities in terms of prevalence or

predictive factors. For example, a longitudinal study of radiology residents found that individual resilience predicts lower burnout, and that although women and men residents did not differ on resilience levels at baseline (i.e., the start of residency), women residents’ resilience decreased significantly over a period of 3 years. Additionally, studies have also shown that women physicians reported higher stress, lower emotional well-being, greater fear and worry, and more significant anxiety, both at home and in interpersonal relationships (e.g., Peck & Porter, 2022). The focus on disparities in terms of prevalence or predictive factors is similar in engineering—in a matched-pair study of 102 engineers, women engineers who experienced burnout were more likely to see themselves as less successful at work, while this effect did not hold for engineers who were men (Etzion, 1988). Etzion’s (1988) study, although less recent, also described that women engineers who experienced burnout were more likely to place importance on success “outside of work,” suggesting the challenges for women engineers to achieve or integrate success in both work and nonwork (e.g., family) domains.

Among the studies that have examined disparities in terms of consequences, studies have shown that both health and health behaviors differ by sex. While not specific to the SEM workforce, Ahola et al.’s (2008) study on a nationally representative worker population in Finland found that burnout was associated with musculoskeletal disorders in women and cardiovascular diseases in men, even after controlling for other factors. In two studies of the general worker population in Israel who underwent a health examination, burnout predicted triglyceride levels as well as inflammation biomarkers in women employees, suggesting an association with increased risk for coronary or cardiovascular-related diseases (Shirom et al., 1997; Toker et al., 2005). When compared with men, women physicians and surgeons were at a higher risk of increased alcohol consumption as a function of burnout (Gold et al., 2016; Oreskovich et al., 2012; Templeton et al, 2019). Likewise, women physicians were 2.27 times more likely to die by suicide than women in other professions (Schernhammer & Colditz, 2004) or to experience suicidal ideation as a function of depression and burnout (LaFaver et al., 2018). Women physicians also had a higher suicide rate ratio than physicians who were men (1.76 versus 1.05; Zimmerman et al., 2024).

There are also differences between women and men in the consequences of burnout beyond health and health behaviors, although the evidence is more mixed. For instance, Klein (2010) observed that burnout was significantly associated with therapeutic and diagnostic errors in men, but not women, surgeons in Germany. However, in a study of patients in Sweden,

Gavelin et al. (2022) found no evidence of moderating effects of gender on the relationship between clinical burnout and cognitive impairment, suggesting that some cognitive outcomes of burnout may be consistent for men and women.

When considering work-related outcomes and coping mechanisms, women had higher odds of intending to leave a job, with Apple et al. (2023) showing 51.4 percent of women, compared with 42.4 percent of men, intending to depart among a sample of U.S. healthcare workers. Likewise, there were indications that women family physicians, in particular (Eden et al., 2020), and physicians inclusive of all specialties (Lyubarova et al., 2023) were more likely to reduce work hours, particularly to accommodate work-life balance. Women were also more likely to hire domestic help or talk to a therapist than men (Eden et al., 2020). Coping strategies were different among women in science; Lee and Riach (2024) identified three cognitive pathways through which these women navigate burnout: combative, regenerative, and promissory. More specifically, women using the “combative” ritual navigated burnout by resisting the status quo and asserting personal agency. Women using the “regenerative” ritual coped through reconciling and compromising. Lastly, women in the “promissory” frame coped through utilizing mental framings that showed movement away from the burnout experience (e.g., put burnout behind them). The identification of these cognitive pathways highlights the diverse ways in which women navigate burnout, with each approach reflecting different coping strategies and responses to workplace stress. These observations emphasize the need for organizations to recognize the varied emotional and cognitive processes in which women engage when experiencing burnout, because tailored interventions that acknowledge these differences may be more effective in addressing burnout and promoting well-being in the long term.

