The author practised emergency medicine for fourteen years. She left clinical practice last summer.

I want to write honestly about why I stopped practising. The broader public conversation about emergency medicine often emphasises burnout in the abstract; the reasons specific physicians leave are more particular than the abstract framing captures. The particularities matter for the policy conversations that depend on understanding what is actually happening.

What I had been doing

I worked in a regional emergency department in the Mountain West that handled a defined population's emergency-care needs across a wide geography. The work was demanding; it had been demanding for the entire fourteen years; the demand was not the principal reason I left.

What changed

What changed was the operational support infrastructure around the work. The administrative burden expanded. The available resources for handling psychiatric emergencies, for managing patients with substance-use issues, and for finding inpatient beds for admitted patients all narrowed. The clinical work itself was not harder; the conditions under which the clinical work happened became harder.

The breaking point

The breaking point was not a single dramatic event. It was the cumulative effect of months of practising under conditions where I could not, on most shifts, actually do what I had trained to do. The patients deserved better than the operating environment was supporting.

What I would tell policymakers

What I would tell policymakers is that the workforce question is not principally about burnout; it is about whether the operating conditions allow physicians to do the work they trained to do. Improving the conditions would, on what I observed, retain more physicians than wellness programmes addressed at burnout symptoms.

The honest read

The honest read is that the system loses physicians like me at higher rates than the policy conversation acknowledges, and that the loss is the result of operational decisions that the system can change. The choice to change those decisions has not, on the available evidence, been made.