Burnout and Work Engagement in Young Endocrinologists: Do Organizational Variables Matter?

Abstract

The impact of work engagement and burnout on medical activities, physicians’ performance, and quality of care has gained interest over the last decades. However, the effect of demographics, job-related, and organizational variables on burnout and work engagement in young endocrinologists has not been fully investigated. To assess the impact of demographics, job-related, and organizational variables on burnout and work engagement in young endocrinologists who joined the Italian Association of Clinical Endocrinologists. The levels of burnout and work engagement were assessed by the Maslach Burnout Inventory and the Utrecht Work Engagement Scale, respectively, as a part of an online survey of the “Associazione Medici Endocrinologi” addressed to young members (31–40 years). Eighteen MANOVAs were applied to analyze differences in burnout and work engagement based on demographic, job-related, and organizational factors. We collected responses from 160 young endocrinologists, mainly women (80.6%), aged 31–35 years (33.8%) and 36–40 years (66.2%). Most were in a stable relationship with (40%) or without (45%) children. Most of them worked in hospitals or local healthcare districts (35.6%), as independent contractors (31.9%), or as Ph.D. students or residents (25.6%). Multivariate analyses found no statistically significant differences in burnout and work engagement due to demographics (gender, age, and partnership) and job-related variables (type of job and contract). On the other hand, organizational variables (levels of conflict amongst colleagues, more than expected time spent working, and no involvement in team-building activities) were associated with higher emotional exhaustion, lower dedication, and less vigor. The novelty of the study is that both burnout and work engagement can be affected by organizational variables in early-career Italian endocrinologists, highlighting the need for supporting the healthcare system to overcome this gap.

1. Introduction

Work engagement is the harnessing of organization members’ selves to their work roles; in engagement, people employ and express themselves physically, cognitively, and emotionally during role performances (Kahn, 1990). For Kahn (1990), the self and the work roles exist in a dynamic and negotiable relationship in which an individual pushes energies into carrying out behaviors in line with the work role and shows the self within the role (self-expression). Such commitment serves to realize the human spirit at work (May et al., 2004). Engaged workers (i.e., characterized by work engagement, WE) experience a sense of energetic and effective connection with work activities and consider themselves able to cope well with job demands (Schaufeli & Bakker, 2004a).

It should be considered that WE concerns a persistent and pervasive affective/cognitive state, not focused on a particular object, event, individual, or behavior (Schaufeli & Bakker, 2004a). A work environment that makes the worker feel at ease, for example, by enabling the person to perceive organizational support, is one of the critical factors for promoting WE (Qiaoqin et al., 2018; Wu & Lee, 2020). WE is a state of profound involvement and passion for specific job tasks, driven by intrinsic motivation and often resulting in a flow state. Schaufeli et al. (2002) defined WE as a positive and satisfying state of mind related to work characterized by vigor, dedication, and absorption. Vigor is characterized by high levels of mental energy and resilience while working, a willingness to invest effort in one’s work, and persistence even in the face of difficulties. Dedication refers to a strong involvement in work and a sense of meaning, enthusiasm, inspiration, pride, and challenge. Last, absorption is characterized by total concentration and being happily absorbed in work, where time passes so quickly that one has difficulty detaching oneself from work (Schaufeli & Bakker, 2004a).

At the opposite pole of WE, there is burnout (BO). BO is a psychological condition characterized by emotional exhaustion, depersonalization, and reduced personal achievement in response to chronic interpersonal stressors and work overload (Maslach & Jackson, 1981). Maslach and Leiter later modified the syndrome’s components into three factors: deterioration of commitment to work, deterioration of emotions associated with work, and maladaptation to work due to excessive demands (Leiter & Maslach, 1988). Unlike acute stress reactions, BO is a cumulative reaction to chronic stressors at work.

Since Kahn (1990) introduced the concept of engagement, researchers have found a significant and positive relationship between WE, life satisfaction (Shimazu et al., 2015), and performance at work (Bakker & Bal, 2010). Despite the high investment they dedicate to work, work-engaged people participate in social activities and have hobbies (Burke, 2000; Bakker et al., 2008), also managing to have moments to recover their energy (Van Beek et al., 2011). WE is also characterized by high job satisfaction and good mental and physical health (Seppälä et al., 2022). They also consider themselves satisfied with the tasks to be carried out and with the organization itself. WE is also associated with low absenteeism, greater job satisfaction, and a low frequency of turnover requests (Bailey et al., 2017).

