Burnout in the Emergency Department
February 1, 2025 29 minutes read
By Ellen Feldman, MD
EXECUTIVE SUMMARY
- Burnout is characterized by a steady decline in energy, motivation, and commitment to the job, as well as emotional depletion over time.
- Burnout most often occurs in professionals with jobs requiring empathy and personal involvement.
- Physician burnout, characterized by emotional exhaustion, depersonalization, and a reduced sense of accomplishment, often results from heavy administrative burdens, large patient loads, limited resources, and systemic inefficiencies.
- Symptoms overlap with depression but are work-specific, whereas depression is pervasive; both require targeted interventions.
- Addressing burnout requires both organizational changes and individual support strategies.
- Some organizational solutions include streamlining administrative tasks, improving work-life balance through flexible scheduling and adequate time off, and implementing wellness programs and mental health resources tailored to physicians.
- Professional coaching helps the individual provider reconnect with their purpose and self-care strategies. However, systemic support must complement individual interventions for sustainable outcomes.
Friday Night in the ED
The waiting room buzzes with tension and pent-up frustration — a stark contrast to the weariness creeping into the team’s voices as the evening stretches on. “That’s the last ambulance call for me,” the physician says, tossing his gloves into the bin with a tired grin. “Catch you later,” his colleague replies, heading toward the breakroom — or at least what serves as one between crises.
The provider sits at the workstation, staring at the screen, nodding absently as colleagues check out. The to-do list looms: three critical cases from earlier need follow-up notes, a growing backlog of labs to review, and a handful of patients still waiting for consults. Then comes the reminder: Her daughter’s school recital starts in 30 minutes.
“Guess I’ll catch the recording,” the provider mutters, pulling up another chart while wondering: Is this sustainable?
The Challenge
Emergency medicine providers, like their colleagues across medicine, often find purpose in their work despite its inherent challenges. The adrenaline of high-stakes decision-making, the immediacy of saving lives, and the opportunity to serve at the front lines of healthcare are deeply fulfilling. Yet, the relentless pace, unpredictable demands, and constant exposure to human suffering come at a cost.1,2
The modern emergency department (ED) often is defined by overcrowding, excessive administrative burdens, and chronic staffing shortages. These pressures give little time for providers to process and address the emotional and physical toll of their work, fostering an environment where burnout has become pervasive.
While the literature agrees the COVID-19 pandemic worsened burnout among front-line providers, a 2020 meta-analysis found that even before the pandemic, emergency medicine providers were among the most susceptible to burnout, with close to 40% reporting high levels of this condition.1,2
This article examines the unique challenges of burnout in ED providers, exploring its impact on individuals, teams, and patient care. After an overview of the phenomenon, including historical trends and current statistics, this article will discuss actionable strategies to mitigate burnout and foster resilience, illustrated through real-world experiences of emergency medicine professionals.
What Is Burnout Anyway? Is It a Diagnosis or a Catch-All Term?
Images of people with substance use disorders sitting in group sessions with blank expressions, staring at cigarettes slowly burning out prompted psychologist Herbert Freudenberg to coin the term “burnout” in the 1970s. He borrowed this phrase from drug slang where “burnout” was used casually to describe functional decline in peers. Freudenberg used the term in his research and writings to describe a phenomenon he observed among colleagues and patients — and experienced himself. Characterized by a steady decline in energy, motivation, and commitment to the job, as well as emotional depletion over time, Freudenberg noted that burnout most often occurred in professionals with jobs requiring empathy and personal involvement.3,4
Researchers Maslach and Johnson extended Freudenberg’s work on burnout, and in the 1980s they developed the Maslach Burnout Inventory (MBI), still in use today as one of the few validated research tools to measure the degree and effect of this state. The team was the first to describe burnout as an all-encompassing condition involving emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment stemming from the weight of professional stressors and responsibilities.5,6
Although burnout as a defined syndrome was not recognized in the scientific literature until the 1970s, evidence suggests its existence long before that time. The term “burnout” may have first been used metaphorically as early as 1599, in poem VII of The Passionate Pilgrim, a poetry collection attributed to William Shakespeare: “She burn’d with love, … She burn’d out love, as soon as straw outburneth.”7 By the turn of the 20th century, burnout was depicted in popular literature. Thomas Mann’s 1901 Buddenbrooks (later adapted into a 2008 movie) portrays a protagonist grappling with progressive mental exhaustion, disillusionment, and loss of drive.8 In medical literature, an early hint of burnout emerged in 1952, with a published case study of a psychiatric nurse diagnosed with “exhaustion reaction.” In hindsight, viewing this case with “2025” vision, the symptoms clearly align with what we now identify as burnout.9
The works of Freudenberg and Maslach in the 1970s marked a turning point, sparking global interest and research into the effects of burnout on the medical workforce. Despite inconsistent findings from these investigations, burnout underwent a pivotal reclassification in 2015, transitioning from an amorphous concept to a mental “state” in the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM).10
In 2019, the World Health Organization (WHO) introduced further nuance by reclassifying burnout to an occupational syndrome in the ICD-11. This change stirred controversy and prompted a clarification from WHO that burnout is not yet considered a medical diagnosis, per se.11 However, the triad of symptoms identified in the 1970s remains central to its definition. The ICD-11 outlines burnout across three dimensions:12
- feelings of energy depletion or emotional exhaustion;
- increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job;
- reduced professional efficacy.
