I think I’m finally burned out. And it’s been a long time coming.

It likely started when my private physician-owned emergency group got bought out by one of the big corporate groups. The changes were small at first. Turning us into hourly paid employees instead of an RVU-based salary. Shiny new VPs and directors sending us emails. Things seemed fine for a while. Then came the many, many emails about better charting to increase RVUs. And emails about increasing patient satisfaction.

Then the volumes in our emergency department went down, and instead of keeping things status quo, which is what would’ve happened in our old group, we were told to cut our hours. This was disheartening to everyone in our group. It led to multiple physicians getting credentialed at other facilities and working shifts at small outlying hospitals. Basically, planning for the eventual hammer drop and layoffs.

At the same time this is happening, our nurses are overworked and underpaid. The staff turnover on the nursing side of the department is worse than ever. We are constantly getting new, just out of school nurses to staff the department. This is fine when it’s a few at a time. But when the majority of the unit is staffed by nurses less than 1-2 years out of school? Everything suffers. Patient care. Patient satisfaction. Throughput. Door to everything times.

And don’t get me started on the door to everything times. Ever try to make those door to pain medication times for long bone fractures in a busy emergency department where the nurses aren’t allowed the autonomy to even give a Tylenol? There’s no way to give pain meds to every broken patient in an hour when the waiting room is 15 patients deep, the EMS radio keeps going off with critical traffic and transfers from outside hospitals backing up at the triage desk. And it’s impossible to meet the 1-hour mark for sepsis bundles when there is nowhere to start their IV, give medicines and fluids.

There is literally no space for new patients. The hospital is full. (Or at least at capacity because there aren’t enough nurses to staff all the beds upstairs). The waiting room is full of angry patients. And potentially very sick ones too.

The whole system is at a breaking point. And so am I. I don’t know how much longer I can work in a system where I feel like they’re trying to squeeze every last bit out of me. Without any support. Without anyone caring about us caregivers.

And I know I’m not the only one who feels like this. Broken. Beaten down. Disrespected. Abused. And simply burned out.

But I won’t quit yet. I haven’t even made it a decade in my field. I feel I owe it to my teachers, mentors, attendings, and patients to keep going. I will keep churning out these billable hours for my corporate overlords. Because in the end, it’s all about the patients. And caring for them is what matters most.

The author is an anonymous emergency physician.

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