The Long Game in Emergency Medicine

I have been reflecting a lot recently about what it takes to build a long, sustainable career in Emergency Medicine. The latest ACEM Sustainable Workforce Survey makes for sobering reading (see link below).

ED overcrowding and access block remain the two most commonly reported workplace stressors. More than half of respondents reported moderate to severe levels of personal and work-related burnout. 80% said fatigue had affected their performance at work.

Notably, 72% said they were likely to reduce their hours of clinical practice over the next 10 years. More than a third were considering leaving clinical practice altogether. 79% of respondents were FACEMs or PEM specialists.

I think these figures matter but I am not surprised by them; I consistently hear about the impact of access block, relentless demand, staff shortages, rostering challenges and late rostering notice, and the experience of carrying risk and responsibility in a system that makes it extremely difficult to do the job well.

However, not to be all doom and gloom, I also hear something else. ED doctors still love medicine. They are just questioning how they can continue to practise in these conditions for the next ten, twenty or thirty years.

Career sustainability is probably one of the most important conversations happening in my sessions with FACEMs right now. I am not suggesting doctors need to become more resilient and can simply "self-care" themselves out of access block. In fact, those of you who have worked with me will know that I often push back on this notion and assert that Critical Care doctors are incredibly resilient and have extraordinary capacity to tolerate (and grow) under pressure and adversity.

Nevertheless, while we absolutely should continue to advocate for system change, there is important work that can be done at an individual level.

We can become far better at recognising early warning signs. We need to understand the difference between stress, burnout and moral injury. They require different responses.

We can develop greater tolerance for uncertainty, discomfort, and cognitive load, without becoming numb to it.

We can learn to regulate more effectively after difficult shifts and critical incidents. We need to think with more intention around recovery, relationships, and sleep.

We can unlearn deeply rooted beliefs that saying no is incompetence or asking for help is weakness.

This survey found that doctors are already thinking of ways to sustain their careers. The report identifies growing fractionalisation of the ED workforce. For some doctors, sustainability is reducing clinical hours and/or increasing time in education, research, and leadership.

Rather than thinking "how long can I cope with this?", ask yourself "what do I need to put in place now so I can continue to do meaningful work without sacrificing myself to it?".

I think this is the question we need to be reflecting on earlier in the career and not when already burnt out and the dread of arriving on shift has set in.

If you want to have that conversation with me, reach out at hello@natalieharman.com.au

2025 ACEM Sustainable Workforce Survey