Comparing Burnout Among General and Emergency Veterinarians | Episode 92 | Reviving Vet Med

Burnout is a universal challenge in veterinary medicine, but does the practice environment change the experience? In this episode, we are joined by Dr. Emily Li, an Emergency and Critical Care specialist based in Melbourne, Australia.

Emily’s interest in mental health was forged on the front lines of emergency medicine during the COVID-19 pandemic. Driven by her own lived experience and the challenges she saw in the clinic, she dedicated her Master’s thesis to comparing burnout drivers among general practitioners and emergency veterinarians across Australia.

During this episode, we discuss how workplace structures and workload predictability impact both groups. We also explore what surprisingly does not differ between general practice and ER burnout, and why Emily believes systemic changes, rather than just individual resilience, are the only way forward for the profession. Emily shares a grounded, evidence based perspective on the real drivers of exhaustion and highlights the importance of the person in environment fit.

Watch the Video Version of this Episode
https://youtu.be/ycynLHKEEHc

Resources
Follow Dr. Emily Li on LinkedIn: https://www.linkedin.com/in/emily-li-b59309137/  

Read Dr. Li’s papers: A comparison between veterinary small animal general practitioners and emergency practitioners in Australia Part 1 (https://pmc.ncbi.nlm.nih.gov/articles/PMC10993158/) and Part 2 (https://pmc.ncbi.nlm.nih.gov/articles/PMC10932987/)  

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For more information about Hill's products and nutritional philosophy, please visit HillsPet.com or HillsPet.ca.

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Thank you to Hill’s Pet Nutrition
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Transcript

Dr. Marie Holowaychuk - Founded more than 75 years ago with an unwavering commitment to science led pet nutrition, Hill’s Pet Nutrition is on a mission to help enrich and lengthen the special relationships between people and their pets. Hill’s is dedicated to pioneering research for dogs and cats using a scientific understanding of their specific needs as a leading veterinarian. Recommended Pet food brand knowledge is the first ingredient. With nearly 200 veterinarians and PhD nutritionists and food scientists working to develop breakthrough innovations in pet health. Hill’s Prescription Diet, therapeutic nutrition, plus our everyday wellness product line Hill’s Science Diet are sold at vet clinics and pet specialty retailers worldwide. For more information about Hill's products and nutritional philosophy, visit their website at hillspet.com or hillspet.ca for Canadian listeners. Hey everyone. Welcome to another episode of Reviving Vet Med. 

Dr. Marie - Today we're exploring how the day to day work experiences of general practitioners and emergency veterinarians differ and what those differences can tell us about the factors linked to burnout. In our professional discussion, I'm joined by Dr. Emily Li, a board certified specialist in small animal emergency and critical care based in Melbourne, Australia. Emily works on the frontline of emergency and referral practice and has also contributed important research examining the differences between GP and emergency veterinarians. In this episode, we talk about what actually differs between general practice and emergency work, including shift structure, staffing and exposure to emotionally intense cases. We also discuss what surprisingly does not differ when it comes to burnout levels. 

Dr. Marie -  Emily and I explore what her findings reveal about the real drivers of burnout in vet medicine and we also reflect on what this means for how we think about solutions and why individual resilience alone is never the full answer. This is a compelling conversation about the realities of veterinary work and what needs to change if we want a more sustainable profession. So let's get into my conversation with Dr. Emily Li. This is the Reviving Vet Med podcast and I'm your host, Dr. Marie Holowaychuk. My mission is to improve the mental health and wellbeing of veterinary professionals around the world. Hi Emily, thank you so much for joining me today. It's great to have you on the podcast. 

Dr. Emily Li -  Thank you for having me. 

Dr. Marie -  Yeah, I am really excited to talk to you about this. Obviously we're both critical care and emergency specialists, so this is right in our wheelhouse. And I was really excited to see this research that you published recently. And your research compares general practitioners and emergency veterinarians in Australia, which is of course where you live. I'm wondering what initially drew you to exploring these two particular groups side by side. 

Dr. Emily -  I guess it's quite personal for me, I think, because like many of our colleagues, I started my career in GP in general practice and I moved across to emergency a little bit later on and I think I immediately noticed that there were different stresses, like there were different challenges in the job when I moved across, but it didn't really hit until we kind of hit the COVID19 pandemic in Australia here, sure is quite similar across the globe, but in Australia here we saw a surge in, obviously, people owning companion animals, also a surge in the number of pets that were seeing through the door. Also at this time dealing with, I guess, the uncertainties of COVID and different veterinary clinics employing different strategies and that might be, you know, doing POD work or might be an increase in sickness and absenteeism and things like that. 