Even with WHO recognition, there remains difficulty pinpointing a universal definition of burnout and each of its components. (For example, what exactly is “emotional exhaustion”?)
Despite this problem, studies consistently note negative consequences from this syndrome.13 Healthcare providers, and particularly physicians, are at high risk for developing burnout; a nuanced understanding of this condition gives the provider tools to monitor themselves as well as colleagues who may be starting to display signs of burnout.
Burnout in physicians is associated with an increased risk of medical errors, decreased quality of care, and reduced patient satisfaction. Without intervention, physicians with burnout are at increased risk of both developing health complications and of leaving the profession.13,14
Although wellness initiatives likely contribute to mitigating burnout, research consistently shows that they are not a standalone solution. This is not surprising, since recent investigations have highlighted a strong connection between burnout and specific workplace factors rather than individual traits or even job type. The evidence points to the combination of robust organizational support and personal wellness efforts as the most effective approach.14,15 To this point, Dr. Tait Shanafelt, a leading expert on burnout in healthcare and chief wellness officer at Stanford Medicine since 2017, emphasizes that healthcare organizations must take proactive measures to prevent provider burnout.16
That said, the individual provider still plays a vital role in addressing burnout. Recognizing early signs, staying mindful of burnout risks, and practicing self-care and wellness techniques are essential steps. As Shanafelt observes, “Physicians must acknowledge that they are subject to normal human limitations and attend to rest, breaks, sleep, personal relationships, and individual needs.”15,16
Regardless of classification or precise definition, the term burnout deeply resonates with many medical providers who experience its hallmark symptoms: emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment — all stemming from chronic, work-related stress and responsibilities. Presentation can vary widely, and overlapping symptoms with other conditions often complicate recognition and treatment.13-16
The two clinical scenarios presented here illustrate typical manifestations of burnout in emergency medicine providers and explore potential strategies for resolution.
Meet Dr. P.
Dr. P., a 55-year-old emergency physician with two decades of experience in a bustling urban hospital, sits in the dimly lit break room, staring blankly at the wall clock ticking away the minutes of his brief respite. A notification pings, signaling another incoming trauma, but he does not move to respond or see more information. Outside the door, the ED whirls with activity — monitors beeping, stretchers clattering, voices paging overhead — but Dr. P. feels detached, as if encased in a bubble separating him from the frenetic environment where he once thrived.
“If I had more energy,” he muses, “I would feel guilty.” Earlier in the shift, during staff huddle, his frustration had boiled over… again. When the ED director announced a new protocol aimed at reducing patient wait times, Dr. P. could not suppress a sardonic chuckle. “Another initiative to squeeze blood from a stone,” he muttered, his voice dripping with cynicism. The comment hung in the air, met with uneasy glances — some colleagues nodding in silent agreement while others looked away and shifted in their seats.
Later a nurse, approaches cautiously. “Dr. P., just a reminder about discharge orders. Patients are waiting for their prescriptions and the hospital pharmacy closes soon.” Without looking up, Dr. P. responds curtly, “I’ll get to it.” The nurse hesitates, then retreats. Dr. P. sighs, rubbing his temples. The irritation is not directed at the nurse but at himself. Once meticulous, he now finds routine tasks overwhelming.
