Wellness Week January 23 – 27, 2023

It’s CAEP Wellness Week 2023!

It seems to have rolled around again very quickly… and yet very slowly too. We had some internal debate about what would be best for this week. We didn’t want to paint the current situation with toxic positivity, and we also recognized that speaking of “doom and gloom” all the time doesn’t make us feel better.

Many of us felt that self-compassion has really been key our mindsets right now, and so the content this week mirrors the 3 elements of self-compassion that have been described by Dr. Kristen Neff.

  • mindfulness: acknowledgement of the current emotional state with honesty
  • common humanity: recognising that we are not in this alone
  • self-kindness: “being warm and understanding toward ourselves when we suffer, fail, or feel inadequate, rather than ignoring our pain or flagellating ourselves with self-criticism.”1

So, what we have for you this week is: a discussion of where we are right now, what is happening in EM internationally, and finally, because we are emerg docs, both Wednesday National Grand Rounds, and the final day post will include practical activities to help cultivate hope and energy. National Grand Rounds free! The topic is Shame Resilience for Emergency Physicians, with Dawn Lim presenting & Sara Gray moderating. Don’t let the word “resilience” scare you off. This is a talk full of thoughtful messages and practical take-aways!

Dr. Rodrick Lim 

Dr. Lim is an Associate professor and Medical Director & Section Chief of the Paediatric Emergency Department at the Children’s Hospital at
London Health Sciences Centre and Chair of the Wellness Committee, and Leadership Committee at CAEP.

Dr. Louise Rang

Louise Rang is an emergency physician and associate professor at Queen’s University Department of Emergency Medicine. She is currently in her dream role as the Professional Sustainability & Wellness Lead for the department, which allows her to work creatively and collaboratively to improve physician and departmental wellbeing. She is an active member of the CAEP Wellness Committee.

On with the show: Turning things over to Dr. De Wit.

Dr. Kerstin de Wit

Dr. Kerstin de Wit is an Associate Professor in the Department of Emergency Medicine at Queen’s University. She works clinically in Kingston Health Sciences Emergency Department and Thrombosis Clinic. She is heading a longitudinal study on emergency physician wellness during the pandemic.

What is going well?

“Now is a great time to live in the place you always wanted to. Staff emergency medicine positions are available for the taking across Canada (and, in fact, across the world). Departments will welcome you with open arms.

The public (and the rest of the hospital) have never been so aware of the role of the emergency department. I don’t remember being thanked by so many patients before. My neighbours finally seem to understand I work during holidays and nights. Nonemergency physicians tell me they find it hard to visit our department. Maybe, finally, other people get what happens in emergency medicine (and what is happening now)”

What is hard in emergency medicine right now?

“Emergency physicians stepped up in March 2020. We trained on how to manage COVID-19. We turned up to our shifts when everyone else was at home. We home-schooled our children, distanced ourselves from family and friends, dealt with our fears and anxieties, stopped travelling. But perhaps the hardest thing has been to maintain our enthusiasm and energy for our jobs when Canada re-opened. Emergency department patient visits are at records highs. Viruses are unabating. Patients are without family physicians. Many of our colleagues have retired, side stepped into other roles or left emergency medicine. Emergency departments have closed. We are too few physicians covering too many shifts. We worry how we will be able to sustain the system and what is going to happen to emergency medicine.

What is hard for us right now? Burnout, real, raw burnout. We have followed almost 600 Canadian emergency physicians since the pandemic start. During the first two months less than 20% of physicians reported experiencing high burnout. You could invert these numbers for our most recent emergency physician survey with high burnout levels found in the vast majority of the same participants.

Words like ‘tired’, ‘exhausted’, ‘lack of empathy’, ‘hopelessness’, ‘getting out’, ‘leaving’ and ‘retiring’ are recurrent in the October 2022 survey. Recurrent themes are the utter lack of energy, that things are worse now than they were at the height of the pandemic, that work is overwhelming and there is political inaction.