The impact of BO on medical activities and physicians’ performance has gained interest over the last decades, including the Coronavirus disease 2019 (COVID-19) pandemic. The sudden health crisis due to the pandemic has led to a consequent work overload, the need for a relevant reorganization of structures to cope with the new challenge, concerns for one’s safety and that of others, and perceived susceptibility to COVID-19. All these stressful conditions could have had sufficient weight to influence BO levels toward either resilience or work impairment (Ortega et al., 2023; Cao et al., 2023). Our previous study on cohort of Italian endocrinologists (Loscalzo et al., 2021) found that BO and WE levels before and during the first wave of the COVID-19 pandemic were significantly affected by several variables, including age, gender, and demographics with the youngest colleagues, compared to mid- or late-career physicians, being more likely to experience higher emotional exhaustion and reduced professional accomplishment. Therefore, the study’s aim is to assess the leading factors influencing WE and BO levels in early-career endocrinologists from the same cohort of colleagues.

2. Literature Review and Work Hypotheses

Satisfaction at work and perceived performance are widely influenced by work regime, which also significantly affects relationships between colleagues and institutions. One study found that job satisfaction was higher among workers experiencing remote or alternating (remote and in-person) jobs than those with an in-person job alone (Pinheiro & Palma-Moreira, 2025).

One study revealed that the higher the conflict level between employees and clients, colleagues, or managers, the more the severity of BO (Danauskė et al., 2023).

Another survey-based study tested the level of anxiety and the leading factors associated with anxiety among students during the lockdown. The results of this survey showed that around 25% of students experienced apprehension with female (OR = 2.2, 95% CI: 1.8–2.7) and those having relatives hospitalized due to COVID-19 (OR = 3.3, 95% CI: 1.4–7.9) being significantly more likely to be at risk for anxiety (Bourion-Bédès et al., 2021).

Climate at work and organizational justice are also important determinants of BO severity among schoolteachers (Capone et al., 2019).

Loscalzo et al. (2021) published one of the first studies assessing the level of BO and WE in a cohort of Italian endocrinologists. More in detail, a survey was conducted with the members of the Italian Association of Clinical Endocrinologists (Associazione Medici Endocrinologi—AME) and found that women reported higher emotional exhaustion and reduced professional accomplishment than men. At the same time, the oldest physicians had lower levels of emotional exhaustion and depersonalization and higher professional accomplishment than the youngest. Overall, the pandemic did not affect BO severity after comparing the pre- with post-COVID, except for physicians directly involved in managing COVID-19 cases. Despite the findings, no specific data on young endocrinologists have been examined. So, as the level of BO arose as particularly high among the younger AME physicians and worsened during the first wave of the pandemic, the present study aimed to assess the leading determinants, including demographic, job-related, and organizational variables, of BO and WE levels among young AME members.

Data from the literature about the severity and the leading causes of BO and WE among early-career physicians are limited but suggest that this class of physicians could be at a significant risk of BO or humble WE because of job and financial conditions. Our hypotheses were therefore conceived to verify specific differences in the levels of BO and WE according to several independent variables, including job stability, salaries, and type of contracts, and career and financial satisfaction (Pinheiro & Palma-Moreira, 2025; Danauskė et al., 2023; Bourion-Bédès et al., 2021). On this basis, our work hypotheses can be represented by the following questions:

• Is job insecurity (typically observed among early careers) associated with more severe BO level and less WE compared to job stability (typically observed for middle-to-late careers)?
• Could low salaries (typically observed among early careers), compared to higher (typically observed among middle-to-late careers) incomes, negatively affect BO level and WE?
• Are more prestigious careers and financial satisfaction (typically observed among middle-to-late careers) associated with lower BO levels and higher WE compared to less career satisfaction (typically observed among early careers)?