He noticed this first in patient encounters, where the differences between now and the past were stark. Dr. P. still asks the necessary questions, performs an adequate examination, and orders appropriate tests, but the connection is missing. Conversations feel hollow. The warmth and empathy that once characterized his bedside manner have evaporated, replaced by a mechanical efficiency. “We’ll adjust your treatment,” he says to a patient, barely making eye contact. “Follow up with your primary care provider.” The patient nods, but her confusion lingers behind as she gathers her belongings and leaves.
Back in the break room, Dr. P. slumps in his chair, scrolling absentmindedly through an inbox, the weight of unread consults and pending lab results pressing down on him. He had thought about retirement more in the last few months than in the past 20 years combined. It is not just the exhaustion; it is the creeping sense that his work no longer matters. The system feels irreparably broken, and he doubts his ability to continue to function within it.
Is This Burnout, Depression, or Both?
The relationship between burnout, depression, and anxiety remains a topic of ongoing debate in the literature. Some studies suggest these conditions share common neuroendocrine changes and that their clinical presentations often overlap, especially when looking at emotional exhaustion — a core component of burnout. This has led some researchers to propose that, in fact, burnout may represent a dimension of depression or that burnout may act as a risk factor for its development.17
Conversely, other experts emphasize that it is critical to distinguish burnout from depression and anxiety. They argue that burnout is specifically tied to work and situational stressors, whereas depression is pervasive and independent of context. This distinction is important, since the treatment approaches for these conditions differ significantly.18
A large 2019 meta-analysis examined studies using the MBI — a widely accepted tool for measuring burnout. It found that this tool effectively differentiates burnout from depression and anxiety. This study concluded that depression, anxiety, and burnout are distinct conditions, although they do share some common characteristics, and they may develop in tandem.19 Likewise, burnout has an association with other medical comorbidities, such as headaches, insomnia, gastrointestinal distress, and musculoskeletal discomfort.19,20
A 2020 study published in the Journal of the American Medical Association (JAMA) emphasized the importance of distinguishing between burnout and depression among medical professionals. The findings revealed that while depression in physicians is directly related to suicidal ideation, burnout does not show this direct association. However, burnout has a stronger connection to the risk of medical errors compared to depression among healthcare providers.2
Back to Dr. P.
Dr. P. looks up in response to a light knock on his door. “Do you have a moment?” asks Dr. E., the director, closing the door behind her as Dr. P. nods hesitantly.
“I gather you were unhappy about what I said in huddle, and I’ve noticed you have seemed different lately. Your dedication has always been evident, but now … you seem distant. How are you really doing?”
For a moment, Dr. P. does not answer. He considers deflecting, saying he was just tired, but something in her tone invites honesty. “I don’t know,” he admits, his voice heavy. “I’m exhausted. I feel like I’m failing my patients, my team, and even my family — everyone. The system is broken, and I don’t think I can keep up anymore. I’ve seen patients with depression, and maybe that is what is wrong with me — but somehow, that diagnosis does not seem to fit how I feel. When I take time off, I feel reinvested and energized, but it all crashes down when I return.”
Dr. E. listens intently. “It sounds like you are experiencing burnout,” she says quietly. “It is more than just fatigue; it is what happens when we’ve given everything we have without getting what we need in return. You are not alone in this, and we can address this together.”
“Burnout,” echoes Dr. P. “Really? I know it’s prevalent among emergency physicians, especially after the pandemic. I read that in 2021, 60% of emergency physicians reported burnout, up from 43% the previous year. Somehow, I never thought I was at risk. Not after all those years.”
Dr. E. nods. “It’s pretty common — I wish we would talk about it more often and more openly. But for now, let’s work on strategies to support you.”
Dr. P. feels a glimmer of relief, recognizing that while the challenges still feel immense, he does not have to face them in isolation.
