Executive summary
Middle management is where an organization's strategy becomes work. It is also where the strain of that translation collects, and where it is least likely to be visible to anyone with the authority to act on it. The data now describes a layer disengaging faster than the people it leads, planning its exit in larger numbers than the executives above it, and doing so quietly enough that most employers find out at the resignation.
Managers hold pressure from above and constraint from below and are expected to show neither, while 97 percent of them still carry a full individual-contributor workload.06
Every internal route to help asks a manager to disclose strain inside the same system that judges their fitness to lead, which is the one thing the role makes unaffordable.
Confidential clinical care held outside the reporting line, delivered by licensed clinicians who work with people in leadership roles, in more than one session format so depth can follow the problem rather than the calendar.
The manager layer stays intact: fewer avoidable exits, earlier recognition of decline, and engagement that holds in the teams reporting into it.
The problemThe layer that absorbs everything§
Manager engagement worldwide fell to 22 percent in 2025, down from 30 percent in 2023, while engagement among the individual contributors those managers lead held close to 19 percent and barely moved.01 That divergence is the subject of this paper. The layer closest to the work is not simply sharing in a general decline. It is falling faster than the layers above and below it, and it is falling in a way that is structurally difficult to see. In the United States the shape was already visible three years earlier: 31 percent of managers were engaged as of May 2023, down from 38 percent in January 2020; 55 percent were watching for or actively seeking a new job, up from 46 percent; and only 22 percent believed their organization cared about their wellbeing, down from 47 percent.03
The population this describes is not small. Management occupations in the United States are projected to produce about 1.1 million openings a year from 2024 to 2034, at a median annual wage of 122,090 dollars as of May 2024.12 Most of those roles are nowhere near a C-suite. They are directors, department heads, service line leaders and first-line managers: the people who turn a strategy deck into a staffing plan, a delivery date and a difficult conversation. The usual framing treats this layer as overhead to be optimized, a cost of coordination that a flatter structure would remove. The evidence says it is the transmission system, and that it is currently running hot.
A middle manager is the only person in the building expected to absorb pressure from two directions and show it in neither. CEREVITY clinical whitepaper series, 2026
The evidenceWhat the research shows§
Four independent bodies of evidence converge on the same finding: the manager layer carries more load than the layer beneath it, receives less support than the layer above it, and reports the strain least. What follows is drawn from large-sample workforce panels, a management survey of 706 middle managers, a four-country wellbeing survey of 3,150 workers, managers and executives, and US federal occupational data. The figures are reported separately rather than pooled, because each study defines manager differently.
22%
Managers engaged at work worldwide in 2025, down from 30% in 2023
Gallup, 202601
35%
US managers reporting burnout very often or always in 2021, up from 28%
Gallup, 202104
64%
Managers seriously considering leaving for better wellbeing support
Deloitte, 202309
12bn
Working days lost worldwide each year to depression and anxiety
WHO, 202411
04, 05 Gallup. (2021). Manager Burnout Is Only Getting Worse. US managers, n=1,569, fielded 25 January to 23 August 2021.
Gallup. (2022). The Antidote to Manager Burnout. Gallup COVID-19 Workforce Study, n=14,419 full-time US employees.
Read together the figures describe one condition rather than a set of separate problems. The load is structural: 97 percent of managers still hold individual-contributor responsibilities, and the median manager spends 40 percent of working time on non-managerial work, so people leadership is an addition to the job rather than the job itself.06 McKinsey's survey of 706 middle managers found nearly half their time going to non-managerial work and less than a third to talent and people management, with only 20 percent strongly agreeing their organization enables them to succeed as people managers.08 The strain is chronic rather than acute, which is precisely the condition the World Health Organization's ICD-11 entry describes: a syndrome resulting from chronic workplace stress that has not been successfully managed, expressed as energy depletion, mental distance or cynicism about the job, and reduced professional efficacy.10 And the exposure is widening. The average span of control rose from 10.9 direct reports in 2024 to 12.1 in 2025, close to a 50 percent increase since 2013.06
None of this is invisible to the people around a struggling manager. It is invisible to the systems that measure them. The behavioral markers that run ahead of a manager's exit are recognizable in advance, which is why CEREVITY publishes a field guide to the signs a leadership team is burned out. What the survey data adds is scale. This is not an occasional bad quarter for one director; it is a measurable condition of the layer.
