How to Effectively Manage Stress and Burnout in Emergency Medicine

Raise your hand if you’ve ever been personally victimized by Regina George burnout. If you have, you’re not alone.

Burnout is exceedingly common in medicine. For us, it’s not a personal illness or disease—it’s more like an occupational hazard. Actively working to prevent yourself from reaching burnout won’t just improve your quality of life, but also allow you to give better care to your patients.

In this post, we’ll discuss why burnout is so prevalent in emergency medicine specifically, the difference between stress vs burnout, and a few ways to prevent stress from turning into burnout.

---

Burnout in Emergency Medicine

What does stress and burnout look like in medicine?

Scientists have been interested in burnout for some time. In fact, researchers have been studying how frequently workers experience burnout for decades. The Maslach Burnout Inventory (MBI)—a measure often used to assess burnout in medical professionals—has been a key tool for burnout research since the 1980s. 

Recently, the pandemic reminded everyone what a serious problem burnout is. Hundreds of thousands of clinicians left the healthcare workforce in the wake of COVID-19. Clearly, the pot was coming to a boil before that crisis, and many of the institutional efforts (from pizza parties to yoga) were falling short of the mark.

Are emergency medicine clinicians more susceptible to burnout?

Unfortunately, emergency medicine clinicians are at especially high risk for burnout. Our day-to-day life is inherently stressful. We must manage our patients’ emotions with empathy and grace, while balancing overwhelming patient volumes, staffing shortages, and high-stakes clinical care. Even the most stalwart optimists might falter when tasked with transferring a patient during a shift when every hospital is on diversion status.

While the realities of emergency department medicine can make things difficult, it’s important not to become too pessimistic. Burnout may be an occupational hazard, but that doesn’t mean it’s inevitable when faced with difficult circumstances. With this spirit in mind, let’s talk about some things you can do to reduce stress and prevent burnout.

We’ll begin by taking a look at how stress can lead to burnout, and some of the signs to be on the lookout for.

---

How Stress Can Lead to Burnout in Emergency Medicine

Stress Begets Stress, Begets Stress

During my residency, patient volumes came back with a vengeance after the height of the pandemic ended. I worked a stretch of shifts during which nothing seemed to be working smoothly. The hospital was constantly overcrowded and diagnostic studies took forever. The daily crush of patients boarding for a veritable eternity (picture the older patient lapsing into delirium in a hallway bed) added to a mounting sense of frustration.

I distinctly recall a particularly challenging code when the patient died. My staff seemed especially dejected about the case. Instead of feeling the same sadness, I felt numb and just moved to the next patient. After all, death happens, and there are other patients waiting. Another internal voice wondered, “When did you become so cynical? Am I broken?“

These shifts felt like a toxic merry-go-round of experiences curated to foster burnout: heavy workload, work-life imbalance, wanting to help but feeling helpless, and an overwhelming lack of control. The burnout response to situations like this is varied. It can present with cynicism, fatigue, irritability, loss of empathy, and decreased efficiency. Sadly, all of it is a recipe for losing the spark that brought us to healthcare in the first place.

Health Systems Must Help Prevent Physician Burnout

Let me be clear: the burden of managing burnout sits squarely on the shoulders of the organization and the health system. Research from the CDC shows that healthcare workers with access to social support, working conditions that foster productivity, and a solid safety culture had decreased odds of burnout (among other things). Employers and policymakers need to prioritize preventive actions and interventions to address friction points in the work environment. 

While there are many aspects of your work that aren’t within your control, there are several strategies you can use to manage stress and burnout. Here are some things I’ve found to be immensely helpful when I feel myself getting “crispy.”

---

6 Tips to Prevent Burnout in Emergency Medicine

1. Remember the basics.

Working in the emergency department doesn’t need to be a death sentence for good sleep habits. For me, eight hours of sleep is a priority. My brain simply doesn’t handle stress well without it.

Consistent sun exposure and regular exercise are just as important, and if I can combine the two, I’m able to buffer significant stress. You tend to avoid doom-scrolling on social media when you’re on a hike. In fact, experimenting with a break from social media is a good strategy. Comparison is the thief of joy, after all. 