Moreover, we analyzed other independent variables not yet addressed by the literature, including being actively involved in team-building activities, and two hypotheses were also formulated to address the following:

• If BO levels are negatively affected by organizational variables;
• If WE is deteriorated by organizational variables.

3. Methods

3.1. Selection of the Study Population

We defined young members as those endocrinologists aged 31 to 40 who had joined the AME at the time of the study. This age group was selected because, at the time of the survey (i.e., 2020), it well representated a sample of the Italian population of early-career endocrinologists.

3.2. Materials

3.2.1. Maslach Burnout Inventory (MBI)

The MBI is a 22-item self-report scale to evaluate BO severity in three specific dimensions: emotional exhaustion (9 items), depersonalization (5 items), and professional accomplishment (8 items). The response format is a 7-point Likert scale ranging from 0 (Never) to 6 (Every Day). We administered the Italian version of the questionnaire by Sirigatti, Stefanile, and Menoni (Sirigatti et al., 1988), allowing us to distinguish between high, average, and low levels of BO (Sirigatti & Stefanile, 1992).

3.2.2. Utrecht Work Engagement Scale (UWES)

The UWES (Schaufeli & Bakker, 2004b) is a 17-item self-report scale to evaluate the WE in three specific components: vigor (6 items), dedication (5 items), and absorption (6 items). The participants rate each item through a 7-point Likert scale ranging from 0 (Never) to 6 (Every day). We administered the Italian version of the UWES (Pisanti et al., 2008).

3.3. Procedures

We conducted a web-based survey with Lime Survey, an open access platform providing several question templates. All participants were invited by email to respond to questionnaires. Email addresses of all members were registered at the time of the AME subscription, and all members provided the privacy license to store basic information on the AME database, including email addresses, to be used for professional or research purposes.

An email service sent reminder messages to non-respondents weekly until the request automatically expired after three consecutive reminders.

The survey responses were gathered and electronically stored by the system, and participants had free access to their information masked with a password. The survey service automatically blocked repeated submissions from the same IP address.

3.4. Statistical Analysis

We conducted the analyses using the statistical software SPSS.28.0. More specifically, we performed 18 MANOVAs to analyze BO and WE differences about demographic variables (i.e., gender, age [31–35 vs. 36–40 years], civil partnership), job-related variables (i.e., type of work activity and type of contract), and organizational variables (i.e., levels of conflict in the organization, respect of the working hours foreseen by the contract, money earning congruent with the working demands, and presence of team-building activities). Through one sample t-test, we analyzed if the present sample of endocrinologists gathered after the end of the first wave of the COVID-19 pandemic differs in BO levels compared to doctors (mainly endocrinologists) who filled the MBI before the COVID-19 outbreak and during the COVID-19 pandemic (Loscalzo et al., 2021). Since our analyses foresee 54 follow-up ANOVAs on the same sample, we adjusted the alpha level to 0.001, using the Bonferroni correction for multiple comparisons (S. Y. Chen et al., 2017). For all the MANOVAs, when the independent variables involved more than two groups, a Bonferroni post hoc test was performed.

4. Results

4.1. Participants

We collected responses from 160 young endocrinologists (mainly women, 80.6%) between 31 and 40 years (31–35 years, 33.8%; 36–40 years, 66.2%). Respondents were mostly from Lazio (18.8%), Lombardy (15.6%), Emilia-Romagna (11.3%), Sicily (8.1%), and Sardinia (5.6%). Most respondents were in a stable relationship with (40%) or without (45%) children, while only a minority of respondents were single (15%).

Some respondents were working in public healthcare services, including hospitals and local healthcare districts (35.6%), and some others were working as independent contractors (31.9%) or were engaged as Ph.D. students or residents (25.6%). There were also a few endocrinologists working in private clinics (2.5%) and seven endocrinologists involved in other types of professions. Regarding the kind of contract, 26.9% had a permanent contract, 10% had a fixed-term contract, 25.6% were on studentship, 17.5% were working in public or private clinics, and 16.3% were on private practice (16.3%) or other types of contracts (e.g., agreement with the National Healthcare System, 3.8%). As indicated in

Table 1. Participants’ risk of burnout according to the Maslach Burnout Inventory (MBI).