While there were differences in consequences of burnout by sex, it should also be noted that the prevalence of burnout among men, compared with women, is widely established in the literature. Women in primary care were more likely to report burnout (Apaydin et al., 2021) and women physicians and engineers tended to report higher levels of burnout than men (Marshall et al., 2020; Ronen & Pines, 2008). Mehta et al. (2019) found that women cardiologists reported burnout more frequently than men (31 percent vs. 24 percent). Similarly, Cullen et al. (2021) surveyed cardiovascular program directors and reported that women were less satisfied with their jobs and experienced higher stress levels than men, and that men reported higher rates of enjoyment

without burnout (43 percent vs. 13 percent), though this finding must be cautiously interpreted due to the smaller sample size of women in the study (22 women vs. 78 men). Women veterinarians showed early signs of burnout more frequently than veterinarians who were men (Elkins, 1992, in Platt et al., 2012), and women biosafety lab technicians in China had a higher job burnout detection rate (Lu et al., 2021). In physicians, women had 60 percent higher odds of being burned out than men (McMurray et al., 2000), and that gap has persisted over time (Linzer et al., 2020) with burnout being almost twice as high for women physicians in some studies (Linzer et al., 2024). The differences in prevalence are also true for women engineers, who reported higher levels of burnout than engineers who were men (Ronen & Pines, 2008).

The differences in burnout prevalence by sex may be due to higher expectations for spending more time by women physicians. These gendered expectations may contribute to higher burnout rates in multiple fields (Linzer & Harwood, 2018). Indeed, research on clinician-scientists indicates that gendered expectations of women at work and at home are imposing significant mental burden and stress on women (Szczygiel et al., 2024). Some studies suggested that burnout rates are highest in nonbinary respondents and nurses when compared with other health workers (e.g., Prasad et al., 2021). Also, the role of the organizational environment should not be overlooked, as it is associated with the experience of burnout. Women in SEM fields who are exposed to environments that challenge their professional identity (e.g., science is seen as a men’s occupation), and where the environments are unwelcoming or hostile toward women, experience higher levels of burnout (Jensen & Deemer, 2019).

Differences by Race

Literature that examined the differential consequences of burnout by race was sparse. In a systematic review, Lawrence et al. (2022) noted the wide variation in burnout among underrepresented minorities in medicine, although studies examining prevalence yielded inconsistent findings. When examining medical students whose races are underrepresented in medicine, O’Marr et al. (2022) indicated that underrepresented minorities tended to be in the top quartile of exhaustion-related burnout but were less likely to experience disengagement from burnout. In a study of sexist and racial/ethnic microaggressions against women physicians, women physicians who identified as racial minorities and experienced

racial/ethnic microaggressions were more likely to report burnout, though the consequences were not examined (Sudol et al., 2021). In examining the intersection of burnout, gender, and racial identity, this result suggests women physicians who identified as racial/ethnic minorities who had a compound experience of microaggressions that were both racist and sexist had a higher likelihood of experiencing burnout compared with racial/ethnic–minority (OR, 1.60; 95% CI, 1.01-2.42; P = 0.05) and White physicians who were men (OR, 2.50; 95% CI, 1.51-4.14; P = 0.001; Sudol et al., 2021). In an examination of medical student burnout, Briggs et al. (2023) discovered that Black medical students reported that their experience of burnout was influenced more by poor diet and lack of sleep, whereas Asian medical students reported stress over residency, grades, and publishing pressures. In either case, as it was a cross-sectional survey, the authors did not attempt to claim causality. In examining the association between various facets of burnout and quality-of-life domains in Brazil, Pai et al. (2022) found an inverse relationship between depersonalization, skin color, and the environmental domain of quality-of-life. In the study, environmental indicators of quality-of-life included physical and financial security, recreation, home life, healthcare, and transportation.

Alternatively, in an examination of planned turnover among healthcare workers during COVID-19, Mercado et al. (2022) found that identifying as a person of color was associated with higher stress levels but lower burnout, a finding contrary to their hypothesis. This finding was also found in Prasad et al.’s (2021) study of coping with COVID-19, where persons of color were found to experience higher levels of stress but significantly lower burnout. These findings may have been explained in part by the large number (13.9 percent) of respondents who preferred not to identify (PNTI) race or ethnicity, a group that had substantially and significantly higher burnout rates (e.g., 42 percent burnout in Black respondents vs. 62 percent in those who PNTI). These data raised the question whether many persons of color do not find burnout surveys to be safe spaces to report burnout using standard metrics, thus making a case for a deeper look at burnout metrics and survey construction that would allow a fuller understanding of the lived experiences of minoritized groups and, indeed, of all survey respondents. Linzer et al. (forthcoming) suggest numerous reasons why those within healthcare systems who feel vulnerable may not perceive surveys as safe spaces in which to report burnout and propose ways to improve perceived survey safety and to provide convincing evidence that action will be taken to rectify adverse work conditions, if identified.

