Emergency medicine can be a very trying career. I should know. I’ve been at it for almost 30 years! I still enjoy the ER-making a difference in patients’ lives, thinking on my feet, solving complex problems (or at least trying to) and of course meeting some great people, both patients and health care team members.

Still, there are times when I wonder, what in God’s name was I thinking? Awful hours, not being able to cure everything and dealing with patients upset about the long wait. Yet these times for me are not all that common.

It seems that I am in the minority of ER physicians, who still has not experienced a lot of burnout. A recent study of ER docs revealed the startling finding that about 60% of my colleagues feel significant burnout. Many are thinking of working in different areas of medicine; others of quitting medicine entirely.

What is interesting and sad is that 20 years ago this percentage would have been much, much lower. What happened?

Nowadays hospital based doctors have many administrators watching over them. Patient satisfaction surveys, which are generally an unscientific way of looking at quality, make many order tests and give medications which we wouldn’t have done otherwise-just to up that percentage of “excellent care”. This may or may not be in the patient’s best interests. Length of stay, time until seen are also evaluated and compared with national standards. Protocols are developed for many conditions and deviations need to be justified. And the list goes on and on. In short, there is a feeling of not having much control of our profession.

Add on to this electronic medical records, which basically is in my mind a misguided attempt to computerize medical documentation and for the most part doesn’t really prevent errors or speed things up but does add significantly to our frustration.

There are no easy solutions here, but if I were a government bean counter, I’d be very concerned about the figure of 60% of ED physicians experiencing burnout. I just guess I’m lucky not to be one of that 60%.