 If you are feeling like this, know that you are not alone.”

This week is an invitation to keep taking it one shift | patient | coffee at a time, and to recognise 2 things: one day at a time is OK, and doing it with others that you care about, is a win. Join the twitter conversation with #CAEPWW23

  1. https://self-compassion.org/the-three-elements-of-self-compassion-2/

See you everyday for new content!

Rod & Louise

Headshot - Nour Khatib

Dr. Nour Khatib

My name is Nour Khatib and I’m an emergency physician working in the Greater Toronto Area and rural/remote Canada. For the longest time wellness was a foreign concept to me. I was far from well. In fact, I felt every ‘wellness talk’ I heard was an eye-rolling management-mandated waste of time. That’s the truth, you know it. You’ve rolled your eyes and sighed just like I did. Now I give these talks. Ironic, right?  I give these talks and make sure they’re practical for the average physician. A personal view of my journey and the roller rides of ‘hell and back’ every few years – cycles of burnout, that awful occupational hazard that comes with our profession (insert shameless self-promotion here: drnourkhatib.com). Part of my learning process involved talking to international colleagues about their experiences.

At CAEP, I’m the global health Swiss liaison. CAEP has developed partnerships with multiple EM societies worldwide and I am the Swiss connection. Switzerland: the country with the most chocolate per capita and Nobel prize laureates per capita – connection there?  I digress… One of our initiatives is a mutual project on wellness for EM doctors. How can we in Canada learn from the Swiss and vice versa?


We know how badly burnout has hit us here in Canada. Our EM specialty is suffering nationally, but is this an international problem? EM is new to Switzerland and in fact is not yet recognized as its own specialty, so in addition to growing pains they have to deal with pandemic consequences to the specialty. Let’s ask the Swiss how things are going.


Insights from Dr. Eric Heymann and Dr. Valerie Romann are provided below.


Dr. Eric Heymann

Dr. Eric Heymann is an Emergency Medicine (EM) and prehospital EM physician based in Switzerland. With experience in the United Kingdom, Singapore, South Africa, Australia as well as Switzerland, interests include critical care, airway management, analgosedation, medical simulation and well-being  in healhcare teams. Dr Heymann holds an academic role at the University of Bern, committee positions for the Swiss Society of Emergency and Rescue Medicine, as well as teaching roles for the european catastrophe medicine course (MRMI), the Advanced Trauma Life Support course (ATLS), swiss prehospital (paramedic) courses, and is a member of the Swiss Humanitarian Aid Unit (SHA) corps.

3 things that are going well in EM in Switzerland:

  • A turning point for recognition: the creation of a dedicated training pathway and specialist title looks set to become reality in the next 5 years
  • A sense of unity between Emergency physicians, regardless of linguistic differences, is forming – a consequence of COVID? Swiss Community of Emergency Medicine (SCEM) has been formed.
  • Training programs have begun for seniors to aide in the reconnaissance of learners in difficulty (e.g. Teach the teachers)

3 things that are hard about EM in Switzerland:

  • Long hours, irregular schedules -> minimum of 60 hours/week for most
  • Increased workload from burned out colleagues not being replaced -> seeing the difficulties of everyday work, less and less young MDs are attracted to EM -> future generation?
  • Silo culture and the difficult relationship with other departments -> access block

A description of 2-4 Solutions underway:

  • Training of all senior physicians to recognize burnout and how to address it -> cantonal initiative (‘Canton’ is equivalent to a province in Canada)
  • Reaffirmation of importance of EM: Negotiations and lobbying for EM directly at the political level -> bypass access block in place by hospital

The collaboration and work the Swiss EM committee is doing for EM Staff Wellness

In collaboration with the CAEP, our committee is currently finalizing the first national survey of burnout incidence in EM physicians in Switzerland. The results will Qualify and quantify burnout and depression in EM physicians in Switzerland, and help identify protective and harming factors, in a bid to address these through national policies.


