In 2021, I was the most burned out I had ever been in my career. Burnout peaked during the pandemic for many emergency physicians. At first, I thought receiving my first COVID-19 vaccine would be more than just protection against the virus; perhaps it was the shot I needed to come out of the burnout fog as well. Although I use the term “burnout,” it was a much deeper level of exhaustion; it was more of a soul-level existential crisis.

On the one hand, I still loved emergency medicine: the social mission, the undifferentiated case, the sick patient, and my colleagues. On the other hand, I felt that the ED had become like the game Skee-Ball, where it was the lowest ring into which all of society’s problems landed. I took a three-month sabbatical, and during that time, I read and listened to everything I could about burnout. I got a career coach and started a master’s degree in health professions education.

After three months, I wanted to return to emergency medicine, but in a different way. Around the same time, I was introduced to the concept of appreciative inquiry: Instead of looking at what is going wrong in a system, we should focus on what is going right and amplify it. I became interested in physicians who, despite the challenges in medicine, were successful in enacting positive change. In the business world, people who enact change are called change agents. I later came across another term in the nonprofit sector: changemakers.

Changemakers exhibit creativity and tenacity to enact a change that benefits society.¹ Suddenly, I had a lightbulb moment: Medicine was full of change agents, many of whom were enacting changes that harmed our patients and us. We don’t need any more change agents; we need changemakers.

Further, we need frameworks to focus our change efforts. First is the Quadruple Aim, which seeks to improve quality, decrease costs, improve population outcomes, and promote health care worker well-being.² The Stanford Model of Occupational Well-being involves a culture of well-being, workplace efficiency, and individual factors.³ These two frameworks provide guidance on how we can focus our resources and attention toward improving health care. Additionally, the American Medical Association’s Get Rid of Stupid Stuff (GROSS) is also an excellent initiative, with a memorable name!

From there, I completed a qualitative study of 15 physician changemakers. The study population was predominantly emergency physicians. Several themes emerged, which I have summarized in the mnemonic PULSE: