Burnout: Emergency physicians worldwide at the limit

In this interview, Dr. Abdo Khoury addresses a global survey revealed that 62% of emergency medicine staff have been diagnosed with burnout, and how this unfolded

Burnout syndrome in the central emergency room

Translated from the original French version

Also known as "occupational burnout", it affects more particularly professionals involved in care work. The severity of each of the three dimensions of burnout is assessed separately by the Maslach Burnout Inventory (MBI).

In this survey, "extensive burnout" was defined as showing high levels of at least one of the dimensions "depersonalisation" or "emotional exhaustion".

Several studies have already shown that burnout, which is common among physicians, is even more prevalent in the field of emergency medicine. What causes it is a heavy emotional load, a quantity of work that is difficult to predict and the disregard of the circadian rhythm. Emergency physicians sometimes suffer from a lack of recognition from medical specialists in other fields.

Interview with Dr Abdo Khoury: "Burnout detected in 62 % of employees"

Dr. Abdo Khoury is an emergency physician at the University Hospital of Besançon, France. Since 2020, he has been the president of the European Society for Emergency Medicine (EUSEM), which unites 36 national emergency medicine societies.

Dr Khoury, what are the main findings of the EUSEM survey on burnout?

Khoury: Extensive burnout was found in 62% of all respondents. High levels of depersonalisation, emotional exhaustion and reduced self-actualisation were identified in 46%, 47% and 48% of respondents respectively.

In our survey, up to 75% of Italian or French ER staff show at least one of the two major symptoms of burnout. Germany scores slightly better1. What's even more worrying is that 31% of all respondents suffered from both high levels of depersonalisation and emotional exhaustion. Such severe burnout requires both medical assessment and psychological support.

Were you surprised by these results?

Khoury: Not at all. They confirm findings from before 2020. The pandemic has obviously aggravated the burnout problem. More recent studies had already highlighted the fact that all hospital carers suffered as a result of the pandemic, and that emergency physicians were among those most heavily affected.

Why did EUSEM conduct this survey?

Khoury: The reality of burnout is something we all see every day in our departments. In concrete terms, burnout means a series of sick leave, resignations and care workers leaving our profession. Within EUSEM, all the representatives of the national emergency medicine societies share this observation.

We wanted to make the issue of burnout the theme of our fifth campaign, which will be launched on 27 May to mark World Emergency Medicine Day.

These information campaigns are aimed at the general public. They demonstrate how the issues of emergency medicine are above all social issues that directly concern the population at large.

Since 2018, the campaigns have addressed issues such as the training and skills of emergency physicians, as well as the resources needed to guarantee access to quality emergency care for everyone. In 2020, in the midst of the pandemic, the campaign named "Together We Can" denounced the chronic lack of personnel.

For 2022, we have opted for the theme of burnout, with a simple message to the public:  "We take care of you, please take care of us".

EM Day 2022: Please take care of us from EUSEM on Vimeo.

The survey shows that chronic understaffing in emergency rooms is a major cause of burnout. How do you explain this?

Khoury: The survey shows a clear link between understaffing and the levels of burnout among emergency physicians. 57% of respondents report "frequent understaffing in their place of work". Professionals dealing with such conditions are ten times more likely to burn out.

Understaffing is a worldwide and longstanding problem, which is mainly related to the expansion of outpatient care. The mistake was to think that we could reduce the number of beds in hospitals and in the process reduce the number of staff. But hospitals cannot be run like factories.

Business management as taught in business schools may work when manufacturing cars, but it doesn't work for patient care. In the emergency room, no one knows when patients will arrive, or in what condition, or how long it will take to treat them, and even less when a bed will become available. While models do exist, they are still far from perfect in helping us to manage patient flows.

It seems that something else was overlooked: our society is changing. The way our health care systems were designed forty years ago is no longer adequate. We have an ageing population and in addition, families have become increasingly dispersed. In the event of a health problem, there is an increasing need for hospital admissions. And this is a worldwide trend. In China, for example, young people are moving thousands of kilometres away from their parents. We now have a social role that didn't previously exist. For some people, we are the only human link left.

No one saw this coming. We should have transformed those beds that were cut into resources for aftercare or for home nursing care. The consequence is that everyday we see dozens of people, often elderly, who remain on stretchers for hours because of the lack of available beds. We don't have enough time for the patients, and we feel that we are doing our job badly.

Are some healthcare workers more prone to burnout?

Khoury: The poor working conditions have a significant impact on young professionals. The less experienced individuals reported a higher level of burnout, which reached 74% among emergency physicians with less than 5 years of experience, compared to 60% among those with more than 10 years of experience. If a young professional suffers from burnout at an early age, the risk of a relapse or depression in later working life seems to increase. This is concerning.

The survey also found that women show higher levels of fatigue and exhaustion in general compared to men (64% vs. 59%). The number of women in our field is growing as well. However, social progress notwithstanding, women are more likely than men to encounter obstacles in how to reconcile irregular working hours and night work with family life. Not to mention the "glass ceiling", a sad reality that still impedes access to positions of responsibility.

What are the consequences of this widespread burnout in the emergency services?

Khoury: At an individual level, burnout can evolve into a severe anxiety-depression syndrome, addictive behaviours or even a post-traumatic stress disorder. For ER physicians, the risk of making a mistake increases, which only exacerbates their unhappiness. Like all doctors confronted with psychological difficulties, emergency physicians are still reluctant to ask for help. But psychological support has proven to be effective. In the survey, only 41% of respondents said they have sought this type of counselling.

Another lesson learned from this survey is that there is a clear connection between the high level of burnout among emergency physicians and their desire to change jobs. 25% of respondents consider leaving the field, which would further destabilise the healthcare systems. For patients, the consequence is a loss of quality and safety of care.

What are the measures that could save emergency physicians from burning out?

Khoury: We have to make our discipline more appealing in the long term. Emergency medicine is the only specialty where you can experience the most exciting 15 minutes of any other. It is a blend of both technology and humanity. We see patients as people, not as organs. There is no routine and we work in close-knit teams. In the United States, it is one of the three most popular specialties for aspiring medical doctors.

In Europe, things are different. Young physicians are enthusiastic at first, but then suffer from a lack of opportunities. This is another aspect that emerged from our survey: working only in the emergency department increases the risk of burning out. What keeps emergency physicians safe is to also work in pre-hospital care, or to be involved in research or training.

What about the training of emergency physicians?

Khoury: In the United States, emergency medicine has been a specialty in its own right for 50 years. In Europe, it wasn't until 1993 that a European directive was issued that led several countries to declare it a speciality. But the situation is not consistent: In countries like Portugal, Spain and Austria, emergency medicine is still not recognised as a separate discipline. In Lithuania, it has only recently become a speciality and there is a huge lack of trained specialists. In these countries, emergency services are mainly run by young, insufficiently trained physicians.

What would you say today to a young colleague starting out in the field of emergency medicine?

Khoury: My message is straightforward: "Protect yourself by diversifying your job. Everyday life in emergency medicine is exciting, but you should also take an interest in research or new developments in other countries. Educate yourself in new technologies or in the area of leadership. Expand your horizons as much as possible. Emergency medicine is a discipline with a future".


  1. More detailed data will be published soon by EUSEM.