Screening Tools for Burnout
Notably, burnout is not a formal medical diagnosis but is assessed primarily through self-reported data gathered via screening tools. This reliance on subjective reporting can make accurate measurement challenging. In response, the medical field is working toward establishing a consensus definition of burnout and standardizing measurement tools. These features should help physicians better understand prevalence moving forward.21
Although newer tools have been introduced and are being tested, the MBI, developed and introduced in the 1980s with some modifications over the years, remains the most common tool to measure burnout in the United States. Currently, there are multiple forms of this questionnaire, including one geared specifically toward healthcare professionals.5,6,22
There is a self-administered format of the MBI that, as is typical of this tool, involves responding to questions on a gradient regarding frequency. The questions pertain to each of the three main elements of burnout: exhaustion/fatigue, depersonalization or loss of empathy, and a diminished sense of personal achievement. For example, the questionnaire asks to quantify a feeling of being emotionally drained, sensitivity toward patients, and self-assessment of professional effectiveness.23
Measurements of burnout in medical providers stem back to the midpoint of the 20th century when articles describing “doctor discontent” and low morale began to point to a growth of burnout in the medical profession. Notably, measurements of physician satisfaction declined from 1986 to 1997. Studies at the time pointed to the growth of managed care, loss of physician autonomy, and increasing popularity of employed provider models as likely culprits.24 In response, in 2001, The Joint Commission mandated that all hospitals have a policy to address well-being of physicians (distinct from disciplinary processes).25
Since 2011, the American Medical Association (AMA), Mayo Clinic, and Stanford Medicine have collaborated on triennial surveys to measure burnout among U.S. medical providers.26 More recently, the AMA, recognizing the profound effect of provider burnout on healthcare organizations — including reduced efficiency, financial strain, and poorer patient outcomes — introduced a new initiative: the “Organizational Biopsy.” This tool offers a holistic approach to assessing burnout and improving organizational health across key areas such as administrative culture, efficiency, self-care, and employee retention.27
According to the AMA data, the percentage of physicians endorsing at least one symptom of burnout dropped to 48.2% in 2023. This marks the first time since the COVID-19 pandemic that the rate has fallen below 50%.28 Similarly, a recent Medscape survey reflected this downward trend, albeit with different percentages.29 Despite these variations, the data consistently show that a significant number of physicians continue to experience burnout symptoms, with EM physicians being among those at the highest risk.1,2,29
Among physicians who reported at least one symptom of burnout in the Medscape survey, 83% attributed their symptoms to job-related factors. Although female physicians were more likely to report signs of burnout than their male counterparts (56% to 44%, respectively), this gender gap appears to be narrowing compared to previous years.29
As in prior surveys, doctors singled out bureaucratic tasks as the leading contributor to burnout, with almost two-thirds of respondents citing administrative work as the primary stressor. Additional factors contributing to burnout included excessive working hours, lack of respect from administrators and colleagues, and inadequate compensation.29
Importantly, nearly one-half of the surveyed providers felt their employers failed to acknowledge or recognize issues with burnout, while another 29% said they were unsure.29 The significance of this metric cannot be overstated, since research increasingly emphasizes that addressing burnout requires systemic changes on an organizational level rather than relying solely on individual coping strategies.2,13,15,16,21
For examples of systemic changes on an organizational level that can address burnout, see Table 1.
Table 1. Organizational Level Changes to Address Burnout2,13,15,16,21 |
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To address Dr. P.’s comment on age and experience, a 2021 Medscape survey revealed that burnout affects physicians across all age groups, with the highest prevalence among generation X (born between 1965 and 1980) at 48%. Slightly lower rates were reported among baby boomers (born between 1946 and 1964) at 38% and millennials or generation Y (born between 1981 and 1996) at 39%. Predictably, physicians of the baby boomer generation were the most likely to attribute burnout to the increasing role of technology in medical care.30
Data on burnout in generation Z (born between 1997 and 2012) is more limited because this cohort is just beginning to enter training and the healthcare workforce.30
Back to Dr. P.
Dr. E. leans forward, her tone steady and empathic. “Burnout can impact any of us, especially in the ED where the pace and pressure never seem to let up. Here’s what I would like to suggest. First, let’s make immediate changes to your schedule. You have been taking on the busiest shifts — let’s reallocate that for now so you have some breathing room. Second, I’d like to connect you to a coach we’ve partnered with. They specialize in helping emergency physicians manage burnout and rediscover their sense of purpose. It is fully covered through your benefit package. And, finally, let’s talk about system-level changes. Your frustrations about the inefficiencies in our workflow are valid. We need your input to advocate for improvements that will benefit the whole team.”
