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:

• 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.

Dr. Austin is the emergency medicine program director at FSU-Pensacola. She is the author of Revitalized: A Guidebook to Following Your Healing Heartline and host of “Heartline: Changemaking in Healthcare.” She is the current chair of the American Association of Women Emergency Physicians (AAWEP). Reach her at either www.andreaaustinmd.com or @andreaaustinmd.

Disclaimer: Opinions in this piece are my own and do not represent the views of any entity I work for or with, and do not reflect AAWEP or ACEP opinion or official policy.

References

1. Rahman R, Herbst K, Mobley P. More than simply “doing good:” A definition of Changemaker: what children, truckers, and superheroes all have in common. Arlington, VA: Ashoka Changemaker Learning Lab;
2. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573-576..
3. Bohman BD, Makowski MS, Wang H, et al. Empirical assessment of well-being: the Stanford Model of Occupational Well-Being. Acad Med. 2025;100(8):960-967.
4. Austin A, host. Dr. Christina Shenvi: unlocking career fulfillment with coaching and diversification [podcast]. Heartline: Changemaking in Healthcare. Episode 30. April 11, 2023. Accessed June 7, 2026. https://podcasts.apple.com/us/podcast/dr-christina-shenvi-unlocking-career-fulfillment-with/id1623136794?i=1000608439123.
5. Wildermuth A, Hartzell J, et al. Developing the Next Generation of Physician Changemakers: “You Have to Love the People, and Love the Process”. Cureus 17(5): e84861. doi:10.7759/cureus.84861