Dr. Emily -  So we saw quite a significant drop in staff numbers at the same time, which brought in new pressures. So I personally, probably about one to one and a half years into the pandemic, felt quite burned out myself, though I don't know if I, at the time I had the language for it, to be honest. I just felt an overwhelming sense of dread with the prospects of going to work. And every shift was very difficult for me coming back home. So I actually looked into doing something a little bit differently. I was in emergency at the time, so I had to look into going back into GP, but many of my GP friends were struggling with similar things, didn't look that much better, to be honest. 

Dr. Emily -  So I did actually look into putting a professional together because it was not something that was sustainable for me and my family could obviously see that in me as well. So that's kind of what started, I guess, my interest in the topic and also prompted me to look into burnout on both sides because I did feel at the time that, yeah, both sides were quite similar in some ways in terms of experiencing a lot of stresses in life. So I did what a lot of veterinarians do is to look into the literature to see if there's anything that can help me gain some clarity on what I was feeling. And I couldn't find anything. So, yeah, that's why.

Dr. Marie -  I love that you shared all that because it really personalizes it and I can attest to a lot of what you felt. I grew up in general practice. My parents owned a general practice, which is where I grew up working from a young age. And I always thought I would go into GP when I was finished school. And then I ended up doing an internship where I fell in love with emergency medicine. And then shortly into my career as a criticalist, I also experienced burnout. And there was a time where I toyed with similarly. Do I return home and take over my parents' practice? It was still an option at the time. Do I turn it into an ER and specialty practice? What is the plan here? And you're absolutely right. Is there up until your research, there really hasn't been anything comparing the two. 

Dr. Marie -  And I think people in GP practitioners, they often have this misconception that ER is so hard and, you know, it's way harder than what they do in GP. And as you uncovered in your research, there's stressors that are unique to both. And so I'm really excited to dig into that today. One of the clearest differences in your study that you identified was the structure of the work, which I think is logical. Right. There's these predictable schedules in general practice, right. You know, you're going to be in appointments, you're going to be in surgeries and so on, versus the highly variable high intensity shift work in emergency medicine. How do you think that particular difference shapes? Well, being amongst these two groups? 

Dr. Emily - Yes, I think those differences, like when people work in our field and think about it, oh, you're like, oh, of course there will be obvious differences, you know, day shifts, shift work, the unpredictability of not having a schedule and things like that. But I think for me it was important to kind of name those things and show that there is a difference. And I think because of those differences, it really puts on different types of stress. For example, I feel that shift work obviously comes with its own baggage of changing schedules all the time. Sometimes that might not conform to what we call normal people work. So partners, family, etc. Doesn't fit in with their schedule as well. So you can pull these professionals away from their families and they can feel isolated in a different way. 

Dr. Emily - Where I feel without gps, even though their schedule is more predictable, they are tending to suffer from other problems. Like a lot of people don't feel like they have control over their schedules at all. So whether the consoles are running too short for them, how their consoles are structured, along with how their procedures are structured for the day, there's a lack of sense of control there, I think as well. So I think there are different strains in both sides because of that. 

Dr. Marie - Yeah, those are really in points that you bring up and I never really thought about it until you said that, but yeah, I remember working in GP and just feeling like we've got to stay on schedule, like it was so stressful when the wait time just went up and up, and, you know, you're three appointments behind, so to speak. And so versus in er, it's kind of like, well, you wait until we see you. We work on a triage basis. Like there is no structure. And like you said, they both are uniquely stressful in their own way. So really important to highlight that, you know, despite these differences in workload and exposure to different cases, your findings showed similar levels of burnout between general practitioners and emergency vets. Honestly, it was interesting to me when I first read that. 

Dr. Marie - I'm wondering how you make sense of that. 

Dr. Emily - Yeah, definitely. Quite a surprising outcome for me too, because prior to undertaking this research, I've done a lot of literature reviews in the human literature, and often what came up was that emergency physicians showed a high level of stress or burnout compared to family medicine or other specialties. So I thought that going in, this reflects in my hypothesis in the study as well, that our emergency group might suffer from higher levels of burnout. But I think in the end, we found that both groups had moderate levels of burnout, which is, I guess, not great on either side. I had to think about, you know, why that might be the case. I think part of the reason I chose to compare the two groups, there are a lot of differences, but also a lot of similarities. Like. 