MBI Scale	Level of Risk	n	%
Emotional Exhaustion	Mild	52	32.5
	Moderate	48	30.0
	Severe	60	37.5
Depersonalization	Mild	67	41.9
	Moderate	48	30.0
	Severe	45	28.1
Personal Realization	Mild	68	42.5
	Moderate	45	28.1
	Severe	47	29.4

Notes: the level of risk has been defined according to the Sirigatti and Stefanile’s (1992) cut-off scores.

, most participants had moderate-to-high risk BO estimated with the Maslach Burnout Inventory (May et al., 2004).

4.2. Burnout and Work Engagement Differences on Demographic Variables

We conducted three MANOVAs with the three MBI scales: emotional exhaustion, depersonalization, and professional accomplishment. The other three MANOVAs were conducted using the three UWESs: vigor, dedication, and absorption. Tests were performed to verify differences in BO and WE related to gender, age, and civil partnership. In multivariate tests, gender was not statistically significant for BO [F(3,156) = 1.63, p = 0.185, partial η² = 0.03], while it was statistically significant for WE [F(3,156) = 3.16, p = 0.026, partial η² = 0.06]. However, follow-up ANOVAs did not reach the adjusted alpha levels for the three subscales.

We found similar results for age. The multivariate test was statistically significant for BO: F(3,125) = 2.92, p = 0.037, partial η² = 0.07. However, follow-up ANOVAs did not reach statistical significance using the adjusted alpha value. Regarding WE, the multivariate test was not statistically significant for age: F(3,125) = 0.67, p = 0.575, partial η² = 0.02.

Finally, the multivariate test for the effect of civil partnership on BO was statistically significant [F(6,310) = 2.28, p = 0.036, partial η² = 0.04], but ANOVA results did not reach the adjusted alpha level for statistical significance. The multivariate test did not find a statistically significant effect of civil partnership on WE [F(6,310) = 1.19, p = 0.312, partial η² = 0.02].

4.3. Burnout and Work Engagement Differences on Job-Related Variables

We also conducted two MANOVAs with the three MBI scales and two MANOVAs with the three UWESs as dependent variables to explore differences in BO and WE related to work activities and contracts. The results highlighted no statistically significant differences in BO and WE levels according to the two work-related variables. More precisely, we compared the group of endocrinologists who worked in private structures (n = 4) with those who practiced in public structures (n = 57), private practice (n = 51), and Ph.D. students or students attending a postgraduate residency (n = 41). The multivariate test was not statistically significant for both BO [F(6,296) = 1.83, p = 0.093, partial η² = 0.04] and WE [F(6,296) = 0.34, p = 0.916, partial η² = 0.01].

Regarding the type of contract, we considered the following groups: permanent contract (n = 43), scholarship (n = 41), independent contractors working in public or conventional clinics (n = 28), and any contract as being a private professional (n = 26). The multivariate test was not statistically significant for both BO [F(9,321.40) = 1.42, p = 0.176, partial η² = 0.03] and WE [F(9,321.40) = 0.71, p = 0.697, partial η² = 0.02].

4.4. Burnout and Work Engagement Differences on Organizational Variables

Finally, we conducted four MANOVAs with the MBI scales and four MANOVAs with the UWESs as dependent variables to explore differences in BO and WE levels related to the following organizational variables: levels of conflict experienced by the physicians concerning the working hours foreseen by contracts, fair earnings to working demands, and involvement in team-building activities.

Concerning the levels of conflict, we found a multivariate statistically significant effect on BO [F(6,310) = 4.68, p < 0.001, partial η² = 0.08]. More precisely, follow-up ANOVAs showed a statistically significant difference in emotional exhaustion (

Table 2. Descriptive statistics and ANOVA results for burnout by organizational variables.