Some scholars assert that the lower rates of burnout reported by racial and ethnic minorities, particularly on the metrics of depersonalization and exhaustion, is further support for the potentially protective effects of delivering healthcare in a culturally diverse community, and that it is an asset to the healthcare system, as it could mitigate known effects of burnout, including turnover and poor quality of care (Douglas et al., 2021).

Differences by Age and Job Tenure

Research underscores significant variations in burnout outcomes based on age and job tenure, with younger and less experienced workers often experiencing more severe consequences. While there is evidence, for example, that mid-career cardiologists had worse levels of burnout than early- or later-stage professionals (Mehta et al., 2019), data on the consequences that have been reported for early-stage professionals is far more limited. Burnout has been shown to predict mental health outcomes for newly qualified nurses in several studies (Rudman & Gustavsson, 2011; Laschinger et al., 2015; Dall’Ora et al., 2020). Cullen et al. (2021) observed that early-career professional cardiology fellowship directors reported higher levels of stress than did their mid- and late-career counterparts. Furthermore, those in late-career stages experienced more enjoyment without burnout, while early-career individuals were more likely to consider resignation. In a study of early-career construction management professionals, Franz et al. (2023) observed that emotional exhaustion and cynicism among early-career professionals were similar to mid-to-late career professionals, but also that professional efficacy dimension was higher in the early-career group, suggesting a discrepancy of experiences across the dimensions of burnout. Research in technology also seems to suggest a U-curve of occupational consequences of burnout based on one’s tenure in the organization: One study of more than 13,000 software professionals at a global information technology firm showed that new employees (< 6 months) had higher intention to stay compared with employees who had worked for 1–3 years at the organization, but also that employees who had 1–3 years of tenure were less inclined to stay when feeling burned out, compared with employees who had worked for more than 5 years (Trinkenreich et al., 2024). These findings raise two possibilities: that those in late-career stages have developed better coping skills as a function of experience or that there is a “survivor effect” among people who did not leave their jobs. Nurses who perceived more prominent levels of organizational politics, which might be more immediately experienced

by those newer to the environment, also reported more burnout (Dall’Ora et al., 2020). Likewise, Peck and Porter (2022) and West et al. (2018) both found that younger, less experienced workers had higher rates of stress and depression, indicating that early-career stages are particularly vulnerable to emotional burnout outcomes. For instance, the relationship between burnout and patient safety events was most pronounced in younger physicians (20–30 years old), whereas the link between burnout and low professionalism was weakest in physicians aged 50 years or older (Hodkinson et al., 2022). Furthermore, a link between burnout and low professionalism was greatest in physicians in training, residents, and those working in emergency medicine or intensive care (Hodkinson et al., 2022).

Differences by Job Role

The literature revealed differences in consequences of burnout by job role, with a particular emphasis in healthcare, as driven by clinical responsibilities and patient interactions. According to Peck and Porter (2022), physicians were less likely to experience nervousness or anxiety compared with other healthcare workers; they exhibited fewer symptoms of depression than did nurses. Nurses working in COVID-19 wards, on the other hand, reported significantly higher workload changes compared with physicians and scored higher in the three dimensions of burnout: exhaustion, deterioration of relationships, and work efficacy. These observations are consistent with de Vries et al.’s (2024) systematic review and meta-analysis, which revealed that nurses are more likely to have the intention to leave their job and profession (38 percent and 28 percent, respectively) compared with physicians (29 percent and 24 percent, respectively).