Dr. Emily - Like both groups, the primary receivers of cases from clients, whether that's a general practitioner or emergency bed, they're the first point of contact for most hospitals, for most referrals. I think that the nature of work brings in similarities in what they're exposed to. The other thing that I thought about was the contributing factors we found in our study that contributed to burnout. A lot of the things were commonalities shared between the two. They weren't the differences that we found, basically. So we are under the same kind of work environment in certain ways. There were a lot of factors that were talked about with things like your workplace environment in terms of your relationship with your colleagues or management, and things like that, which I think both sides share quite equally in that sense. 

Dr. Emily - We tried to take this work a few years after what we thought was after the pandemic. But I think the effects of the pandemic lingered on for longer than what we thought, really. So I think some of those workplace pressures were still quite, very much present in Australia at the time. We took the survey as well. Yeah, yeah. 

Dr. Marie - So many great points. You know, I think for both of us as specialists, our specialty is unique in that we can work very much within the frontline receiving of the ER and also wear our specialty hat in the icu, where we are receiving cases that have already filtered through other doctors. And I didn't think about that, but you're right. In GP and in the emergency room, you are really the first responder, so to speak, in terms of what we do in Met Med, in terms of not having paramedics in the field in most circumstances. So you are really on the front lines of that. 

Dr. Marie - And I suspect, and I know this isn't really something that you were able to investigate in your research, but certainly exposure to euthanasia, which we know can have its unique impacts on, well, being in vet medicine, would probably be quite similar in GP and ER. Like both of those settings, would probably tend to see more euthanasia than, for example, specialists, where they're going for surgery or going to see a dermatologist or an ophthalmologist or something like that. So really interesting that it didn't play out the same way as it has been in the literature in human medicine. And yeah, recognizing that all veterinary practices have similar environments and that, like you said, there can be issues with conflict, issues with supervisor interactions and so on, and those things are going to contribute to burnout. 

Dr. Marie - Which leads me to the next question I wanted to ask you because both groups reported a high exposure, a strong exposure to emotionally charged situations, but it was interesting that emergency veterinarians in particular seem to have a higher exposure to death, euthanasia and delivering bad news. How do you see those repeated exposures to those experiences shaping the emotional health of practitioners over time? 

Dr. Emily - Yeah, I think the kind of constant bombardment sometimes of having to walk in, consult after consult delivering bad news, whether that's, you know, your animal's just really sick or I can't help you in the ways that I want to. I think having repeated exposures to that does cause a certain amount of moral distress in the individual because obviously a lot of us are in the profession because we want to help. And not being able to help, I think slowly rose into that job satisfaction in certain ways, and that's not always within our control. Sometimes it's because our medicine advancements are just not up to there. Sometimes it's because of financial factors. And I think whichever way it is, both are equally difficult. 

Dr. Marie - Yeah, so what I'm hearing you say is that these situations of exposure to death or having to tell a client or a pet owner that their pet has a terminal diagnosis, or maybe the cost of their care is going to be very high or whatever. It might be those situations are just going to weigh on an individual over time, probably especially in circumstances that lead to moral distress, like you said, where they might know that this case needs to be referred to a specialist and the client doesn't wish to pursue that, or they are recommending a surgery that is going to be in the thousands of dollars and the client just can't afford that. So certainly nobody plans to go into the ER. Right. I think that's one big difference. 

Dr. Marie - And not to dispute the fact that general practitioners don't see emergencies because they certainly see their fair share of emergencies and walk-ins and drop offs and so on. And that is the only thing that we see in the ER is things that a person didn't anticipate having to deal with that day, most likely. And so I do think that carries that extra emotional weight, seeing clients at their worst of times. Do you know what I mean? Like, it's not taking a puppy in for vaccines, it's something more. Yeah. 

Dr. Emily - And I often feel that, like you said, that our GPs do share some of that work, but it can be a little bit more diluted out with, you know, a bit more maybe puppy kitten vaccinations and happier chats with clients. 

