Emergency physician burnout and attrition in Canada: a longitudinal study

BACKGROUND: Canadian emergency staff have been dealing with record patient attendances, long wait times, bed blocking, and department overcrowding. We sought to report temporal trends in Canadian emergency physician burnout, and describe the impact of emergency medicine practice on physician well-being. METHODS: We undertook a longitudinal study on Canadian emergency physician wellness that enrolled participants in April 2020. Participants were invited to 3 follow-up surveys in November 2020, September 2022, and January 2025. The primary outcomes were emotional exhaustion, depersonalization, and personal accomplishment scores. We conducted a deductive qualitative thematic analysis of the 2025 survey free-text responses by applying the framework created with our 2022 survey, to identify interconnected themes explaining burnout causes, consequences, and mechanisms that physicians use to stay in the specialty. RESULTS: The response rate to the survey was 410/615 (67%) in January 2025, from respondents in all provinces or territories in Canada except Yukon and Nunavut. Of 410 participants, 41 (10%) had left the profession. Among those who remained in emergency medicine and completed the full survey, 69/351 (20%) had taken time off emergency medicine and 170/351 (48%) had reduced their clinical hours in emergency medicine. In total, 229/351 (65%) scored either high emotional exhaustion, high depersonalization, or both. Burnout levels in 2020, 2022, and 2025 remained unchanged. Respondents pointed to a broken health care system, unrealistic societal expectations, and insurmountable workplace challenges as reasons for burnout. The consequences were physician distress and leaving the profession. Mechanisms to continue in emergency medicine were reducing work hours, modifying work roles, and changing health care institutions. INTERPRETATION: Emergency physician burnout remains high, with almost half of respondents having reduced their work hours, and 10% having left the profession. Provincial, regional, and institutional health care leaders could reduce emergency physician burnout by following EM:POWER recommendations and instituting work models that facilitate reducing clinical hours and taking time away from emergency medicine when needed.