When comparing physicians to physicians, Mukherjee et al. (2022) observed that 30.8 percent of frontline physicians fell in the high-risk category compared with only 21.3 percent of second-line physicians, described by the authors as those who did not directly treat COVID-19 patients. Similarly, 10.5 percent of frontline compared with 5 percent of second-line physicians reported high levels of Post Traumatic Stress Symptoms (PTSS). Burnout was the second-highest predictor of PTSS for frontline physicians. Additionally, the relationship between burnout and patient safety incidents was most pronounced in physicians working in emergency medicine given the critical nature of the work (Hodkinson et al., 2022). Indeed, a cross-sectional study of 11,743 nurses across 60 magnet hospitals in the United States reported that emergency nurses are significantly more likely

to report burnout, job dissatisfaction, and intention to leave compared with other inpatient nurses who worked in the same hospital (Turnbach et al., 2024). A separate study of 221 hospitals in New York and Illinois documented that 58 percent of emergency nurses experienced high levels of burnout, and 27 percent intended to leave their jobs (Muir et al., 2023). In comparing primary care practitioners who specialize in women’s health and primary care practitioners in general practice, burnout was higher in the former (55 percent compared with 47 percent), though there was no significant difference in intent to leave by provider type (Apaydin et al., 2021). These discrepancies can be due to gendered expectations for women physicians to spend more time listening during care delivery (Linzer and Harwood, 2018).

Beyond healthcare, we identified one study on Australian cybersecurity professionals that found that women security consultants reported higher levels of emotional exhaustion compared with their counterparts who were men (approximately 28 percent vs. 13 percent; Reeves et al., 2024). Gender and job role were significant predictors of emotional exhaustion, but not of depersonalization or professional efficacy. The study authors posited that women in cybersecurity, particularly in consultant roles, experienced higher burnout levels, possibly due to poor cultural fit in a men-dominated industry characterized by stereotypes, harassment, and lack of flexible work options.

DISCUSSION

This report shows that the consequences of burnout are both pervasive and consequential—they impact SEM workers at the individual, occupational, organizational, and societal levels and pose important implications for equity. At the individual level, we find evidence of lower cognitive function, poorer mental health, and substance use and suicidal ideation among some occupational groups. At the occupational level, we find consensus on the impact of burnout on one’s intention to leave their jobs, and lower levels of professionalism, productivity, and commitment to the organization. At the organization level, we find a robust body of literature on the consequences of burnout on self-reported service quality, as well as pronounced estimates of financial costs related to personnel turnover and reduced working hours. While findings at the societal level are scanter, researchers have demonstrated how burnout among healthcare workers can be linked to greater healthcare use and spending as a whole. A handful of studies

have also demonstrated a dose-response relationship between burnout and its consequences, suggesting the utility of conceptualizing burnout as a stage-like process with varying levels of severity that warrant different types and intensities of intervention at each stage. In terms of equity, we report striking gender differences in the health and health behaviors between women and men SEM workers, although the knowledge to date has focused on disparities in prevalence and predictive factors. We also raise issues and concerns surrounding SEM workers who identify with underrepresented racial and ethnic groups, who are younger and/or have less organizational tenure, and who are in certain job roles, such as being on the frontlines of care delivery.

We organize this discussion as follows. First, we synthesize areas in the burnout literature that represent existing evidence of the consequences of burnout and their implications for equity. We suggest these areas as blocks of foundational knowledge that can inform current research and practice, including interventions, on burnout. Second, we synthesize the perceived research gaps. Third, we discuss the implications of our findings for action—by both researchers and practitioners—in the future. Finally, we discuss the limitations and strengths of the report.

EXISTING EVIDENCE

Our findings suggest that there is already a strong knowledge base of the individual- and occupational-level consequences of burnout, and that research seeking to expand this array will have less impact when compared with research focusing on organizational- and societal-level consequences. Most of the published knowledge on burnout, however, is concentrated in medicine and the healthcare setting. This disproportion is plausibly due to differences in the nature of work between workers in medicine and workers in science and engineering. Maslach and Leiter (2016) and others have described burnout among the “caring professions” (i.e., healthcare, social work, education, and counseling) due to key characteristics these professions share, namely, the emotionally demanding nature of the work, the tendency for these emotional demands to lead to compassion fatigue (Figley, 1995), as well as workplace characteristics such as high workload (Demerouti et al., 2001), underappreciation (Stillman et al., 2024), or moral distress (Epstein & Hamric, 2009; Rushton et al., 2015). In addition to emotional demands, healthcare professionals like physicians, nurses, and other frontline workers also face intense requirements such as working long