Dr. Valerie Romann

Dr. Valerie Romann is an internist and attending emergency physician in Bern, Switzerland. She studied Medicine in Bern and Lausanne in Germand and in French, and was a research intern for a summer at UBC in Vancouver. Besides emergency medicine, special interests include ultrasound, dive medicine and digital health. She has a personal connection to Canada after having spent a high school exchange year in Ontario and is involved in the Swiss-Canadian collaboration with CAEP.

What is it like to be a Swiss EM Doctor?

In Switzerland, the title of EM doctor may describe different roles: It may be an internal medicine or surgery specialists with additional qualification in emergency medicine who works in an ED. Or, it may be an anesthesiologist who accompanies paramedics to provide preclinical emergency care. Some do both. For me, working at a medium-sized urban hospital, it means spending each day closely working with a team of nurses and residents trying to solve medical puzzles and providing primary care.

3 things that are going well in EM in Switzerland:

Swiss EDs are well equipped with readily available diagnostic tools, including MRIs and specialist consultations. Follow-up specialist consultations usually take place within a short time span, as required by guidelines.

EM is seen as an attractive occupation among young residents. It is an incredibly interesting field with varying working hours, which is why – luckily – positions available at EDs can usually be filled. However, this is threatened by less attractive working conditions that have emerged post COVID-19.

Collaboration between hospitals usually works well: If a there is no availability in-house, or patient needs care that is only available in a different hospital, we work together to transfer patients to wherever care can optimally be provided.

3 things that are hard:

Currently there is a concerning shortage of (mostly nursing) staff, which results in a severe lack of in-hospital care availabilities. This has worsened after the COVID-19 pandemic. We now engage daily in long searches for an available hospital bed elsewhere for a patient in need, which binds resources and results in stress for everyone involved.

While there is a diploma for EM, it is not its own specialty. This results in greatly varying skills and backgrounds of EM physicians, and weakens the position of EM in cooperation with other disciplines. This has even resulted in interdisciplinary EDs being shut down and medical emergencies being directly referred to specialists.

The increasing shortage of family doctors, the growing population, and the shifting understanding of a medical emergency in the public leads to staggering increases of emergency consultations each year. We continually expand resources to accommodate this increase, but it still leads to longer wait-times and over-filled EDs.

Description of 2-4 solutions underway

There are continuous political efforts on multiple levels to establish EM as its own specialty. Recruiting initiatives of family doctors and nursing staff look promising: We just passed a political initiative to improve working conditions for nurses. Family doctors have been working closely with universities to create interest in the profession among medical students.

Day 3 – CAEP National Grand Rounds (Wednesday, January 25th)

“The system is broken. No one is coming to help.”

“We are on the brink of disaster. I have nothing left. A coffee and a cookie is not going to fix this.”

“My pain has no voice. Don’t tell me to be more resilient, practice gratitude, or meditate.”

No one thing will fix this mess. But one thing is certain: change starts when one person decides to act. When I experienced the peak of my burnout in 2013, understanding my shame triggers was the keystone habit that helped me choose the aligned path. It was a habit that I didn’t appreciate until I looked back and realized “that was when everything changed.”

We can learn these habits.

We can take back control.

We can influence the trajectory of our lives.

Then, if we all do this, maybe one day the system won’t be so broken.

Or we can be angry. And complain. And blame.

According to the Harvard Grant Study, strong relationships create a meaningful life. As physicians, we work in the profession of relationships. Some interactions bring happiness and joy. Others, grief and shame. In the third year of a global pandemic, can we navigate and learn from the wheel of emotions that challenge and enrich us?

Can we learn how to navigate the deep waters of our feelings and name the shame that silences us?

To hear more, tune into CAEP National Grand Rounds on Wednesday, January 25th to hear Dawn Lim present on this topic.  Dr. Sara Gray will moderate a conversation following the presentation.