Burnout Variable	Organizational Variable	Group	n	M(SD)	F	df	p	Partial η2
Em.Exhau.	Conflict levels	Absent	21	16.48 ± 8.33	14.24	2157	<0.001	0.15
		Physiological	103	23.87 ± 11.69
		Excessive	36	32.67 ± 12.47
		Total	160	24.88 ± 12.43
Depers.		Absent	21	4.71 ± 3.48	6.75	2157	0.002 #	0.08
		Physiological	103	8.14 ± 6.54
		Excessive	36	11.08 ± 7.17
		Total	160	8.35 ± 6.62
Prof.Acc.		Absent	21	38.81 ± 3.67	3.54	2157	.031 #	0.04
		Physiological	103	37.43 ± 6.49
		Excessive	36	34.56 ± 7.82
		Total	160	36.96 ± 6.64
Em.Exhau.	Hours respected	Yes	46	17.72 ± 11.15	28.86	1157	<0.001	0.14
		No	113	27.96 ± 11.65
		Total	159	24.99 ± 12.38
Depers.		Yes	46	5.35 ± 4.74	14.52	1157	<0.001	0.08
		No	113	9.59 ± 6.92
		Total	159	8.36 ± 6.64
Prof.Acc.		Yes	46	38.85 ± 6.12	5.29	1157	0.023 #	0.03
		No	113	36.20 ± 6.75
		Total	159	36.97 ± 6.66
Em.Exhau.	Fair salary	Yes	80	29.16 ± 11.69	21.43	1158	<0.001	0.12
		No	80	20.60 ± 11.70
		Total	160	24.88 ± 12.43
Depers.		Yes	80	9.61 ± 6.86	6.01	1158	0.015 #	0.04
		No	80	7.09 ± 6.16
		Total	160	8.35 ± 6.62
Prof.Acc.		Yes	80	36.32 ± 7.06	1.48	1158	0.226	0.01
		No	80	37.60 ± 6.17
		Total	160	36.96 ± 6.64
Em.Exhau.	Team building	Never	67	26.82 ± 13.28	3.39	2157	0.036 °	0.04
		Rarely	67	25.04 ± 11.27
		Often	26	19.46 ± 11.86
		Total	160	24.88 ± 12.43
Depers.		Never	67	8.95 ± 7.16	2.15	2157	0.120	0.03
		Rarely	67	8.69 ± 6.29
		Often	26	5.92 ± 5.60
		Total	160	8.35 ± 6.62
Prof.Acc.		Never	67	36.33 ± 6.87	4.09	2157	0.019 °	0.05
		Rarely	67	36.30 ± 6.75
		Often	26	40.31 ± 4.67
		Total	160	36.96 ± 6.64

Note: Em.Exhau. = Emotional Exhaustion; Depers. = Depersonalization; Prof.Acc. = Professional Accomplishment; ^# = not statistically significant according to the adjusted alpha level for multiple comparisons; ^° = not statistically significant according to the adjusted alpha, plus MANOVA not statistically significant.

). As highlighted by Bonferroni’s post hoc test, endocrinologists experiencing an excessive conflict level reported higher emotional exhaustion than those perceiving physiological (p < 0.001) or absent (p < 0.001) levels of conflict. In terms of WE, the multivariate test was statistically significant [F(6,310) = 3.51, p = 0.002, partial η² = 0.06]. Nevertheless, follow-up ANOVA reached statistical significance for dedication only (

Table 3. Descriptive statistics and ANOVA results for work engagement by organizational variables.