hours and at times the pressures of having to make life-or-death decisions (NASEM, 2019). In contrast, engineering and science professions are often viewed as highly technical and problem-solving oriented, with fewer emotional demands and emotional labor than the caring professions (Rasoal et al., 2012). Additionally, science and engineering disciplines focus on productivity and achievement, which may obfuscate burnout, or lead to it being underresearched. As Singh et al. (2012) demonstrated, there was a paradoxical relationship between burnout and improved job performance, meaning software developers experiencing high burnout may actually perform better. By comparison, the day-to-day tasks and work of the caring professions have more immediate concerns for human health, safety, and well-being—both of the professionals and of the people they care for—which may have driven substantial research interest in the field of medicine.

Our findings suggest that early-career SEM workers are particularly vulnerable to the consequences of burnout. Younger workers, and those with less tenure in the organization, face greater risks from burnout, which impacts their mental health, job satisfaction, and performance (Cullen et al., 2021; Hodkinson et al., 2022). This effect may be due to newness in the profession, feelings of being overwhelmed, and/or having fewer mechanisms for coping with stress at work (Dyrbye & Shanafelt, 2016; Satterfield & Becerra, 2010; Zhou et al., 2020). Additionally, early-career SEM workers may feel pressured to “prove” themselves or feel that they have less control over the situation, making them more susceptible to working longer hours and meeting high expectations (Shanafelt & Noseworthy, 2017). The constant pressure to perform and succeed, especially in highly competitive fields, can lead to a cycle of chronic stress (e.g., Rice et al., 2015). Without adequate support systems, mentorship, or opportunities for professional development, early-career SEM workers may struggle, and fail, to balance personal well-being with career ambitions (Dyrbye et al., 2019). Over time, this imbalance can exacerbate burnout symptoms, contributing to decreased productivity, lower retention rates, and even early exits from their chosen profession (Cullen et al., 2021; Trinkenreich et al., 2024). As a result, organizations and institutions must prioritize mental health resources, work-life balance initiatives, and mentorship programs to mitigate burnout and to support the long-term success of early-career professionals (Ripp et al., 2017; Shen et al., 2022).

Our findings also highlight that differences among occupations, work responsibilities, and work settings drive, in part, differences in the consequences of burnout. As a result, some SEM workers are at a higher risk of burnout and require more attention to burnout prevention and

mitigation efforts than others. High-stress environments like healthcare or emergency response require quick, high-risk decision-making, and can often lead to severe emotional exhaustion (e.g., Hodkinson et al., 2022). Indeed, in our review of the literature, job roles that require a frontline presence were associated with higher burnout than job roles for non-frontline presence. Frontline workers in healthcare were encountering acute burnout specifically from direct patient interaction (Mukherjee et al., 2022). Moreover, differences exist even among frontline workers (e.g., physicians vs. nurses), suggesting that interventions will require tailoring to each occupational group (Peck & Porter, 2022). These differences exist because work conditions related to burnout and its mediators (e.g., feeling valued by the organization) vary by role. For example, Mallick et al. (2024) showed that, among cardiology physicians, a sense of meaning and purpose directly reduced their burnout, but among nurses and other clinical staff, a sense of feeling valued was most effective in reducing burnout. The mechanisms surrounding a sense of value had repercussions for staff turnover: physicians were the most vulnerable, leaving the practice within 1–5 years, while other clinical staff were the most vulnerable to leaving the practice within 16–20 years. These differences reflect how different types of roles and workers experience burnout and its consequences differently, with a different set of work conditions surrounding the outcome of burnout and its varied consequences. More research across varied disciplines and worker roles will be meaningful in expanding our understanding of these relationships and patterns.