Another crucial tool for burnout defense is nutrition. However, a healthy, balanced diet is just a part of this. Minimize or entirely cut out alcohol consumption. I’m looking at you, post-shift drink! Using drugs or alcohol to manage stress or fall asleep is never a good option, and should prompt you or your loved ones to reach out for help.

2. Talk freely.

Being able to share fears, mistakes, and frustrations with your community is important. It’s always easier to speak freely about the things we see and experience with other healthcare workers, who tend to understand them more easily. In a lot of ways, I’m fortunate—my wife was in medical training at the same time as me, and we were able to talk through some of the more challenging days.

Talking freely and sharing both the good and the bad was an important therapy. An open dialogue with a partner, friend, co-resident, medical school roommate, mentor, therapist, or family member—even if they’re not in medicine—can work wonders. Even just hearing yourself talk about what you’re struggling with may clue you into excessive negative thinking. 

3. Turn mistakes into an opportunity for growth. 

Feelings of burnout can be especially prominent when you make a mistake. Always try to remember, if you make a mistake, be honest about it, and use it as a building block, not as a strike against your identity.

Part of this mental rewiring hinges on your ability to find positives in difficult situations. I sometimes even use positive affirmations as a sort of mantra, and I subscribe to the “get to” philosophy. For example, although my brain upon waking might want to say “ugh, I have to work today,” I try to counter it with, “I get to work today!” 

Of course, this isn’t a recommendation to exude positivity at all costs. Take Spongebob Squarepants and Squidward Tentacles—they both work in the same job environment, arguably under very challenging conditions, but each has a different mindset. Both have a time and a place. A job can have highs and lows, and there isn’t always a perfect way to behave. Observations like this help me get through some of the difficult moments. 

4. Reset. 

During training, I made it a point to make sure my days off were truly off. That meant no emails and no catching up on work. This allowed me to fully enjoy that time, spent mostly outside, where my mind could wander. Spending time in the woods, in the mountains, or in the waves gave me much-needed minivacations. This was my personal mindfulness and meditation routine. 

5. Renew.

During fellowship, I alternated between clinical shifts at a tertiary care center and a remote critical access hospital. Whenever I started to feel tired at one, I rotated to the other. This change of environment and practice pattern was surprisingly refreshing. 

6. Devise a long-term strategy. 

Finally, I also engaged in emergency medicine development projects abroad, during which I took on more of an educator role. I found that these activities kept me engaged and feeling deeply rewarded by my work.

For me, continuing to engage in global EM development and rural locum work is a key part of my long-term burnout prevention strategy. For others, it may be teaching residents, developing an app, or writing poetry. Emergency medicine allows you to be fabulously creative in developing your own niche.

---

The Importance of Preventing Burnout

It’s important to understand that stress and burnout are like atherosclerotic plaque and myocardial infarction. In many ways, stress is a slow killer. Identifying the formula that works for you in keeping stress under control is crucial. Clinicians suffering from burnout are less efficient and make more mistakes. 

For a cost-conscious health system, prioritizing healthcare worker satisfaction is a no-brainer. Once somebody is burned out, a lot of the strategies for stress mitigation may not be as effective. Burnout is a tipping point, leading to poor performance, leaving the workforce, or—even worse—developing symptoms of depression. Finding your personalized formula for stress prevention is important, and employers must prioritize burnout mitigation strategies.

Emergency clinicians are hardcore. We run three codes in a shift, eat a granola bar, go rock climbing, and sleep during the day as if circadian rhythms don’t exist! Give us the right work environment and support, and we take care of our patients like there’s no tomorrow. But, even when others don’t properly support us, there are things we can do to alleviate stress.

Remember these tips for how to manage it, so you can prevent burnout. Our patients need us, and we need to take care of ourselves so we can take care of them.

---

Further Reading

For more (free!) content for practicing physicians, check out these other posts on the Rosh Review blog:

• The Important Role of Empathy in Medicine
• A Physician’s Guide to Communicating with Your Medical Team
• Staying Healthy as a Physician: Our Top Fitness Tips