“Hmm,” Dr. P. clears his throat and blinks rapidly, feeling surprised. He had braced himself for criticism or a formal warning and did not anticipate understanding or even a tangible solution. “That sounds … helpful,” he begins cautiously. “But won’t shifting my workload place more pressure on the rest of the team?”
Dr. E. looks thoughtful. “They want you to succeed as much as I do — this isn’t just about offloading tasks. It’s really about creating a sustainable balance for everyone, including you. And helping you find a way forward. We’ve seen too many experienced emergency physicians leave the profession early because of burnout. I don’t want to see you go in that direction — not without trying a new approach first. You’ve been a pillar of this department over the year. Let us support you in return.”
Over the next few months, the changes begin to take effect. With a lighter schedule, Dr. P. finds he can focus more on the quality of care he provides, rather than feeling overwhelmed by the sheer volume. One day in the trauma bay, as he stitches a young child’s laceration, he finds himself smiling at the patient’s nervous jokes. It’s a small moment, but it reminds him of why he went into emergency medicine in the first place.
The sessions with the coach initially feel uncomfortable, but they quickly become a revelation. Guided reflection on his values and motivation reignites his sense of purpose. The coach also helps him develop practical strategies for managing stress during chaotic shifts, such as grounding techniques and time-blocking strategies for reviewing charts.
A few months later, Dr. P. speaks up during a department meeting, but not out of frustration. Instead, he shares an idea for streamlining the triage process, sparking an engaging discussion among his colleagues. He proposes a new way to organize administrative tasks, an idea that sparks a productive discussion among his colleagues. Dr. E., listening from the sidelines, catches his eye and gives an encouraging nod. For the first time in years, Dr. P. feels hopeful about his place in the ED.
What Is a Physician Coach?
It turns out, coaching is not just for athletes. Although business coaching has been around since the early 1900s, the profession became more standardized toward the end of the 20th century with the establishment of the International Coaching Federation (ICF). The ICF introduced formal training criteria and credentialing, elevating coaching to a recognized profession.31
Physician coaching is a specialized and growing area within this field. Many physician coaches are healthcare providers themselves, but this is not a requirement. Recent studies suggest that physician coaching can be a promising intervention for addressing burnout.32 However, experts agree that individual-level changes achieved through coaching must be paired with systemic organizational efforts for long-term success.15,16,21
As mentioned earlier, one notable initiative in addressing burnout on an organizational level is the AMA’s Organizational Biopsy, which gathered feedback from more than 12,000 physicians across 81 health systems in 31 states.33 Although this initiative provides valuable insight into the factors contributing to burnout and potential solutions, it represents only a fraction of the broader healthcare landscape.
For context, the American Hospital Association reports there currently are 407 health systems in the United States, and the Association of American Medical Colleges estimates there are nearly 1 million active physicians nationwide.34,35 This gap underscores the limitations of current programs in reaching the majority of providers. Although the AMA’s efforts to address burnout are laudable and set a strong foundation for systemic change, the limited scope highlights the need for broader, scalable interventions to support the providers and health systems that remain untouched by these initiatives. Expanding access to resources and increasing collaboration with additional health systems are critical next steps in tackling this widespread crisis.
Meet Dr. M.
Dr. M., 42 years of age and an experienced emergency physician working in a rural high-volume ED, sits in her car in the hospital parking lot at the end of her shift. Beyond the health center, fields stretch to the horizon, the early evening sunlight casting long shadows over the two-lane highway. She should have been home by now, but she cannot bring herself to leave. The idea of facing her family — the unfinished homework, the dinner conversations, the endless bedtime rituals — feels overwhelming. She grips the steering wheel tightly, as if the pressure might somehow help her overcome the exhaustion and detachment threatening to overwhelm her.
Inside the ED that day, the chaos had been relentless. A steady stream of patients filled every bay and spilled into the hallway. Among them:
- a man in his 50s, combative and confused after a suspected overdose;
- a young mother panicked about her toddler’s high fever and inconsolable cries;
- a neighbor teenager with abdominal pain and severe bruising.
