Organizational Support and Burnout Among Gender-Affirming Care Providers: A Structural Equation Modeling Approach

Background and Purpose:
Clinicians providing gender-affirming (GA) care operate within increasingly politicized environments, compounding the emotional labor and burnout commonly experienced in healthcare. Although research has documented high distress among GA providers, little is known about the protective role of organizational support in shaping workforce sustainability. This study applies Conservation of Resources (COR) Theory to assess whether organizational support reduces burnout and enhances well-being, including coping, compassion satisfaction, psychological distress, and intention to leave. We hypothesized that greater perceived organizational support would indirectly reduce provider turnover intention by decreasing burnout and increasing coping and compassion satisfaction.

Methods:
A cross-sectional online survey was administered to a national sample of 142 GA care providers between April and August 2024. Participants were recruited through professional networks such as WPATH, PACT, and the LGBTQ+ Healthcare Directory. Eligible participants included medical, mental health, and social service providers currently engaged in GA care. The survey included 92 items measuring burnout, secondary traumatic stress, and compassion satisfaction (Professional Quality of Life Scale), psychological distress (Kessler-6), resilient coping (BRCS), intention to leave, and perceived organizational support.

An 11-item measure of organizational support was validated through exploratory factor analysis (EFA), which identified three subscales: supervisor support, autonomy in decision-making, and inclusive workplace climate (Cronbach’s α > .80). Structural equation modeling (SEM) was conducted in R using the lavaan package, with robust maximum likelihood estimation and bootstrapped standard errors (5,000 resamples). Missing data (<5%) were handled via listwise deletion.

Results:
The final SEM demonstrated acceptable fit (CFI = .911, TLI = .853, SRMR = .082). The model included both direct and indirect pathways from organizational support—including the latent factors of supervisor support, autonomy, and workplace climate—to intention to leave, mediated by burnout, compassion satisfaction, coping, and psychological distress. Greater organizational support predicted lower burnout (β = –.181, p = .011), higher resilient coping (β = .265, p = .005), and increased compassion satisfaction (β = .346, p < .001). Burnout significantly predicted higher psychological distress (β = 3.362, p < .001), greater intention to leave (β = 2.061, p = .003), and lower compassion satisfaction (β = –.622, p < .001). Compassion satisfaction was also inversely associated with intention to leave (β = –.419, p = .002). Indirect effects confirmed that organizational support lowered turnover intention through reductions in burnout and increases in compassion satisfaction. Coping was not a significant mediator.

Conclusions and Implications:
Organizational support functions as a key protective factor against burnout and turnover among GA providers. Findings suggest that enhancing supervisor support, promoting decision-making autonomy, and fostering inclusive workplace climates may buffer the effects of professional strain and improve workforce retention. As social work increasingly engages with integrated healthcare, results support the need for training in organizational leadership and workforce well-being. This study contributes to SSWR’s 2026 theme by demonstrating how applied organizational research can inform sustainable, justice-oriented social work practice in politically vulnerable fields.