The annual engagement survey is the usual early-warning instrument, and for this population it is the wrong one. A manager answering a company survey is disclosing to the system that decides whether they are promoted, which is a large part of why what an engagement survey misses is concentrated in exactly this group. Gallup's own comparison is instructive: managers are 67 percent more likely than individual contributors to report frequent interruptions and 40 percent strongly agree they are juggling multiple competing priorities, yet 8 percent strongly agree their performance review inspires them to improve.05
| Measure | Managers | Comparison point | Source |
|---|---|---|---|
| Engaged at work, worldwide, 2025 | 22% | 19% among individual contributors | Gallup, 202601 |
| Change in engagement, 2023 to 2025 | Down 8 points | Individual contributors close to flat | Gallup, 202601 |
| Burnout very often or always, US managers | 35% in 2021 | 28% among the same group in 2020 | Gallup, 202104 |
| Believe the employer cares about their wellbeing, US managers | 22% in May 2023 | 47% in January 2020 | Gallup, 202303 |
| Watching for or actively seeking a new job, US managers | 55% in May 2023 | 46% in January 2020 | Gallup, 202303 |
| Share of working time on non-managerial work | 40% median | 97% of managers still hold such duties | Gallup, 202606 |
| Seriously considering leaving for better wellbeing support | 64% of managers | 60% of employees, 75% of the C-suite | Deloitte, 202309 |
03 Gallup. (2023). The Manager Squeeze: How the New Workplace Is Testing Team Leaders. Gallup Workforce Studies, quarterly samples of roughly 13,500 to 60,800 US respondents.
The frameworkA model you can name and own§
A named model does two useful things. It gives a manager language for something they have been living without a word for, and it gives an executive team a shared reference for a decline that otherwise gets filed as a performance issue. The model below describes what clinicians in the CEREVITY network see in the middle-management population specifically, which is not the same pattern seen in founders or in the C-suite. It is a description of sequence, not a diagnostic instrument, and its value is that each phase is recognizable before the next one arrives. Structured clinical work on that sequence is what therapy for executive burnout is built to do.
CEREVITY model
The Absorbed-Load Model
A four-phase description of how burnout develops in the layer between strategy and delivery. Each phase is defined by where the pressure goes rather than by how the manager feels, because in this population the feeling is the last thing to become visible to anyone else.
Absorption
Pressure arrives from above as a target and from below as a constraint. The manager holds both, filters what the team hears, and treats the buffering as part of doing the job well. Nothing looks wrong yet, because it is working.
Translation
Converting strategy into executable work consumes the day, so the manager's own deliverables migrate to evenings and weekends. Output still holds. What is being spent is recovery time, and nobody is measuring that.
Insulation
Strain stops moving in either direction. Escalating upward reads as an admission of not coping, and showing it downward destabilizes the team. The manager becomes the only person in the reporting line with nobody who can hear the whole picture.
Detachment
Cynicism arrives before exhaustion is ever admitted. Discretionary effort withdraws, decisions get deferred, and team engagement begins to track the manager's. The exit, when it comes, is presented as a career move and read by the organization as a surprise.
SCHEMATIC Schematic, not measured data.
Illustrative model of the sequence described in section 03. No underlying measurement is claimed.
The decision this model is meant to inform is when to intervene, not whether. Absorption and translation are invisible by design, because a competent manager buffering pressure is doing the job as written. Insulation is the point at which the organization loses its ability to see the problem at all, and it is also the last phase at which a confidential conversation is still an ordinary thing to arrange rather than a crisis response. Everything an employer does to shorten the distance between translation and a first clinical conversation is repaid at detachment.
By professionHow it presents across roles§
The sequence is common to the layer, but its content is sector specific. What a manager is being asked to absorb, and what disclosure would cost them, differ enough that a single program design will fit none of them well. Three populations illustrate the range, and each is large enough to plan around.
Technology and engineering management
Computer and information systems managers held 667,100 US jobs in 2024, at a median wage of 171,200 dollars, and the occupation is projected to grow 15 percent through 2034.13 The role is defined by planning and directing the work of other technical staff, which in practice almost never displaces the technical work itself. The engineering manager who still owns a service, still reviews code and still carries on-call is the normal case rather than the exception, and it is the clearest expression of the finding that 97 percent of managers retain individual-contributor duties and spend a median 40 percent of their time on them.06 Distributed work sharpens the effect. Only 30 percent of hybrid managers had received any formal training in leading hybrid teams, and only 30 percent strongly agreed their own supervisor kept them informed about what was happening in the organization.03 Clinicians in the CEREVITY network see the resulting pattern reliably in this population: sleep goes first, because the only uninterrupted engineering time left in the day is after midnight; then decision latency rises, because every judgment call is being made on a depleted system; then the manager quietly stops advocating for the team upward, which is the point at which attrition beneath them begins. What is rarely present is any language for it. In a culture that prizes technical mastery, exhaustion is experienced as a skill failure rather than as a workload signal, and the first honest account of it is often given to a clinician rather than to a manager, a partner or a peer.