Presenter:  Dr. Dawn Lim

Dawn Lim is an emergency doctor at the University Health Network and an assistant professor of medicine at the University of Toronto.  Her love of learning and exploration led her to the peaks of a European Space Agency parabola, the rough roads of rural Cambodia, and the shiny halls of business school. She eventually took a much-needed pause to walk an 800 km spiritual journey to find her way home through photography, writing, and motherhood.

As a trained facilitator of The Daring WayTM, Dawn uses storytelling as a tool for self-compassion in medical practice with a particular focus on changing the shame-based culture of medicine. Her work has been supported by a National Geographic Covid grant and can be found in various national media outlets.

Moderator:  Dr. Sara Gray

Dr. Sara Gray is cross-trained in Emergency Medicine and Critical Care and works at St. Michael’s Hospital in Toronto.  Her academic interests include optimizing resuscitation performance, knowledge translation of best practices, and resilience.  She is also an ICF-certified professional coach, and works with clients around goal-setting, communication, career transitions, and well-being.

If you want to try some other activities to cultivate shame resilience for yourself and your team, click here for Dr. Lim’s Shame Resilience Toolkit which presents several exercises.  These are the active takeaways that we all love as emerg docs!

(This is one of several toolkits that are being created for CAEP – they are documents designed to help you get started on wellness projects in your department or hospital.  Check out Friday’s post for another!)

Day 4:  We are all in this together! A Danish perspective (Thursday, January 26th)

Dr. Kimberly deSouza 

I am Dr. Kimberly deSouza.  As a Canadian EM doc who moved to Denmark a few years ago, I have learned to embrace the culture, language and a new working environment in emergency medicine.  I note that each system has its strengths/ weaknesses and there is value in learning from each other despite our age difference.  Emergency medicine was recognized as a specialty in Denmark in 2017 and the first specialty education/ residency programs in emergency medicine began in 2019.

The healthcare system in Denmark and Canada have many similarities including publicly funded healthcare, the commitment for high quality care to meet the needs of the people they serve, evidence based medicine and even using CanMEDS framework (“7 lægeroller/ 7 Doctor Roles” in Denmark)  to set high standards for medical education.  Notable system differences include a 37 hour work week, social system benefits including paid vacation, pension, maternity leave and sick days.

The Canadian EM specialty is nearly 50 years established and is still in evolution.  No system is perfect.  We can attempt to learn from each other’s strengths and weakness as we strive towards our own emergency medicine utopia.  In early 2022, CAEP and DASEM entered a partnership to learn from each other.

Dr. Dea Kehler 

Headshot - Katrine Nielsen - COPY

Dr. Katrine Nielsen

Dr. Dea Kehler, Chair of the Work Environment Committee at DASEM (Danish Society of Emergency Physicians) and Dr. Katrine Nielsen Chair of YDAM (Younger Danish Emergency Physicians) provide insight into Danish emergency medicine.

What is it like to be a Danish EM Doctor?

As a specialty, emergency medicine is popular and meaningful. Emergency departments are very different in DK both in terms of organization, the number of specialists and the conditions they are run on. Most emergency departments are organized as hybrid organizations where staff coverage is shared by emergency physicians and other specialties. In general, resources do not balance patient volume and the emergency departments suffer from existing capacity problems in the healthcare system.

There are more and more role models in emergency medicine. The work of DASEM and YDAM (Younger Danish Emergency Physicians) and their priorities for change are recognized on the national agenda.

What three things are going well in EM in Denmark?

There are increasing numbers of interns and residents and specialists nationally.

Important subjects on the national agenda have been identified and prioritized including finances, specialist capacity and organization as well as national agreement on how to run the emergency departments.

Emergency medical doctors have gained greater representation in central bodies nationally.

What are three things that are difficult right now?

