Turnover Intention Among Gender-Affirming Care Providers: Burnout, Organizational Support, and Survey Year across Two Cross-Sectional Samples

Background and Purpose

Healthcare providers delivering gender-affirming care (GAC) operate within increasingly complex and shifting policy and organizational environments. While prior research has documented high levels of burnout and distress among these providers, less is known about how provider wellbeing and workforce stability may differ across policy and organizational contexts. This study examines predictors of turnover intention among gender-affirming care providers using two cross-sectional samples collected in 2024 and 2025, with a focus on burnout, perceived organizational support, and survey year. We situate these relationships within broader frameworks of policy-driven organizational strain and workforce sustainability.

Methods

We conducted a cross-sectional analysis using two independent samples of gender-affirming care providers collected in 2024 and 2025 (N = 183). Measures included intent to leave (assessed as a continuous composite reflecting likelihood of leaving one’s current position), burnout (ProQOL), psychological distress (K6), resilient coping (BRCS), and perceived organizational support. To assess comparability between samples, chi-square tests and independent samples t-tests examined demographic and professional characteristics. Pearson correlations examined bivariate associations between key variables. A multivariable linear regression model was estimated to identify predictors of intent to leave, including burnout, organizational support, survey year, and demographic covariates (gender, years in practice). Model diagnostics assessed multicollinearity, autocorrelation, and residual assumptions.

Results

The 2024 and 2025 samples were largely comparable across demographic and professional characteristics. In bivariate analyses, intent to leave was associated with higher burnout (r = .46, p < .001) and lower organizational support (r = −.43, p < .001). In the multivariable model (R² = .33, p < .001), burnout (β = .38, p < .001) and organizational support (β = −.30, p < .001) remained significant predictors of intent to leave. Survey year also remained a significant predictor (β = .21, p = .002), indicating higher turnover intention in 2025 after adjusting for burnout, organizational support, and demographic covariates.

Conclusions and Implications

Burnout and organizational support were significant predictors of turnover intention, and survey year remained independently associated with higher intent to leave. The persistence of the survey year effect after adjustment suggests that factors beyond individual wellbeing and perceived organizational support may contribute to workforce instability. These findings point to the potential influence of broader policy and organizational conditions shaping clinical practice environments. Efforts to support provider retention should address both organizational context and structural conditions.