Individual therapy for technology leadership
Organizational the remote and hybrid team burnout partnership
Clinical and healthcare management
Medical and health services managers held 616,200 US jobs in 2024 at a median wage of 117,960 dollars, and the occupation is projected to grow 23 percent through 2034, one of the fastest rates in the economy.14 Many of those roles are filled by practicing clinicians who have added a management remit to a caseload rather than replaced it. They arrive already carrying the profession's baseline: 45.2 percent of US physicians reported at least one symptom of burnout in 2023, down from 62.8 percent in 2021 but still above other US professions.17 CDC analysis of the Quality of Worklife survey found health workers reporting burnout very often nearly doubled between 2018 and 2022, from 11.6 percent to 19.0 percent, with poor mental health days rising from 3.3 to 4.5 a month.16 The same analysis found what protects against it, and the finding is uncomfortable for anyone designing a program: supervisor help was associated with roughly 74 percent lower odds of burnout, and trust in management with about 60 percent lower odds.16 In other words the medical director, service line chief or nurse manager is the single most powerful protective factor available to the department, which is exactly why their own depletion propagates so fast. Disclosure carries a specific and well-founded fear in this group, because licensure, credentialing and privileging processes are the frame through which clinicians read any mental health record. Support that leaves no such record is not a preference here. It is the precondition for the conversation happening at all.
Individual physician mental health care
Organizational the hospital system partnership for physician burnout
Financial services management
Financial managers held 868,600 US jobs in 2024 at a median wage of 161,700 dollars, with 15 percent growth projected through 2034.15 The middle of a bank, an asset manager or an advisory firm is a compressed environment: a desk head or regional director carries a revenue number, a risk and conduct obligation, and a team whose compensation depends on both. Performance is measured continuously and publicly, which removes the ambiguity a struggling manager elsewhere can hide inside for a quarter. The general manager finding applies with unusual force here, because the individual-contributor load these managers retain is client-facing and revenue-bearing rather than administrative, so it cannot be deferred without an immediate cost.06 McKinsey's observation that only 20 percent of middle managers strongly agree their organization enables them to succeed as people managers is reported by this group as a structural fact rather than a complaint.08 The pattern clinicians in the CEREVITY network see is a compressed version of the model in section 03: absorption and translation move quickly, and insulation arrives early, because in a firm where the annual number is the identity, any admission of strain is read as a signal about next year's book. Sleep and alcohol are the two places the load usually surfaces first. Presentation to care is typically late, often after a specific trigger such as a restructuring, a compliance matter or a peer's exit, and by then the picture is months old rather than weeks.
Individual confidential therapy for finance
Organizational the firm-level partnership for advisor and desk burnout
The stakesThe cost of inaction§
Burnout in the manager layer does not present as a line item. It presents as a slower quarter, a delayed launch, an unexplained resignation and a team that stops volunteering ideas. Each of those carries a number, and the numbers are large enough to justify a line item of their own.
Replacement, at management salaries
Gallup puts the cost of replacing a departing employee at one-half to two times annual salary.07 Applied to the May 2024 US median management wage of 122,090 dollars, one manager exit costs roughly 61,000 to 244,000 dollars before any disruption to the team is counted.12 Deloitte found 64 percent of managers seriously considering leaving for an employer that better supported their wellbeing, against 60 percent of the employees they lead.09 That is a rate, not an event.
Execution, before anyone resigns
The expensive part happens while the manager is still in the seat. Managers spend a median 40 percent of their time on non-managerial work, and engagement falls further among those pushed past that share.06 Only 20 percent of middle managers strongly agree their organization enables them to succeed as people managers.08 Work still ships. It ships later, with more rework, and with fewer of the early judgment calls a rested manager would have made.
Health cost, which becomes a business cost
The World Health Organization estimates 12 billion working days are lost each year worldwide to depression and anxiety, at about 1 trillion dollars in lost productivity.11 In the United States an estimated 21.0 million adults, 8.3 percent of the adult population, had a major depressive episode in 2021, and the rate among adults aged 26 to 49 was 9.3 percent.19 That is the age band most middle managers occupy.
07, 12 Gallup. (2019). This Fixable Problem Costs U.S. Businesses $1 Trillion. Replacement cost of one-half to two times annual salary.
US Bureau of Labor Statistics. (2025). Management Occupations, Occupational Outlook Handbook. Median annual wage $122,090, May 2024.