Dr. M. moved through the cases methodically, her mind focused but detached. She knows she made the right calls — airway secured here, antibiotics ordered there — but the human connection that once defined her practice felt absent. Even the small moments of reassurance she used to offer, like a comforting hand on a shoulder or a few kind words, felt out of reach.
In the breakroom earlier that day, she overheard two nurses talking as she grabbed a protein bar from the counter. “She’s barely said a word all week,” one of them whispered. “Dr. M. is just burned out,” replied the other, shaking her head. “We all are.”
They were not wrong — she was burned out. She had not eaten a real meal in days, and her reflection in the bathroom mirror, pale and hollow-eyed, seemed to confirm what the nurses said. Yet, there was no time to address it. The ED was short-staffed, as always, and any hint of vulnerability might shift the burden onto her already overworked colleagues.
That night, after finally making it home well past midnight, she sits alone at the kitchen table scrolling through messages on her phone. She had missed her son’s school concert and bedtime for both kids. She looks at the note with the supper leftovers and feels … nothing. Blank. The thoughts that had been simmering below the surface for months now bubbled up: What is wrong with me? Why can’t I handle this anymore? The weariness and emotional numbness that had crept into her work life seemed to have followed her home.
The hardest part, she reflects, is the isolation. In this rural area, she is the only physician for miles. Several advanced practice nurses have come and gone during her tenure, all lured by better pay and more amenities in highly populated areas. She has never felt that way; having grown up in a nearby town, she deeply appreciates her upbringing and wants the same for her children. “Ironic, isn’t it,” she muses, “that I don’t have the time to enjoy the experience with them.”
The hospital administrators are sympathetic but more focused on keeping the doors open than on supporting staff well-being. When she had hinted at feeling overwhelmed during a monthly call with the regional director, the response was brisk: “We all have to pull through. Our patients depend on us.”
She knows that is true — her patients do depend on her. But Dr. M. is beginning to realize that she is facing a choice — she is going to have to find a way to care for herself or she will not be able to care for her patients — or her family.
Physician Mental Health
In March 2022, the Lorna Breen Health Care Provider Protection Act was signed into law to address the mental health crisis among healthcare providers. Named for Dr. Lorna Breen, a New York City EM physician who tragically died by suicide in the spring of 2020, during the height of the COVID-19 pandemic, the law aims to eliminate barriers to mental healthcare for physicians and other healthcare workers.36
The act allocates funds for healthcare students and providers to be trained in evidence-based methods to “reduce and prevent suicide, burnout, mental health conditions, and substance use disorders” in healthcare providers, and seeks to reduce the stigma surrounding seeking help.36,37
Continuing with Dr. M.
The following week, Dr. M. clears her schedule for the morning and stays home. Sitting at her kitchen table, she hesitates briefly before clicking the “Join Meeting” button on her laptop. As the telemedicine session connects, a video window opens and a calm, professional voice greets her. “Hi, Dr. M. I am Dr. C. It is good to meet you.”
For a moment, Dr. M. feels a wave of self-consciousness. Her finger hovers near the track pad, tempted to exit the call. Instead, she takes a deep breath, adjusts the camera, and reminds herself why she is here. Sitting on this side of the screen feels unfamiliar, even surreal, but after weeks of feeling overwhelmed and helpless, she finally has taken a friend’s advice.
A former medical school classmate had encouraged her to reach out. “If it doesn’t feel right, you can always end the call,” her friend had said. “But maybe it will help. At the very least you’ll get another perspective.” Dr. M. had decided to schedule a telemedicine appointment with a physician outside her health system, hoping to find some clarity — or relief.
“I’m not sure where to start,” says Dr. M., “but I think I need help.”
Dr. C. listens attentively, guiding the conversation with open-ended questions. As Dr. M. opens up, the words and emotions begin to flow. She speaks of the unrelenting exhaustion after back-to-back trauma cases, the sleepless nights spent replaying patient interactions, wondering if she missed a subtle sign or made the right call under pressure.
Her voice wavers as she admits how overwhelming it feels to face the chaos of the ED. “I used to thrive on the adrenaline, but now I feel dread walking through the doors,” she says. I feel guilty — and like I’m failing — not just as a physician, but as a parent and a partner. My family barely sees me, and when they do, I’m too exhausted to engage.”