RESEARCH GAPS

Regarding equity, differences in burnout consequences associated with factors such as sex, race, age, job tenure, and job role have emerged in the literature. The differences between men and women in both the prevalence and severity of burnout are striking. These findings may be associated with women having dual and often competing pressures of professional and personal responsibilities, being sought to take on “invisible” work not counting toward promotion, career development or income, and gendered expectations for greater listening while being allotted similar amounts of time for care as men (Linzer & Harwood, 2018; Ramas et al., 2021). For example, women experience unique challenges related to pregnancy, childbirth, and returning to work with lactation needs, to which men are not susceptible (Chesak et al., 2020). Highlighting the link between childcare

stress and burnout, Harry et al. (2022) determined that healthcare workers facing high levels of childcare stress were 80–90 percent more likely to experience burnout, compared with those facing lower levels of childcare stress. Additionally, the study revealed that workers in underrepresented racial and ethnic groups had a 40 to 50 percent higher likelihood of reporting childcare stress than were White respondents, while women had a 22 percent higher likelihood of reporting it than were men with children. These figures suggest that SEM workers who are women, in underrepresented racial and ethnic groups, and have childcare responsibilities are the most at risk for the consequences of burnout. At the same time, addressing gender disparities in the experience and outcomes of burnout is crucial, especially as growing evidence, such as from Miyawaki et al. (2024), indicates that care by women physicians is associated with better clinical outcomes, including lower patient mortality. To avoid these gender disparities in burnout, workplaces must take intentional steps to reduce burnout through work redesign and acknowledgement of all work. Likewise, organizations can reduce gender disparities in burnout by offering more comprehensive support for childcare, eldercare, and pregnancy-related needs, including flexible work schedules and enhanced policies that can support a more equitable work environment.

When considering differences by race, there are some studies that suggest higher prevalence of burnout among ethnic and racial minorities (e.g., Armstrong & Reynolds, 2020), whereas others have posited that workers who identify as a racial or ethnic minority are less likely to provide identifying data, therefore making it challenging to fully understand the lived experience of underrepresented groups and what and how they choose to report (e.g., Linzer et al., forthcoming; Prasad et al., 2021). Single-item measures of adverse work experiences (e.g., negative experiences by race or gender; see Audi et al., 2021) show promise as a means of directly asking different genders, races, and cultures about their lived experiences. In this study, results of adverse work experiences correlated with burnout metrics. The authors therefore suggest that burnout may be viewed by many as a vulnerable outcome, suggesting “weakness” on the part of the individual who is burned out. Such feelings of vulnerability may make people who identify in racial and ethnic minority groups feel unsafe by reporting experiences of burnout. Current research on the reporting of compromising integrity and moral injury (LeClaire et al., 2022), where injury is linked to an outcome as a result of organizational actions and not necessarily perceived as a personal failing, may be worthy of future investigations to see when SEM workers in

different gender, racial, and ethnic groups feel more comfortable identifying various detrimental work-related outcomes.

IMPLICATIONS FOR ACTION AND FUTURE RESEARCH

This paper has several implications for both action and for future research. Regarding action, there has been a lack of urgency to correct burnout findings despite the overwhelming evidence that the consequences are wide, deep, and serious. In particular, gender differences have been known for more than 20 years, and these should be made visible, followed, and addressed (Van Emmerik, 2002; Leiter et al., 2001; Vermeulen & Mustard, 2000). Proposals have been advanced, including adjusting for differential workloads and expectations (e.g., Linzer & Harwood, 2018; Lyubarova et al., 2023). Similarly, better metrics for understanding the lived experiences of those from racially and ethnically minoritized groups need to be developed through improved survey design, better perceived safety when participating in surveys, and qualitative and mixed-methods studies to listen to those in these groups and those who do not identify race or gender and learn how to better ask about and then understand and improve their work lives. To better include underrepresented groups who may prefer not to identify race and ethnicity on traditional surveys, researchers could benefit by adopting more inclusive and nuanced racial categories, emphasizing confidentiality to alleviate the fear of bias, and by employing community-based participatory methods (Linzer et al., forthcoming). Collaborating with trusted community leaders, members of the communities, and organizations can facilitate trust and engender a more natural space in which participants can share their experiences of burnout at work without feelings of individual vulnerability or weakness.