The solutionWhat effective care looks like§
Effective care for this population starts from an accurate description of the constraint. The problem is not that managers do not know stress is bad for them. It is that every available route to help runs back through the organization generating the load. An internal assistance line sits inside the employer's contract. A wellbeing platform reports usage. A candid conversation with a skip-level leader becomes information about fitness to lead. So the first requirement is separation: care held outside the reporting line, with no report back and no shared record. The second is clinical depth rather than education, because chronic workplace stress that has already produced cynicism and reduced efficacy is a clinical presentation and not a knowledge gap. The third is a shape that survives an operating calendar, which means offering more than one: the standard weekly session where continuity is what does the work, and extended 90-minute sessions where an hour ends exactly where the difficult part begins.
CEREVITY is a nationwide network of independent licensed clinicians, matched to the person rather than assigned by rota, delivered by secure video on a private-pay basis so no diagnosis code and no shared record are created. A third format, therapy intensives, exists for the manager who cannot protect a weekly slot for three months but can protect one long block, which is a common shape in this population. For an organization weighing this against an existing benefit, the structural difference is in CEREVITY's clinical approach: the network carries the capability, so availability never depends on one named clinician.
ImplementationHow to put it into practice§
This is a benefit design problem before it is a clinical one. The four steps below are ordered so that each is executable without the next, and so that the first two can be completed by a people team without waiting for a budget cycle.
- 01
Size the exposure in the manager population separately
Count managers, not headcount. Pull span of control, the share of managers still carrying individual-contributor targets, and voluntary exits in the manager population as their own series. The published benchmarks are a mean span of 12.1 direct reports in 2025 and a median 40 percent of manager time spent on non-managerial work.06 Numbers worse than those describe a load problem before they describe a wellbeing one.
- 02
Separate the support from the employer
Any route that reports usage, sits inside the employer's contract or creates a record the organization can read will be under-used by exactly the people this paper describes. The design requirement is a clinician relationship the employer funds and does not see. Say so in the benefit description, in plain language, and say who does not receive the data.
- 03
Fund depth, not only access
Session caps of six or eight are built for acute, situational problems. The presentation described in section 03 is chronic and layered, and usually needs continuity across months or a long block that can hold a whole problem at once. Fund a range of formats rather than a session count, and let the clinician and the manager choose the shape.
- 04
Measure at aggregate level, and nowhere else
Track uptake, manager voluntary attrition, internal promotion acceptance and the engagement of teams reporting to managers who used the benefit, all in aggregate. Do not track individuals, request outcomes or ask for a clinical summary. The Surgeon General's workplace framework treats protection from harm and mattering at work as organizational conditions rather than individual traits, which is the right level for the metric too.18
RecommendationsWhere to start§
Clinical
Treat isolation as a clinical target
Insulation is where the pattern becomes invisible and where it does the most damage, and it is treatable in its own right rather than as a subheading under stress management. That is the work in therapy for leadership isolation.
Clinical
Start before the resignation conversation
By the time a manager gives notice the clinical picture is usually months old. Leaders who have watched it happen once tend to want a practical sequence for the next time, which is what how to support a burned-out leader on your team sets out.
Structural
Give managers a route you did not build
An internal program is the right answer for most of the workforce and the wrong answer for the people who administer it. Fund an external, confidential option alongside it and state plainly which is which, rather than hoping managers infer the difference.
Structural
Put span of control on the risk register
Average span rose from 10.9 to 12.1 direct reports between 2024 and 2025, close to a 50 percent increase since 2013.06 Span is a lever the organization controls directly, it costs nothing clinical to pull, and it is the cheapest intervention on this list.
FAQCommon questions§
Why do middle managers burn out?
What is the cost of manager burnout?
How do you support middle managers?
How does private-pay billing work?
How is my privacy protected?