Dr. C. asks thoughtful, targeted questions. “Have you noticed changes in your appetite or concentration?” Yes. “Have you had thoughts of quitting medicine or feeling like you can’t go on like this?” Also yes. “Has it gotten so difficult that you contemplated hurting yourself or ending your life?” Never.
By the end of the session, Dr. C. gently and clearly shares her assessment. “What you’re describing aligns with both burnout and symptoms of depression. Burnout stems from the unrelenting stress of your work — the sheer volume of patients, the unpredictable nature of the ED, and the systemic issues that make your job harder. Depression, on the other hand, affects your mood, energy, and your outlook on life. They overlap and amplify each other, but the good news is that both are treatable.”
Dr. M. nods, relieved but still apprehensive. Dr. C. outlines a plan: a trial of an antidepressant to help lift the fog of depression, regular teletherapy session to process emotions and develop coping strategies, and practical advice for managing burnout. “It is important to focus on what is in your control,” Dr. C. adds. “You’ve spent so long advocating for your patients. Consider that now is the time to advocate for yourself — and perhaps your colleagues, too.”
As she logs off, Dr. M. feels a small but significant shift. For the first time in what feels like forever, she does not feel entirely alone.
The Distinction Between Burnout and Depression
As noted previously, although there is an overlap between some of the symptoms of depression and the signs of burnout, these are distinct entities and require targeted interventions. Antidepressants are not indicated for burnout. However, some psychotherapies may be appropriate for either or both conditions. Mind-body interventions, such as meditation or yoga, can be used as adjunctive interventions in both as well, although research is mixed regarding the strength of response.18,19
Although symptoms of depression are pervasive and not related to a specific situation, signs of burnout are related to work; thus, interventions to ameliorate burnout need to address organizational-level factors.2,21,24,25 Without administrative support or intervention, a provider with burnout may need to push the limits of the system to see if change is possible, to advocate for provider needs, and/or to set clear boundaries regarding work conditions that are healthy and acceptable.
Back to Dr. M
As the weeks pass, the fog begins to lift. The antidepressant seems to help her regain clarity and energy, while therapy provides tools to process her emotions and set boundaries. For the first time in her career, Dr. M. permits herself to take time off — initially for the appointments, but eventually for other personal time, including to recharge and reconnect with her family.
As she regains her emotional strength, she starts to reengage with her role as a leader in the ED. During a department meeting, she speaks up: “We need to address burnout,” she says, surprising herself with the strength in her voice. “It’s not just me. Everyone is feeling it, but no one is talking about it. We need a system for peer support and a way to make our workload more manageable.”
To her surprise, her colleagues respond with enthusiasm. “You are right,” says one of the senior nurses, “but what can we do with the resources we have?”
That question ignites something in Dr. M. Over the next few months, she works with her team to implement small, actionable changes:
- organizing regular debriefing sessions after high-stress shifts, creating a safe space for colleagues to share and process their experiences;
- advocating for shift change adjustments to reduce consecutive overnight shifts and ensure adequate recovery time;
- proposing changes to triage workflows to improve efficiency and reduce bottlenecks in the ED.
Her work begins to ripple outward. Other rural providers join her efforts, and the small changes start making a difference. While the larger systemic issues remain daunting, Dr. M. no longer feels powerless. By prioritizing her own mental health and using her experience to spark change, she finds renewed purpose — not just as a healthcare provider, but as a leader and advocate for her community.
