The Relationship Between Burnout, Effort-Reward Imbalance, and Intention to Leave in Early Intervention Rehabilitation Professionals

This study examined the relationship between effort-reward imbalance (ERI), burnout, and intention to leave (ITL) among 465 rehabilitation professionals providing early intervention (EI) services to children from birth to three years in one US state. Using a cross-sectional survey design, physical therapists, occupational therapists, and speech-language pathologists completed validated measures assessing ERI, overcommitment, burnout, and ITL across three domains: early intervention, pediatrics, and the profession. Multivariable ordinal logistic regression and mediation analyses revealed that ERI was the strongest predictor of ITL across all three domains, with effects 11–63% higher than overcommitment. Over 80% of providers reported moderate to high burnout levels, and nearly one-quarter considered leaving EI weekly. Burnout partially mediated the relationship between ERI and ITL EI and the profession, while the relationship between ERI and leaving pediatrics was direct and not mediated by burnout. Years of experience in EI provided protective effects against burnout-mediated turnover. Findings suggest that workforce retention in EI requires systemic interventions that address modifiable organizational factors, such as inadequate compensation, administrative burden, and insufficient mentorship, rather than solely focusing on individual burnout reduction. Evidence-informed policy and organizational changes are essential to stabilize the EI workforce and best support children during this critical developmental period.