• Perpetual learning—half of the study population had an advanced degree beyond MD/DO;
• Unyielding courage and resilience;
• Leveraging the system and intentional, impactful communication;
• Sustaining self by navigating complex emotions and connecting to inspiration; and
• Embodying ownership of the change and job crafting.

Although Kotter’s Model of change is helpful, this framework adds the internal work and connective tissue that must precede and continue throughout change efforts.

By tapping into the rhythm of our changemaking pulse, we can reinvent emergency medicine to better serve our patients and, at the same time, combat the widespread burnout and moral injury crippling our specialty. Through mentoring and coaching countless physicians, I have observed a common pattern: Physicians start out with high levels of altruism and engagement in change efforts. As burnout sets in, a frequent sentiment becomes, “I’m just one person; I can’t change the system.” Apathy takes hold, draining both interest in how the system works and energy to move the levers of change.

While often attempting to right wrongs through their work, changemakers become the human face of the system. Researchers call these wrongs institutional betrayal. For example, many felt institutional betrayal when they lacked personal protective equipment during the early portion of the COVID-19 pandemic. Thus, changemakers are often charged with owning both the good and the bad of change efforts, and in doing so, have the potential to restore trust among stakeholders.

Lastly, we all have the job we’re given, and the job we want. Changemakers in my study were excellent at job crafting, which involves seeking opportunities to shape their current roles to align with what they want to do. For instance, although your primary position may be working shifts in the ED, you may volunteer to review cases if you’re interested in quality, or join a hospital committee to influence change outside your own ED. While we often must bootstrap those efforts initially, with gumption, you may be able to secure protected time.

It is increasingly clear that emergency medicine is a frayed safety net with substantial occupational hazards for those who work in it. It is also clear that neither politicians nor insurers are coming to fix the ED. As Dr. Christina Shenvi reminded me during a , it’s up to us to fix emergency medicine.⁴ While this is daunting, it is also incredibly freeing. We know the ED best. Knowing the grit, ingenuity, and heart of emergency physicians, I am betting on us, especially if we embrace changemaking.