Work Engagement Variable	Organizational Variable	Group	n	M (SD)	F	df	p	Partial η2
Vigor	Levels of conflict	Absent	21	24.24 ± 4.77	6.36	2157	0.002 #	0.08
		Physiological	103	23.59 ± 5.37
		Excessive	36	19.93 ± 6.74
		Total	160	22.85 ± 5.82
Dedication		Absent	21	23.24 ± 4.24	9.69	2157	<0.001	0.11
		Physiological	103	21.34 ± 6.03
		Excessive	36	16.81 ± 7.11
		Total	160	20.57 ± 6.42
Absorption		Absent	21	24.71 ± 4.50	1.27	2157	0.284	0.02
		Physiological	103	24.63 ± 5.42
		Excessive	36	23.01 ± 5.88
		Total	160	24.28 ± 5.42
Vigor	Hours respected	Yes	46	24.48 ± 4.99	5.28	1157	0.023 #	0.14
		No	113	22.16 ± 6.04
		Total	159	22.83 ± 5.84
Dedication		Yes	46	21.91 ± 6.56	2.76	1157	0.099	0.08
		No	113	20.05 ± 6.34
		Total	159	20.59 ± 6.43
Absorption		Yes	46	24.28 ± 5.85	0.001	1157	0.974	0.03
		No	113	24.31 ± 5.28
		Total	159	24.30 ± 5.43
Vigor	Fair salary	Yes	80	21.76 ± 6.61	5.85	1158	0.017 #	0.04
		No	80	23.95 ± 4.71
		Total	160	22.85 ± 5.82
Dedication		Yes	80	19.82 ± 6.66	2.16	1158	0.143	0.01
		No	80	21.31 ± 6.13
		Total	160	20.57 ± 6.42
Absorption		Yes	80	24.57 ± 5.24	0.46	1158	0.500	0.003
		No	80	23.99 ± 5.62
		Total	160	24.28 ± 5.42
Vigor	Team building	Never	67	21.60 ± 5.87	8.49	2157	<0.001	0.10
		Rarely	67	22.56 ± 5.60
		Often	26	26.85 ± 4.57
		Total	160	22.85 ± 5.82
Dedication		Never	67	19.36 ± 6.67	6.69	2157	0.002 #	0.08
		Rarely	67	20.24 ± 6.04
		Often	26	24.54 ± 5.30
		Total	160	20.57 ± 6.42
Absorption		Never	67	23.22 ± 5.18	6.70	2157	0.002 #	0.08
		Rarely	67	24.04 ± 5.56
		Often	26	27.61 ± 4.45
		Total	160	24.28 ± 5.42

Note: ^# = not statistically significant according to the adjusted alpha level for multiple comparisons.

). Bonferroni’s post hoc test highlighted that endocrinologists who reported excessive levels of conflict had lower dedication than those reporting physiological (p < 0.001) or absent (p < 0.001) levels of conflict. Hence, an excessive perceived organizational conflict was associated with greater emotional exhaustion and lower dedication. A physiological level compared to the absent level of conflict also led to higher emotional exhaustion.

Concerning the number of hours spent at work foreseen or not by contracts, the multivariate test was statistically significant for both BO [F(3,155) = 8.78, p < 0.001, partial η² = 0.15] and WE [F(3,155) = 2.81, p = 0.041, partial η² = 0.05]. However, follow-up ANOVAs reached statistical significance for BO only, specifically for emotional exhaustion and depersonalization (Table 2 and Table 3). In particular, the endocrinologists reporting that they sometimes worked more than expected had higher scores in emotional exhaustion and depersonalization than their colleagues who declared that their working hours aligned with those foreseen by contracts.

About fair earnings based on working demands, the multivariate test was statistically significant for both BO [F(3,156) = 7.48, p < 0.001, partial η² = 0.13] and WE [F(3,156) = 4.36, p = 0.006, partial η² = 0.08]. Follow-up ANOVAs reached statistical significance only for one BO variable, namely emotional exhaustion, as those who reported not receiving fair earnings have high emotional exhaustion compared to those receiving fair earnings (Table 2 and Table 3).

Concerning the involvement in team-building activities, the multivariate test was not statistically significant for BO [F(6,310) = 1.80, p = 0.098, partial η² = 0.03], but statistically significant for WE [F(6,310) = 3.24, p = 0.004, partial η² = 0.06]. Follow-up ANOVAs highlighted a statistically significant difference on the WE variable “vigor” (Table 2 and Table 3). More specifically, as shown by Bonferroni’s post hoc analyses, those who reported being often included in team-building activities had higher vigor than those excluded (p < 0.001) or who rarely participated in these activities (p = 0.003).

5. Discussion

BO affects people who practice helping and personal service professions due to the adequate reaction to excessive work-related stress (Favretto, 1994; Maslach & Leiter, 2017; Del Carmen et al., 2019). Since BO is an answer to persisting chronic interpersonal stressors at work, it tends to be stable over time (Khalafallah et al., 2020). BO can, therefore, be considered as work-related chronic stress induced by the relevant discrepancy between work demands and individual resources, as supported by the Job Demands–Resources model by Bakker and Demerouti (Bakker et al., 2023). BO is associated with an increased risk of errors during the management of patients (Li et al., 2023) and could be associated with potentially adverse outcomes (Tawfik et al., 2018).