Additionally, new and more inclusive metrics may be required to understand what burnout means to workers in science and engineering, given that most published knowledge on burnout has been concentrated in medicine and the healthcare setting. Citing two surveys among software engineers, Tulili (2023) suggested that 80 percent were experiencing burnout in 2021, although data on the consequences of burnout among engineers is sparse. The wide spectrum of ways in which workers experience burnout appears to require newer, more nuanced approaches as we seek to include workers in studies of distress at work and how to improve job quality and work environments. In healthcare, for example, there is emerging evidence that moral injury as an outcome of adverse work conditions is a

construct that connects strongly with a variety of worker roles and backgrounds (e.g., Dean et al., 2024). Using constructs like moral injury may therefore complement our understanding of the prevalence, antecedents, and consequences of burnout. Separately, cluster-randomized control trials of varying degrees of complexity (e.g., the Multiphase Optimization Strategy, or Sequential, Multiple Assignment, Randomized Trial; Collins, 2018; Kidwell & Almirall, 2023) can also be quickly implemented, supported at organizational and institutional levels with sufficient funding, and then published and advanced, through organizational learning approaches, to move the field ahead and alleviate the degree of human suffering we have demonstrated here (Greene et al., 2012). There is a universality among fields for what produces stress in humans who work (e.g., Karasek et al., 1981), and thus what can be done to improve it. We urge attention to these factors (e.g., time pressure, lack of control in the workplace, chaotic environments, and unsupportive organizational cultures) in the design of future intervention studies and actions.

In general, more research is needed to link the mechanisms of worker burnout with its organizational and societal consequences. Studies should focus on understanding the organizational and societal contexts in which human capital is being eroded or lost. There are areas replete with opportunity to deepen our understanding of worker burnout and its broader effects. One potential area to explore is the domino effect of burnout among leaders and how their well-being affects the employees they manage (e.g., Huang et al., 2016). This cascading effect can reveal how leader burnout contributes to increased stress, disengagement, and exhaustion among other outcomes experienced by the employees who report to them. These processes may also perpetuate a cycle of exhaustion within organizations, yielding harmful consequences like absenteeism and attrition, particularly in highly demanding fields like SEM. Understanding these dynamics could reveal how burnout creates organizational inefficiencies, hinders organizational efforts made to improve burnout, or even contributes to broader workforce shortages. Additionally, there should be longitudinal studies following the career trajectories of SEM workers who choose to leave their job or profession, and whether and how these workers choose to return. Consequently, future studies can then better track the effect of turnover with metrics that are beyond financial in nature, such as on the talent pipeline within the profession or field. Studies should also consider exploring the degree to which burnout among SEM workers influences creativity, innovation, or other desired aspects within an organization.

LIMITATIONS AND STRENGTHS

Our synthesis of the evidence has several limitations worth noting. Although 7,549 total articles were screened, it became clear that there is a relative scarcity of research in the fields of science and engineering, along with great variety in the approaches used to assess burnout outcomes. Furthermore, little research has been done to differentiate the consequences of burnout based on gender identity or race/ethnic identity, which limited our understanding of how burnout may have disparate effects on different populations. Additionally, the minimal presence of randomized controlled trials or longitudinal studies has relegated many results to assessments of correlation without the ability to assert causation or more robust linkages.

Simultaneously, our synthesis of the evidence has several strengths. We employed a multilevel, systematic approach using a review-of-reviews, as well as relevant nonreview articles, examining burnout at the individual, organization, and societal levels. This approach provided a comprehensive view of the impact of burnout at each of those levels. Our work was enriched by a multidisciplinary team of scholars in the field, ensuring depth and expertise throughout the process. We also adopted a horizon-focused perspective, considering the implications of our findings for future research and, ultimately, interventions that may help to address the continually growing problem of burnout. Importantly, we prioritized equity, aiming to use and advance the findings to foster a diverse and sustainable workforce in the fields of science, engineering, and medicine. Finally, the consequences of burnout, which to our knowledge are being systematically tabulated for the first time, offers a valuable resource to guide future inquiries, innovations, and, most importantly, improvements in the field for those working in SEM occupations.

CONCLUSION

The consequences of burnout are pervasive in SEM occupations, with important implications for equity. More research is needed on the organizational- and societal-level consequences of burnout in science and engineering. SEM workers who are women, early-careerists, and in underrepresented racial and ethnic groups require more research and both attention and support from institutions and their leaders. Although there are some gaps in our knowledge, we know enough to better support disproportionately affected groups and to address burnout and its consequences, especially for women SEM workers. We suggest that the time to take action against the consequences of burnout is now.

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