Physician well-being is vital to delivering high-quality emergency care. A supported and healthy emergency medicine workforce leads to better patient outcomes, fewer medical errors, and greater job satisfaction and staff retention.^[1,2] Emergency physicians (EPs) face unique pressures, including shift work, high patient volumes and acuities, overcrowding, and systemic inefficiencies that escalate their risk of burnout. As a result, EPs have reported the highest rates of burnout among physician specialties.^[1,3] Over the past decade, multiple attempts have been made to promote EP well-being. However, early initiatives were oriented around individual “wellness”, such as exercise, diet, sleep, yoga, and finding “work-life balance”. Recently, there has been evolving recognition of the effects of a number of aspects of burnout that are outside the control of individual EPs, including administrative duties superseding clinical duties, diminishing resources and support, overcrowding and boarding, adverse working conditions, and medico-legal challenges. These factors progressively constrain the ability and capacity of EPs to do the work that they are trained and entrusted to do - rapidly and effectively evaluate, treat, and dispose of acutely ill patients. This sense of “moral injury” has contributed to growing dissatisfaction and premature departure from emergency medicine through reduced hours, transitions to other fields, early retirement, and, tragically, suicide.^[4,5]

We highlight several increasingly pertinent factors that erode EP morale and advocate for a paradigm shift and offer potential solutions to help restore EP autonomy, mastery, and purpose—the three elements author essential for high performance and satisfaction—that may foster greater well-being and happiness throughout our professional lives.^[6]

As more women enter medical school and emergency medicine but disproportionately leave full-time practice, the factors limiting the retention of women EPs require greater attention and investigation.^[7] Physiological changes experienced during pregnancy and peri-menopause warrant flexibility and consideration of ergonomic, safety, and scheduling adaptations. Worldwide, EPs face increasingly diverse family compositions and dynamics, yet women EPs, especially those working in low- and middle-income countries (LMICs), often bear a disproportionate burden of traditional household and cultural responsibilities without sufficient support systems. Ongoing peer mentorship may help individuals navigate a wider range of social expectations associated with early marriage, single parenthood, having multiple children, full-time household commitments, and caring for extended families and relatives with chronic care needs, all while needing to generate income and greater financial security.^[8,9]

While the physical and medical impacts of irregular work schedules are established, shift work also imposes social, financial, and mental burdens on EPs. In many regions, emergency medicine training can be lengthy, up to seven years. It is also grueling and oblivious to holidays, with the latter continuing throughout clinical practice and invariably strains various interpersonal relationships. Compared with other specialties, emergency departments (EDs) in many countries, such as Australia, are usually public and restrict additional income from private work. Financial security is further hampered by cuts to benefits such as financial support for continuing medical education and declining patient care reimbursement. Furthermore, the increasing rates of verbal and physical harassment and violence in EDs directly threaten EP safety and well-being.^[10,11]

In LMICs, efforts to gain recognition for emergency medicine as a specialty are still underway, and associated challenges such as limited professional respect, regulatory and financial support, staffing and resources, and opportunities for professional development and advancement persist. EPs, like their colleagues in other medical specialties, may also be experiencing clinical career plateaus, as other patient care occupations and healthcare administration challenge their traditional roles, authority, and autonomy.^[12-14] In some regions and developed countries where emergency medicine has already been established, EDs are beginning to encounter increasing recruitment and competition from alternative care sites, such as urgent care with more socially acceptable hours and working conditions, as well as acute specialty centers.^[15,16]

As healthcare needs grow in volume and complexity, there are also increases in expectations and demand for more resources. However, the COVID-19 pandemic and subsequent years have highlighted the ongoing reality that healthcare resources are finite for LMICs and high-income nations. These limitations can include unpredictable shortages of various medications and medical supplies, insufficient access to specialty care, and a lack of capacity, such as ED and inpatient beds. Because of these supply chains, staffing, and systemic inadequacies, chronic ED and hospital overcrowding, prolonged ED boarding, ambulance offload delays, and access blocks are daily realities for many EDs globally. Whereas EDs used to be considered patient safety nets for the healthcare system, EDs have increasingly shoulder healthcare system responsibilities. These numerous and protracted operational inefficiencies may degrade patient care and undermine EP morale and performance.

Emergency medicine often attracts a specific kind of individual, one that is versatile, collaborative, and adaptable—sometimes described as the “jack of all trades,” and can perform well, even thrive, amid frequent chaos. EPs often say that they would work in the ED rather than other specialties. However, as various challenges continue to persist and grow, their resilience and preferences are waning.