The leading clinical manifestations of BO are chronic clinical manifestations, feelings of guilt, inadequacy, incompetence, and negligence. BO negatively influences the sense of empowerment and self-confidence in personal abilities (K. Y. Chen et al., 2013; Dong et al., 2023), thus becoming a risk factor for job failure, depressive mood, and suicide (Shanafelt et al., 2012; Lindeman et al., 1996; Kleinhendler-Lustig et al., 2023; Schernhammer & Colditz, 2004).

The present study found no differences in BO or WE levels due to some specific demographic variables. The finding aligned with another report on young medical students (Shrestha et al., 2021). Early-career endocrinologists did not show any difference in reacting to emotional and work overload, and BO and WE levels were similar in men and women. The result was in line with other studies (Kannampallil et al., 2020; Milch et al., 2021) but different from our previously published paper concerning BO in the whole cohort of AME members, where women experienced higher BO levels than men (Loscalzo et al., 2021). This point reflects socio-cultural issues, even in the physician cluster, where women, compared to men, usually spend more time in household and family care, resulting in possible physical and psychological overload affecting the overall wellbeing at work and fostering BO. However, data from the youngest cohort of Italian endocrinologists did not suffer from a gender-related dichotomy, probably indicating that the new generations follow different and more balanced social and household roles than in the past.

No statistically significant differences in BO and WE levels were reported regarding work assignments and contracts. Endocrinologists working in hospitals and private clinics, those engaged in private practice, residents, or Ph.D. students did not show any difference in the level of BO and WE. Although job satiation was substantially low among early and mid-careers compared to late careers due to uncertainty of contractors and future development of plans and projects, work overload, possible abuses (Perumalswami et al., 2020), and reactive mood disorders (depression, anxiety), it should be considered that work-related negative situations are probably not enough to affect the levels of WE and BO in a short period (months). The dichotomy can be explained by the fact that the recent past and current work dynamics are usually less friendly for a comfortable early-career job placement and do not facilitate the development of ambitious and long-term projects. Future studies are needed to clarify the impact of labor market dynamics, which drives early-career endocrinologists to adjust their professional perspective more frequently to achieve acceptable working conditions based on aspirations, capabilities, competence, work satisfaction, WE, and BO. On the other hand, our findings can be the result of a change in expectations of young endocrinologists compared to the late-career endocrinologists in the past due to cultural, economic, and political aspects.

Dealing with possible differences in BO and WE due to the organizational variables, we found that the conflict level perceived by colleagues influences BO, particularly emotional exhaustion, and WE. Endocrinologists reporting excessive levels of conflict in their organizations/institutions had higher emotional exhaustion and lower dedication than those experiencing a physiological or absent level of conflict. Moreover, a physiological level of conflict leads to higher emotional exhaustion compared to the perception of no conflicts in the workspace. Therefore, the feeling of being passionate about the work and the sense of enthusiasm, inspiration, satisfaction, and challenge can be compromised in those individuals. The literature indicates that physicians need degrees of choice, social connectedness, friendship, and opportunities to improve the quality and satisfaction of their profession, mitigate BO, and increase WE (Marck et al., 2024). Leadership and organization are crucial in reducing BO and promoting WE, considering that most interventions to achieve both aims are relatively inexpensive, and small investments can significantly impact physicians’ health (Swensen et al., 2016). Interventions to improve medical procedures, promote team-based care, and incorporate the use of medical assistants to complete documentation and electronic health registries attenuate BO, enhance physician resiliency, and quality of team care (Shanafelt & Noseworthy, 2017). An experience from an academic environment found similar results with trends showing an increasing prevalence of BO, especially exhaustion and cynicism, more in early- compared to mid- or late careers (DeChant et al., 2019).