Dr. Marie - Yeah, absolutely. Absolutely. I know sometimes in the ER I relish the Parvo puppies that come in because it's just the chance to see a puppy and, you know, it's never a good circumstance. Obviously we wouldn't wish parvo on anybody. And it does tend to buffer some of the other quite challenging situations that we can deal with in the ER. At the end of a clinic day, you're not just tired, you're tired and catching up on notes. Covid is the AI copilot pilot built by veterinarians to give your freedom back. It captures your consultations and instantly prepares clear notes and follow up summaries for owners. So you save time and end the day with fewer records to catch up on. 

Dr. Marie - Veterinarian Dr. Deirdre Johnson says, I'm out of the office on time and spending so much more time with both my clients and my family at home. Try for free at CoVet. I want to go back to what you alluded to earlier where you talked about those similarities in workplace environments, staffing challenges, you know, even simple factors like whether breaks are interrupted and how you found in your research that can significantly influence burnout scores. What do you think that tells us about where solutions to burnout actually need to be focused? Because I think these are things that we know of in Vet Med, but we don't talk about them enough. 

Dr. Emily - Yeah, I absolutely feel the same way. I feel that these results are a surprise to no one working in the industry. But I just don't feel like they've been named. And I feel that until we can name something, we can't find the solution to those problems. So absolutely, I think it's very important that we talk about them. One thing I wanted to point out for burnout is the whole idea of burnout, it's a syndrome of a work occupation, not a syndrome of an individual. And I think we should never be separating burnout from the workplace because by definition is not something that we should be doing. And a lot of research kind of digressing a little bit has been on, I guess reinforcing the person in terms of building resilience, dealing with compassion fatigue on the individual level. 

Dr. Emily - But I don't think enough is talked about what we should be doing in the workplace. And I think I often say it doesn't matter how strong that individual is or how resilient that individual person is. And it's an interesting study in Australia a couple of years before mine actually showed even when resilience was accounted for, burnout still occurred in the workplace if workplace stresses are not addressed. So I think it's extremely important that we focus in and zone in on those things. And from the study that we did, we found that in both GPs and our emergency sectors, staff inadequacy was very much prevalent. I think the number one stressors for gps was related to their scheduling, if I remember rightly from the study. And the number one stressor for emergency vets was being inadequately staffed that day. 

Dr. Emily - So in the Australian context, and I think this does differ a little bit across the world, in the Australian context, veterinary nurses or veterinary technicians are actually not registered. So they don't shoulder the same degree of responsibility as they may across other countries. So that all the work they're performing is on the veterinarians that oversee that. So one thing that I thought could help with staff inadequacies because it's actually very hard in the Australian context to be employing more veterinarians in some ways. The Australian Veterinary association did a survey as well, I think around 2023, there's another one coming up now that I think more than 50% of people were aware that their practice was looking for a veterinarian for more than three months. So it's very hard to fill in those spots. 

Dr. Emily - Even if practices recognize that they need to hire more Vets, but where are those vets coming from? So one of the things I thought for the Australian context is that we could increase the support staff, whether that's increasing the administration staff to pull administration tasks away from veterinarians or work on a registration process for our veterinary nurses and technicians, who are often very capable but can't shoulder the same responsibility as veterinarians. So I think in the short term that might be kind of a way of relieving some of those workplace pressures. 

Dr. Marie - It's such interesting information and thank you for highlighting those geographical differences, because you're right. I mean, if there isn't a system in place for nurses or technicians to be registered and regulated, it's hard for veterinarians to feel comfortable allocating some of those procedures, decisions and so on to them. That does place a lot of burden on the veterinarians. And, yeah, that's. To think that half of practices are actively looking for a veterinarian in the last three months is quite astounding. And I don't think we quite are there yet here. We're definitely seeing shortages as well. But a lot of our focus has been on hiring more registered veterinary technicians and technologists to have some of the technical duties taken off the plate of veterinarians. So there certainly are some differences that vary from country to country. And a lot of the stressors are similar. 

Dr. Marie - The solutions might be different, I should say, but the stressors are similar. And that it really comes down to that scheduling and staffing and other things in each of these different environments, which is really interesting. That brings me to another question, actually, that was quite surprising. I think it does align with some of the research that was done a few years ago in the United States. But one of the most striking findings from your research, Emily, was that over half of respondents were considering leaving their current area of practice and about one in three were considering leaving the profession altogether. And I'm wondering what you think is driving that level of attrition. 

