Emergency physicians lead the league in burnout—but when they quit, it’s often for another reason

Among all medical specialties, emergency medicine is the single most likely to burn out its practitioners. 

Yet ED attrition is not uncommonly driven less by burnout than by moral injury, according to a new study.

Burnout may be more widespread, but its symptoms tend to recede with periods of rest, the study authors report. 

By contrast, moral injury “fractures professional identity, making leaving clinical practice feel like the only sustainable path.”

The research was led by emergency medicine physicians at Stanford and published June 3 in JAMA Network Open. 

For the project, lead author Serena Hua, MD, senior author Michelle Lin, MD, MPH, and colleagues conducted semi-structured video interviews with 46 board-certified or board-eligible ED doctors. 

All 46 had either seriously contemplated leaving clinical emergency medicine or already left the profession. 

“Physicians described a growing mismatch between increasing clinical demands and stagnant resources that prevented them from providing safe, high-quality patient care,” Hua and co-authors write. “These tensions were aggravated by the persistent emphasis on volume, efficiency and patient satisfaction over safety and clinical outcomes.”

More to the point: 

‘Participants identified wellness programs as adding insult to (rather than alleviating) moral injury. They felt these programs deflected attention and resources away from systemic problems and implied a lack of individual resilience. Rather than supporting retention, such initiatives deepened frustration and invalidated physicians’ experience of moral injury.’

Stubborn problems, strategic solutions 

Other key observations the team made upon analyzing the video interviews: 

• Physicians described pervasive disrespect, interpersonal conflict and devaluation of the work of emergency medicine. 
   
• Institutional responses promoting individual resilience exacerbated distress. 
   
• Limited opportunities for growth and rigid career structures demanding the same intensity of shifts across life stages led to feelings of stagnancy even among those with fewer negative experiences. 
   
• Women (61% of the field; n = 28) more frequently described gender inequities in advancement and inadequate support for new parents as drivers of attrition. 

Asked for their insights on how to strategically improve retention of ED physicians, the participants commonly named improving staffing, placing less emphasis on throughput and satisfaction, offering career flexibility to support life phases and caregiving, providing mentorship, extending opportunities for professional growth and working toward gender equity in advancement. 

The present study follows the April release of 2026 data from the American Medical Association showing emergency medicine has the highest rates of burnout, 49.8%.

Urological surgery and hematology/oncology are close behind, at 49.5% and 49.3% respectively, but it’s surely no surprise to Hua and fellow researchers that the ED tops even those burnout-addled clinical departments at exhausting and dissatisfying doctors. 

Moral injury is not to be confused with normal burnout 

In their discussion section, Hua and co-authors define moral injury as the persistent, irreconcilable conflict between professional duty and the inability to meet it.

“The distinction between burnout and moral injury is critical because solutions to address each differ,” the team points out.

For moral injury, they state, short-term mitigation strategies may include cultivating psychological safety, peer support groups to process feelings of moral distress and leadership focused on repairing broken trust in institutions. 

Meanwhile long-term resolution “requires realigning financial incentives to support clinical practice that prioritizes outcomes over throughput and margins, aligning reimbursement with the complexity and time required for safe care, and implementing and enforcing national standards for ED boarding and physician and nurse staffing.” 

‘Time to shift from pizzas to evidence-based investments’  

In invited commentary, Mira Mamtani, MD, MSEd, and Chinezimuzo Ihenatu, MD, both of the University of Pennsylvania, note the Hua et al. study presents “concerning evidence” regarding factors contributing to emergency medicine physician burnout, intention to leave and attrition.

“These findings should propel us to design interventions with individual, institutional and national factors in mind,” they write. 

More: 

‘It is time that solutions that support physicians shift from pizzas to evidence-based investments focused on individualized support, institutional programs and policies, and national advocacy to realign financial incentive structures.’

The full Hua et al. study is here, the Mamtani and Ihenatu commentary here.