To our knowledge, a few studies have been conducted on endocrinologists. In the Italian scenario, endocrinologists who sometimes work more than foreseen by their contracts have higher emotional exhaustion and depersonalization than colleagues who declare they work for hours in line with their contracts. Furthermore, endocrinologists who reported not receiving a fair income usually show a high level of emotional exhaustion, thus underlining the concept that improvement of professional performance passes across a better organization of work with better distribution of loads and tasks to avoid spending more time than expected by contracts and fair income. Lastly, the importance of being involved in team-building activities was confirmed by the fact that participating in team leadership was associated with higher WE, higher vigor, higher levels of energy, and mental consistency when working with stressors and overloads.

Overall, the results of this study highlighted that administrative and operational inconsistency, messy workspaces, lack of cooperation, and intolerance result inexorably in work uncertainty, overload, need to move to alternative placement and careers, and dissatisfaction with low WE and higher levels of BO. Early-career endocrinologists are prone to the effect of BO, with a specific issue that should be addressed shortly.

5.1. Theoretical Implications of the Study Results

The results of our study focused on the overall BO and WE levels among early-career endocrinologists joining the AME at the time of the survey. Our findings clearly indicated that organizational variables, with a specific emphasis on the levels of conflict among colleagues, the excessive time spent at work, and the lack of involvement in team-building activities, increase emotional exhaustion, reduce dedication at work, and impair vigor. Therefore, healthcare system organization is necessary to improve the quality of work, prevent BO, and avoid WE deterioration and related consequences.

5.2. Managerial Implications of the Study Results

Specific managerial implications can be inferred from our theoretical implications. First, a working environment should be organized to satisfy individual needs, ambitions, and goals and eliminate job insecurity and competition, thereby enhancing a professional’s self-confidence and engagement. Second, supervising team building and fostering healthy working relationships are key elements that support and refine individual and collective initiatives, reinforce strategies for achieving common goals, and stimulate analyses and research, thereby minimizing the risk of potential conflicts among colleagues. Team-building activities, regular meetings and brainstorming, and continuative formation are also essential to improve the communication, education, and encountering activities between professionals, which, in turn, are expected to ameliorate the work quality, enhance the collaboration between colleagues, optimize time spent on practical work, reduce time spent in useless activates, and attenuate emotional exhaustion while boosting vigor and dedication at work, resulting in less time spent in the workspace and lower work overload.

5.3. Strengths, Limitations, and Future Directions

The study has some strengths and limitations that need to be mentioned. The strength is in the study design, which was initially intended to estimate the BO and WE levels among all professionals, primarily physicians, who joined the AME at the time of the observation. Then, the study protocol was refined to reassess the BO and WE levels during and after the first wave of the COVID-19 pandemic. So, it is one of the first papers to consider a pre- to post-COVID comparison of BO and WE assessment. The second strength point is the methodology used to estimate BO and WE, which employs approved elementary scales widely used in clinical practice. The main limitation is the generalizability of our results, which refer to a specific time point. Novel data are also needed to reevaluate BO and WE levels years later the COVID-19 outbreak. Engaged and motivated professionals are key factors in a healthy healthcare system, with the goal of enhancing the quality of care for both citizens and healthcare providers. Despite the limited generalizability of the results, which mainly referred to the COVID-19 breakdown, so it is required new and specific evaluation of BO and WE levels among clinicians and researchers in the fields of Endocrinology, Internal Medicine, and affine, there is a flawless need to ameliorate the quality of healthcare organization from a managerial viewpoint, establish objective methods of evaluation of work quality and frequent reorganization to cope with the risk of work overload, improve the collaboration among colleagues, educate continuously human resources, and invest on quality from a clinical and research viewpoint.

6. Conclusions

Healthcare system organization is necessary to improve the quality of work, prevent BO, and avoid WE deterioration and related consequences. There is a real need to implement essential reforms and economic efforts to build engaged professionals. The key elements for relevant improvements include improving the working environment to satisfy individual needs, ambitions, and goals. Deleting job insecurity and competition will be another key point to ameliorate a professional’s self-confidence and engagement. Supervising team building and fostering healthy working relationships is another element that supports and refines individual and collective initiative, reinforces the way to obtain common goals, and stimulates analysis and research.