EPs can restore their sense of identity and purpose by shifting from reacting to proactively leading change through active engagement at the individual, departmental, hospital, governmental, and professional organization levels (Table 1).

EPs should continue to nurture their individual essential thirds for life: work, sleep, and everything else (such as recreation, food, music and relationships), as identified and promoted by earlier initiatives focused on physician wellness.

EDs should improve roster management; refine work and scheduling adaptations; develop policies for patient care, personnel, quality improvement, and risk management; designate ED representatives for relevant hospital committees; promote peer mentoring and team building; and cultivate a stronger sense of community. In Australia, the BEACON framework (Belonging, Engagement, Accountability, Compassion, Optimism, Nurture) and “How to Thrive Academy” offer a framework and evidence-based education to build “thrive-ability”—a proactive, organization-wide approach to preventing distress and cultivating psychological safety—for supporting others in their workplaces.^[17]

The most important consideration is that the conversation about EP well-being must move beyond individual self-care and personal resilience toward structural reform. The Canadian Association of Emergency Physicians “EM: POWER” framework reconceptualizes well-being as a system-level performance outcome directly linked to access block, hospital bed capacity, and workforce planning.^[18] The reliable monitoring of workload, crowding, and outcomes is essential for designing safe EDs. Embedding workforce well-being into health system planning shifts responsibility from individuals to organizations and health authorities. This change is especially relevant given that more than 60% of Canadian EPs report burnout driven primarily by system pressures.^[19] A high rate of physician burnout is a strong signal of system misalignment and failed system-wide improvement, not personal failure.^[20] When institutions take responsibility for creating and maintaining the conditions in which care is delivered—through policy, advocacy, and leadership commitment—physician well-being becomes part of operational excellence.

Emergency medicine organizations have prioritized multiple actions to support their members and engage other healthcare stakeholders. The African Federation for Emergency Medicine has incorporated wellness into its leadership and advocacy programs. The American College of Emergency Physicians and Australasian College for Emergency Medicine has accreditation programs that embed well-being into ED standards by evaluating safe staffing and workload, fatigue-awareness and equitable rostering, violence prevention and safety measures, supportive leadership and culture, and access to professional development.^[21,22] The European Society of Emergency Medicine hosted the 2022 Emergency Medicine Day dedicated to calling attention to burnout in emergency medicine professionals and more recently published a Europe-wide consensus statement identifying key factors for sustainable ED working conditions.^[23] The International Federation of Emergency Medicine (IFEM), the global body for emergency medicine, is finalizing a white paper on EP well-being and establishing an academy in which well-being will be one of the main topics. The IFEM is also developing global indicators for safe emergency care and aligning accreditation elements to support workforce sustainability. The United Kingdom’s Royal College of Emergency Medicine Psychologically Informed Practice and Policy Project and the Guidelines for the Provision of Emergency Medical Services were designed to facilitate sustainable working and careers.^[24,25]

Patients present to EDs for a variety of reasons, but ultimately, they all seek the same thing, healing—whether for physical ailments, mental health concerns, or other support and connection. Remembering this foundational premise and their cardinal responsibility and privilege—to care for their fellow human beings—can restore EPs’ sense of purpose and well-being. It is critical that every other stakeholder also recognize and support this rationale behind the existence of healthcare.

In conclusion, as EDs continue to face numerous internal and external challenges, higher rates and severities of burnout increasingly threaten EPs and the manner and quality of care they provide. Effectively addressing the factors that erode EP morale, performance, and identity necessitates a deliberate, proactive, multilevel strategy that now emphasizes system-based accountability. EP well-being should be reframed as a system-level performance indicator, integrally linked to supportive work environments, their clinical expertise and autonomy, and sufficient and effective resources to alleviate access block and boarding, enabling timely patient care and disposition. With greater active and collective engagement, EPs can and should advocate for system-wide accountability and reform that are increasingly critical to their ability to provide timely high-quality emergency care and revitalize and sustain their calling and well-being as well as the sustainable future of emergency medicine.

Funding: None.

Ethical approval: Not needed.

Conflicts of interest: The authors declare no conflicts of interest related to the study, financial or otherwise.

Contributors: All the authors of this paper meet the criteria for authorship identified by the International Committee of Medical Journal Editors; all the authors contributed to the conception, design, drafting, and editing of this manuscript; reviewed the final version of this manuscript before submission; and agreed to be accountable for all aspects of the work. Specifically, using CRediT taxonomy, the contributions of each author are as follows: conceptualization/design: LHF, AK, ET, RE, RL, LAC, SF, and CSK; composition-drafting/editing: LHF, AK, ET, RE, BMV, RL, LAC, SF, and CSK.