Dr. Emily - Yeah, I think from the research we've done, that's not very clear because it's not something that we focused on as a research question, but we did have a free form section for people to leave us comments. And I think a lot of comments were that they couldn't see a way forward that was financially viable or healthy for their emotional health. A lot of respondents in our study were not satisfied with their remuneration. And I think that does also contribute because a lot of people were considering cutting back their hours as a way to balance their mental health and being able to be more present for family, for other things outside of their career. Career. But I think a lot of people felt financially that wasn't something that was possible for them moving forward. 

Dr. Emily - And the kind of conclusion they came to was, well, there are other professions that will meet my remuneration requirements to sustain my family and also maybe help me to decrease the level of stress and feeling. 

Dr. Marie - Yeah, what an important thing to note. I know when I did the research for my book A Compassionate what it really Means to be a Veterinarian, one of my chapters was on student debt. And one of the things that I talked about was the average remuneration for new graduates. And I highlighted the research demonstrating the current salaries being offered to new grads in Canada, the United States and Australia. And it was quite surprising to me how much lower the salaries or the wages that were being offered to new grads in Australia compared to Canada and the U.S. which I feel have risen quite dramatically over the last few years. 

Dr. Marie - And it's surprising actually a little bit in the face of the high demand for veterinarians and the fact that perhaps those salaries just haven't kept up with that or they haven't shifted in response to that high demand. And certainly the research that's been done in the US has shown very strongly that when there is a high amount of debt, and I know schooling thankfully is kind of like it is here in Canada where it's more subsidized, it's not as expensive to go to school in Australia for vet school as it is in the United States. And yet still, if you feel like you're not able to meet your needs or your debt to income ratio does not feel sustainable, then it makes sense that people would consider looking elsewhere. Right. 

Dr. Marie - To pivoting outside of clinical practice, which just feels too hard without cutting back those hours, to pivoting outside of vet medicine altogether and certainly here in North America, I will say that the trend has very much been toward people cutting back their clinical practice more than ever before. We have veterinarians who are doing locum work so that it's flexible, so that it's modifiable to their schedule and that all together they are trending more towards part time clinical practice so that it does feel more sustainable than full time, five days a week, you know, 10, 12, 14 hour days where it just doesn't feel like that is a something that you could sustain, especially as you move forward in your life and in your career and you have other responsibilities. 

Dr. Emily - Yep, absolutely. I do feel like Australia in recent, in the last two to three years have seen that change as well. In terms of people moving away from full time practice. Thankfully, wages do appear to be increasing over here as well. But I have actually, you know, had a lot of friends move across the pond to Canada, to the U.S. to pursue that high income as well. So, yeah, it's interesting that we are losing vets externally as well. 

Dr. Marie - Yeah, that's a shame. And hopefully that's something that can balance itself out in the years to come. When you look at the relationship between burnout and client interactions, this is something that comes up a lot on social media in other research studies where people more recently have been looking at client instability as a cause of poor wellbeing and high levels of burnout. When you look at those client interactions, staffing, job satisfaction, all of these contributing factors, what do you think that veterinary leaders often misunderstand about burnout in veterinary practice? 

Dr. Emily - I think as we talk more about burnout, a lot of leadership groups have now paid a little bit more attention to the space. But I do feel that a lot of people are looking for quick fixes in the way of, you know, we're running this workshop on resilience. We are working this workshop on how to deal with compassion fatigue and things like that. But I think it needs to focus a little bit more on what the staff actually needs to find out in that particular group of veterinarians in that particular hospital. What are the main concerns the staff has and addressing those. I mean, don't get me wrong, I think those workshops are helpful, especially because I don't feel like, at least for myself, going through vet school, I had much exposure to that at all. 

Dr. Emily - But I still feel that is at a more surface level. I think they really need to drill down to what is actually causing the problem within their own practice. I came across a human study they did at one particular hospital where they surveyed the staff of, you know, what is causing stress to your day. And there were things regarding how scripts were printed out, there were things regarding how recheck appointments are 15 minutes and they would rather be 20 minutes. So what this group actually did was they implemented those changes and redid a survey. Six months later, they found a significant improvement in their staff satisfaction, brown out scores, etc. 

Dr. Emily - So I think we can really learn from that study and kind of pull our own practices in terms of what is actually not working and what are the staff saying and how many of those things maybe are things that we can change quite easily. Maybe for this practice recheck appointments from 15 minutes to 20 minutes wasn't such a big deal and something they were quite happy to do. And maybe we can find those things that will make a significant scheduling difference for those veterinarians or make them feel like they have a little bit more control over their workflow and day as well. 