MethodologyHow this paper was built§
Methodology
This paper draws on four kinds of source, and the distinction between them matters when reading the numbers. First, large-sample workforce studies: Gallup's global and US workforce panels, including the 2026 State of the Global Workplace report built on 263,810 respondents worldwide, of whom 141,444 were employed02; the 2021 manager burnout analysis, based on 9,628 full-time US workers of whom 1,569 were managers, fielded between 25 January and 23 August 2021 with a sampling error of plus or minus 3.7 percentage points04; the 2022 analysis of the Gallup COVID-19 Workforce Study, n equals 14,419 full-time US employees05; the 2023 Manager Squeeze analysis, built on quarterly Gallup Workforce Studies with samples between roughly 13,500 and 60,80003; and the 2026 span-of-control work, a meta-analysis of 92,252 teams across 104 organizations in 26 industries and 46 countries, with a separate manager sample of 16,442 surveyed between 2022 and 202406. Second, management and benefit surveys: McKinsey's 2022 survey of 984 respondents, of whom 706 were middle managers, fielded 29 March to 8 April 202208, and the Deloitte and Workplace Intelligence Well-being at Work survey of 3,150 respondents across the United States, United Kingdom, Canada and Australia, fielded 3 to 14 March 2023 in three equal panels of C-suite executives, managers and employees09. Third, government and multilateral data: the US Bureau of Labor Statistics Occupational Outlook Handbook for management occupations and for the three occupational groups discussed in section 04, all reporting May 2024 wages and 2024 to 2034 projections12, 13, 14, 15; the CDC Vital Signs analysis of the General Social Survey Quality of Worklife module, comparing 226 health workers in 2018 with 325 in 202216; the National Institute of Mental Health summary of the 2021 National Survey on Drug Use and Health19; the US Surgeon General's 2022 workplace framework18; and World Health Organization material on the ICD-11 classification of burn-out and on mental health at work10, 11. Fourth, clinical observation from CEREVITY's network, which is used only to describe pattern and sequence and never to assert a rate. The Absorbed-Load Model in section 03 is presented as a schematic and is labeled as such on the figure. Limitations are material and should be read alongside the findings. Engagement and burnout measures here are self-reported and are not clinical diagnoses. Definitions of manager differ between surveys, so the Gallup, McKinsey and Deloitte figures are reported separately rather than pooled. Global and US-only samples are labeled at every point of use and are not compared directly. The CDC health-worker sample is small and its associations are cross-sectional, so they establish correlation rather than cause. Cost figures are ranges applied to published median wages, not observed accounting outcomes. No figure in this paper is an outcome claim about therapy.
References
- 01Gallup. (2026). Global Employee Engagement Continues Decline. Gallup Workplace. gallup.com
- 02Gallup. (2026). State of the Global Workplace. Gallup, n=263,810 respondents worldwide. gallup.com
- 03Gallup. (2023). The Manager Squeeze: How the New Workplace Is Testing Team Leaders. gallup.com
- 04Gallup. (2021). Manager Burnout Is Only Getting Worse. US managers, n=1,569. gallup.com
- 05Gallup. (2022). The Antidote to Manager Burnout. COVID-19 Workforce Study, n=14,419. gallup.com
- 06Gallup. (2026). Span of Control: What Is the Optimal Team Size for Managers? gallup.com
- 07Gallup. (2019). This Fixable Problem Costs U.S. Businesses $1 Trillion. gallup.com
- 08McKinsey & Company. (2023). Stop Wasting Your Most Precious Resource: Middle Managers. Survey of 984 respondents including 706 middle managers. mckinsey.com
- 09Deloitte and Workplace Intelligence. (2023). Well-being at Work Survey, n=3,150 across four countries. deloitte.com
- 10World Health Organization. (2019). Burn-out an Occupational Phenomenon: International Classification of Diseases. who.int
- 11World Health Organization. (2024). Mental Health at Work. Fact sheet, 2 September 2024. who.int
- 12U.S. Bureau of Labor Statistics. (2025). Management Occupations. Occupational Outlook Handbook. bls.gov
- 13U.S. Bureau of Labor Statistics. (2025). Computer and Information Systems Managers. Occupational Outlook Handbook. bls.gov
- 14U.S. Bureau of Labor Statistics. (2025). Medical and Health Services Managers. Occupational Outlook Handbook. bls.gov
- 15U.S. Bureau of Labor Statistics. (2025). Financial Managers. Occupational Outlook Handbook. bls.gov
- 16Centers for Disease Control and Prevention. (2023). Vital Signs: Health Worker-Perceived Working Conditions and Symptoms of Poor Mental Health, United States, 2018-2022. MMWR 72(44). cdc.gov
- 17American Medical Association. (2024). Measuring and Addressing Physician Burnout. ama-assn.org
- 18Office of the U.S. Surgeon General. (2022). The U.S. Surgeon General's Framework for Workplace Mental Health and Well-Being. hhs.gov
- 19National Institute of Mental Health. (2023). Major Depression. 2021 National Survey on Drug Use and Health. nimh.nih.gov
PhD, Licensed Psychologist
Trevor Grossman, PhD is a licensed psychologist licensed in California, seeing clients by telehealth through CEREVITY's nationwide network of independent licensed clinicians. He works with entrepreneurs, tech executives, physicians, attorneys, senior leaders and founders on executive stress and burnout, the psychology of high performance, decision fatigue, high-stakes stress, work-life integration and leadership isolation. His clinical work draws on cognitive-behavioral interventions, mindfulness-based strategies and performance psychology.
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