Recent attention to burnout in emergency medicine has been necessary and overdue. Emergency departments make many pressures in health care highly visible: overcrowding, staff shortages, rising complexity, prolonged waits and repeated exposure to suffering and uncertainty.
But burnout is not an isolated emergency medicine problem, nor is it unique to physicians.
Many people work in occupations involving high demands, limited control, public expectations, personal risk or repeated exposure to trauma. Nurses, paramedics, first responders, social workers, educators and many others understand the consequences of working for prolonged periods in strained systems.
Physicians are fortunate in many respects. We have meaningful work, considerable education and professional opportunity, and comparatively secure and well-remunerated careers. That privilege should bring humility and responsibility. It does not, however, make us immune to chronic occupational stress or to the impact of system failure.
The rates vary across studies and specialties, but comparisons across medical disciplines show that no branch of medicine is immune. The pressures may look different in family medicine, surgery, psychiatry, internal medicine, pediatrics or diagnostic specialties, but the occupational question is shared:
What will allow physicians to remain healthy, engaged and capable of providing good care over an entire career?
A personal transition
I have worked in emergency medicine for more than 30 years. As I have aged, I have reduced my clinical exposure.
That is partly a natural career transition. It is also an honest recognition that the intensity of acute clinical work is not something I can, or should, approach in exactly the same way indefinitely.
I now spend more of my time considering how systems can be changed to improve health care for patients and for the people who provide it, including physicians. This is not a retreat from medicine. It is a different contribution to it.
A sustainable profession should make room for such transitions. Physicians may move between high-intensity and lower-intensity work, or from clinical care into teaching, leadership, research, occupational health and system improvement. We should see this as responsible workforce planning, not as a loss of commitment.
Burnout is an occupational signal
The World Health Organization describes burnout as an occupational phenomenon resulting from chronic workplace stress that has not been successfully managed.
That definition matters. It directs our attention toward the interaction between people and the conditions in which they work.
Physicians should be self-critical. Medicine has sometimes celebrated excessive hours, stoicism and working while unwell. We have not always treated colleagues, learners or other health professionals with the respect they deserve. Physicians must participate constructively in improving access, accountability and the organization of care.
But self-reflection should not become self-blame.
When excessive workload, inadequate staffing, poor technology, repeated moral conflict or lack of control are treated primarily as failures of personal resilience, we ask people to adapt to conditions that should themselves be changed.
Fair compensation and healthy work
New Brunswick’s four-year Physician Services Agreement is an important investment in physician recruitment, retention, competitiveness, team support and patient access. Fair and predictable remuneration matters. It is one expression of professional respect, and perceived unfairness can damage trust and engagement.
Compensation, however, is one part of a sustainable workforce strategy.
A higher rate of pay cannot create recovery time after demanding clinical work. It cannot provide a missing team member, make an inefficient electronic system usable, restore control over an unmanageable workload or resolve the distress of repeatedly being unable to provide the care a patient needs.
This is not an argument against appropriate remuneration. It is an argument for making full use of the opportunity the agreement creates. Its commitments to collaborative care, team support, physician wellness and improved access may ultimately be as important to sustainability as its financial provisions.
The distinction is simple:
Compensation recognizes the value of the work. Work design determines whether that work can be performed safely and sustained over time.
Evidence reviewed by the National Academies of Sciences, Engineering, and Medicine supports this broader view. Organizational interventions addressing schedules, staffing, workload, workflow, teamwork and professional relationships appear more effective than relying on individually focused measures alone.
Begin with the work
In occupational health, the most reliable way to reduce harm is to address hazards at their source.
For physicians, that means asking difficult questions about the design of clinical work:
- Are workloads realistically matched to the available time and resources?
- Do schedules permit sleep, recovery and participation in family life?
- Does technology support care or obstruct it?
- Can physicians influence decisions that affect their work?
- Can staff raise safety concerns without fear of humiliation or reprisal?
These questions move the discussion beyond whether an individual physician is coping well. They ask whether the work itself is reasonable.
Individual resources still matter. Peer support, confidential mental health services, mentoring, exercise, reflection and effective coping strategies can all help. A Canadian study of emergency department professionals in which I participated found that task-oriented coping was associated with lower burnout, while emotion-oriented coping was associated with greater burnout.
That is useful knowledge, but coping style does not explain the whole problem. Even strong coping has limits when demands repeatedly exceed the resources available to meet them.
The answer is not to choose between personal responsibility and system responsibility. We need both.
Medicine must examine its culture
Health systems are not separate from physicians. We lead departments, establish professional norms, influence learners and shape the working lives of colleagues and other health professionals.
A healthier profession will require us to challenge some longstanding assumptions:
- Exhaustion is not proof of dedication.
- Working while unwell is not always professionalism.
- Asking for assistance is not weakness.
- Reducing clinical exposure can be a responsible career decision.
- Efficiency should not remove every opportunity for recovery or human connection.
- Compassion for patients and compassion for staff are not competing priorities.
In a previous discussion of patient care accountability, I argued that health systems need clearer responsibility for ensuring that patients receive the right care from appropriately resourced services.
Accountability should not mean measuring only the physician standing at the point where the system’s failures become visible. It must also include responsibility for providing the conditions required for good care.
Building careers physicians can remain in
The goal should not be to make physicians capable of enduring unlimited pressure. It should be to create work in which they can remain effective, compassionate and professionally fulfilled.
That requires more than reducing burnout scores. It means designing careers and workplaces that preserve meaning, reasonable control, recovery time, effective teams, psychological safety and flexibility across the stages of a career.
Emergency medicine has shaped much of my own experience and writing, but this question belongs to every physician:
Can we provide the care we were trained to provide, in conditions that allow us to do it well, without unacceptable harm to ourselves or others?
Healthy physicians are not more deserving of protection than other workers. But, like other workers, they deserve work designed with reasonable attention to health and safety. Their well-being also matters to every patient who depends on their judgement, compassion and continued presence.
The current attention to burnout offers an opportunity. New investments and agreements can help recruit and retain physicians, strengthen teams and improve access. Their success should ultimately be judged not only by what physicians are paid, but by whether physicians and their patients experience meaningful improvements in how care is organized and delivered.
If we want a healthy and engaged physician workforce, we must support individuals, hold ourselves accountable as a profession and redesign the conditions of work. This is not about claiming exceptional hardship or assigning blame. It is about accepting shared responsibility for building a health system in which patients can receive good care and those who provide it can continue to do so.
Dr. Paul Atkinson MB (Hons) MA FRCPC, Professor, Emergency Medicine, Dalhousie Medicine New Brunswick;
Chief Medical Consultant, WorkSafeNB
