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Publication Briefs

Study Reveals Gender Differences in Relationship between Civility and Burnout among VA Primary Care Providers

Lack of civility in the workplace is defined by rude or discourteous behavior that violates workplace norms. Although the link between workplace incivility and burnout has been well documented in a primarily female nursing workforce (more than 50% of nurses in the US have experienced incivility), incivility has not been well-studied among primary care providers (PCPs), where the gender mix is broader. Further, civility is an increasingly important concept in primary care, as many PCPs work in patient-aligned care teams (PACTs) within the VA healthcare system, and within the community. Thus, this retrospective study analyzed gender differences in civility, burnout, and the relationship between civility and burnout among male and female PCPs. Investigators analyzed data from a 2019 VA survey of 3,216 PCP respondents (1,946 women and 1,270 men) across 135 medical centers. The main outcome was burnout, reported as experiencing emotional exhaustion or depersonalization once a week or more. Investigators also examined responses to survey questions regarding demographic characteristics of gender, race, ethnicity, VA tenure, and supervisory status. Of the study participants, 66% were physicians (MD/DO), 27% were nurse practitioners, and 7% were physician assistants.


  • In multi-level models, greater workplace civility was significantly associated with lower odds of burnout for women, reflecting that in workplaces with higher civility, women were less impacted by burnout. However, workplace civility was not significantly related to burnout among men.
  • Almost half of the sample reported burnout (48%), but this difference was not significant between the genders.
  • Across occupational groups, female nurse practitioners reported lower burnout compared to female physicians. Female supervisors also reported lower burnout rates.
  • Black male and Asian female providers reported lower burnout compared to white male and female providers, respectively.
  • Overall, burnout was lowest among employees with less than or equal to one year of tenure.


  • Interventions tailored to gender- and primary care-specific needs should be employed to increase civility and reduce burnout among primary care providers.


  • This analysis was cross-sectional, precluding causal inferences about reported associations.
  • The survey only asked respondents about workplace civility overall, not about civility between leadership or supervisors and workers – or by any demographic characteristic.

Dr. Apaydin was supported by VA’s Office of Academic Affiliations (OAA) through HSR&D, and Dr. Yano was supported by an HSR&D Senior Research Career Scientist Award. Drs. Apaydin, Rose and Yano (Director) are part of HSR&D’s Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP) in Los Angeles, CA.

Apaydin E, Rose D, Yano E, et al. Gender Differences in the Relationship between Workplace Civility and Burnout among VA Primary Care Providers. Journal of General Internal Medicine. April 26, 2021; online ahead of print.

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