Dr. Marie - Wow, that's fantastic. And burnout is one of those things where often when it's researched, it can take quite a bit of time to see changes after things are implemented. So the fact that there were changes that were seen after just six months of implementing those differences, that's wonderful. And I think this goes back to what you said earlier, where leaders really need to move away from putting the onus on the individual. You know, you talked about these quick fixes. The quick fixes are always on the individual, right? You need to attend a workshop on burnout, or you need to do this compassion fatigue training, or you need to boost your resilience by going to yoga more often, or you need to set better boundaries, whatever it is. And they're not looking at those system issues, right? 

Dr. Marie - The workflow problems, the staffing issues, even looking at things like how leadership rewards and recognizes the work that individuals do on the ground. I mean, there's so many workplace variables that are strongly associated with burnout, and very few of them are in the control of the team member, of the staff member, the veterinarian and the other folks working on the floor. But many of them are within the control of the leadership. And those are the things that we would like the leadership to focus on. So I love that. Well, stepping back from the data, you are somebody who works deeply in emergency and critical care. I'm wondering what gives you hope? What do you think is realistically possible to improve wellbeing and sustainability in vet medicine? 

Dr. Emily - I think increasing the conversation like we're doing now, and I hear it more and more, I feel that, you know, coming out of vet school is something that we discuss in harsh whispers, you know, around the clinic. But over the years, I am finding that people are more willing to talk more openly about these topics that plague the profession. And I think that's already a positive change, that people are willing to talk and willing to address the problems or name the problems. And being more vocal about those issues within our own practices, I do feel does drive change, does make our leadership teams view the problems as more important, something that might be put onto their agenda to have a look at in terms of what to do to improve certain things. I do have hope in that way. 

Dr. Emily - Not all hope is lost in terms of improving things. And I think it's okay if we need to start small as well. It might be something as simple as checking in with your colleague throughout the day to say, you know, how are you going? Genuinely speaking, how did you find your last consult? And things like that. I think from seeking that comfort and that reassurance from our peers, there is a lot of comfort to be had in that as well. 

Dr. Marie - Yeah, absolutely. I mean, so much of our happiness and wellbeing in our work is derived from our relationships within our work. And that is something that individuals have control over. I mean, you have control over how you interact with your peers and your colleagues. And I think starting within, starting with ourselves and asking those questions and checking in and then hoping that leadership is doing the same as well. And like we said, looking at those systems approaches, I think that's great. And I'm all about starting with conversation and just normalizing this and not having it be so shame ridden, resulting in those whispers. Right. That we can own. Just like you've owned your experience with burnout. 

Dr. Marie - I certainly talked about my experience with burnout and then doing this research and gaining this information and being able to put a name to these experiences and the factors that are associated with them. From there, we can move on to those solutions. So I love this work that you're doing, and I'm so grateful for this conversation. Emily, I wanted to ask you one more question that we ask all of our guests that come on the podcast, and that is, what does the phrase reviving veterinary medicine mean to you? 

Dr. Emily - To me, reviving veterinary medicine is about making a profession, one that people can genuinely feel happy and safe to stay in for, hopefully not just a part of their career, but their whole career, without costing them their health, whether that is physical or mental. Yeah. I think to me, that's what that means, is a profession I love deeply. And I'm currently in a very happy place, which is always a good start, and I hope more people can find that. 

Dr. Marie - That's beautiful. What a great place to end. Well, thank you so much, Emily. I know that you're very busy, and I really appreciate you taking the time to connect with me across multiple time zones. And I just can't wait for this information to get out there and for the conversation to continue. So thank you so much. 

Dr. Emily - Thank you. 

Dr. Marie - So that's it for this episode of Reviving Vet Med. I am so grateful to Emily for bringing both her clinical experience and her research lens to this conversation. What stands out is how clearly her work highlights that burnout is not simply about individual coping. It is deeply connected to systems, staffing, workload, and the emotional demands of care. If you'd like to learn more about Emily's research and work in emergency and critical care, or to read her papers, you'll find links in the show notes. If this episode resonated with you, please consider sharing it with a colleague. These conversations matter, and they help move our profession toward greater awareness and change. 

Dr. Marie - A sincere thank you to Dr. Emily Li for joining me today to Podcast Prime Solutions for producing this episode, and to you, the listeners, for being part of this community and listening to these important conversations. Until next time, take care of yourself. Bye for now.