A Word About Suicide, Burnout, and Depression
In response to a 2018 survey of more than 5,000 physicians, one in 15 (6.5%) of the respondents endorsed having had suicidal thoughts during the year prior to the survey, putting physicians at significantly higher risk of such thoughts than the general population. Female physicians appear at higher risk than male physicians, and the suicide rate for physicians exceeds the rate in the general population.38
As noted earlier in this article, a 2020 cross-sectional study involving more than 1,200 physicians found that depression, but not physician burnout, was directly related to suicidal ideation in this population.39
Yet, with the close ties between the two conditions, it is useful to closely evaluate or self-evaluate for both burnout and depression when either is present. Burnout, as illustrated in the earlier vignettes, often creates a fertile ground for depression to develop. Although burnout itself may not directly lead to suicidal ideation, it can contribute to feelings of hopelessness, isolation, and professional dissatisfaction that increase vulnerability to depression — and, consequently, to suicidal thinking.40-42
For the ED physician, who often faces the pressures of demanding workloads, complex patient needs, and systemic inefficiencies, this overlap is especially concerning. It is crucial to recognize the warning signs of burnout and depression, both in oneself and in colleagues. Symptoms such as energy loss, persistent sadness, withdrawal from professional duties or personal activities, or a decline in focus should not be dismissed as “just” overload or stress.38,40-42
The American College of Emergency Physicians (ACEP) provides links to resources specifically designed to address the unique challenges faced by ED professionals. These resources include mental health support, peer networks, and strategies to mitigate burnout. The ACEP Wellness section offers a variety of tools, including resilience training programs, self-assessment tools for burnout, and guidance on creating a culture of wellness within ED teams. More information can be accessed at ACEP‘s wellness section.43
For broader mental health support, the National Suicide Prevention Lifeline (988) remains a critical resource. This confidential hotline provides 24/7 support to individuals in crisis, including healthcare providers.44
The Physician Support Line (888-409-0141) is another free, confidential resource specifically tailored for physicians and staffed by volunteer psychiatrists to address the emotional toll of medical practice.45
In addition, The National Academy of Medicine (NAM) has created a comprehensive “Action Collaborative on Clinician Well-Being and Resilience.” This initiative offers evidence-based strategies, toolkits, and best practices for addressing burnout and fostering systemic change. Resources are available at NAM Clinician Well-Being Collaborative.46
By leveraging these resources, emergency medicine providers can access fundamental and essential support to address burnout, enhance resilience, consider strategies to prevent or identify early signs of depression, and foster a healthier, more sustainable work environment.
A Word About Technology and Burnout
Recent advancements in artificial intelligence (AI) have introduced tools designed to assist medical providers in managing patient communications, potentially alleviating burnout. AI-driven systems can generate draft responses to patient messages, streamlining the communication process and reducing the administrative burden on clinicians.47
A study published in JAMA Network Open evaluated the implementation of a large language model used to draft patient messages in the electronic inbox. The model generated draft responses within seconds, allowing clinicians to review, edit, and send the final response back to the patient seamlessly. These integrations aimed to reduce the time clinicians spend on administrative tasks, thereby addressing factors contributing to burnout. The findings suggested that the use of AI-generated draft replies was associated with improvement in clinician well-being, indicating the potential for these tools for quick adaptation and usability in clinical workflows.48
Although these AI tools show promise in enhancing efficiency and reducing workload, it is essential to implement them thoughtfully. Ensuring that AI-generated messages maintain the quality and empathy expected in patient communications is crucial. Ongoing research and careful integration into clinical workflows are necessary to maximize the benefits of AI in reducing burnout.47,48
Another exciting use of technology in medicine is the development of AI-powered medical scribes that “listen” to patient interactions and generate clinical notes automatically.49 Although the potential of this type of technology to reduce the burden of documentation is significant, it is essential to ensure that these systems accurately capture the nuances of patient encounters and maintain patient confidentiality. Proper training and oversight are necessary to integrate AI scribes effectively into clinical practice, ensuring that they enhance rather than hinder the provider-patient relationship.48,49,50
Take-Home Messages
- Hallmark signs of burnout include emotional exhaustion, depersonalization or cynicism about work, and a sense of reduced personal efficacy.
- Although measures of burnout in all healthcare providers remain imprecise, recent surveys show that burnout continues to be a potentially dangerous occupational syndrome affecting healthcare systems and is highly prevalent in EM physicians.
- Addressing burnout requires recognition followed by both individual and system intervention.
- Distinguishing burnout from depression allows delivery of targeted and effective treatment.
- Looking ahead, thoughtfully applied technological advances, centered on patient care, may play a pivotal role in combating burnout among medical providers.
- More information and specific resources are available and published online on specialty (ACEP) and national medical organization webpages.
Ellen Feldman, MD, is with Altru Health System, Grand Forks, ND.
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This article examines the unique challenges of burnout in emergency department providers, exploring its impact on individuals, teams, and patient care. After an overview of the phenomenon, including historical trends and current statistics, this article will discuss actionable strategies to mitigate burnout and foster resilience, illustrated through real-world experiences of emergency medicine professionals.
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