  1. Resources do not match patient volume. We have too many patients entering the emergency departments who are not acutely ill. Possible solutions to this problem:
  • Sub-acute slots in the outpatient clinics
  • Have elderly patients treated in their own homes
  • 72-hour follow-up on discharges and the possibility of re-admission in those discharged wards if necessary
  • Pre-visiting emergency vehicles with paramedics/ambulance doctors with the possibility of transferring care to the emergency departments or treatment at home under the supervision of emergency physicians
  1. The bed capacity does not match the demand. This may be solved if one succeeds with
  • The solutions mentioned under 1 (see above).
  • Specialists on duty 24/7 – especially in the internal medicine specialties with focus on the ward corridors, so that patients are discharged as soon as they are ready – this reduces limitations on beds, which in turn reduces boarding (one of the main causes of crowding in the Danish emergency departments).
  • More emergency spots or “transition places” for the elderly, so that the only options are not only limited to either 1) home, 2) ambulatory follow-up or 3) hospitalization.
  1. The shift structure and 100% clinical/shiftwork does not match the work life balance for doctors and risks burnout. DASEM and YDAM have in recent months arranged both events and surveys with the goal of identifying an estimate of amount of emergency medicine doctors who are burned out and why – with the focus being how we can change that.

Possible solutions:

  • Take individual consideration of the individual doctor to the extent that it can be done instead of everyone being treated the same. Doctors have different needs depending on where they are in life – correct reality in relation to the art of the possible.
  • Change the collective agreement and the shift structure.
  • Increase finances to ensure adequate staffing.
  • Include the possibility of having a few days a month where you have non-clinical functions that focus on developing and strengthening the department and the community.

Can you describe the collaboration and work your committee is doing for EM Staff Wellbeing?

YDAM (Younger Danish Emergency Physicians) was established under DASEM as an independent organization. They work closely with DASEM to prioritize especially the below mentioned areas. The involvement of YDAM in DASEM’s work ensures the representation of young emergency physicians and their opinions in the decisions that are made in regard to their future work life.

  1. Improvement of the working environment
  2. Revision of the competence card and the goal description
  3. Ensure representation in national central bodies
  4. Advocate for a collective agreement that adequately reflects and renumerates the demanding nature of emergency medicine work and shift structure
  5. Bringing “how to reduce the load on the emergency departments” on the national agenda
  6. Increasing post-graduate education in emergency medicine, so that we can succeed in becoming enough to handle the emergency task
  7. Work for larger training community in emergency medicine, for example through regional educational days

Final Thoughts:

Despite our differences, we are very much the same.  We share a common vision to provide high  quality care for the people in a timely and efficient manner.  Despite system differences, we experience similar physician burnout.  We really appreciate the two groups learning from each other to help solve problems that are common beyond our borders.

Both/And Times in EM

We are practicing EM in a time of paradoxes, where there are so many asks on our time and energy that it is hard to spend it on even just one more thing, and yet, settling into complacency feels defeating. These are “both/and” times in emergency medicine: the times when we need to hold two conflicting realities in our heads and hearts. Health care has imploded; the safety net is broken; there seems to be little political will or action to take steps forward; and yet, our daily work is fulfilling and important—perhaps this is even more obvious to us right now as people wait untold hours for our care. We have raised our voices in advocacy for our patients who suffer societal inequities, and we are working on these challenges both patient by patient and on a larger scale. It turns out that our problem-solving skills are perfectly matched to chaotic times, and we are equipped to lead teams large and small. The people with whom we work—nurses, unit aids, housekeepers, security, respiratory therapists, unit clerks, restockers — are fantastic, and we have developed even closer bonds having endured such hard times by standing shoulder to shoulder together.

And yet. Many days it is hard to remember these bits when faced with the challenges that flow rapidly toward us every hour on shift.

The CAEP Wellness Committee has crowdsourced some pragmatic tips to help manage these two truths right now. These have been accumulated over the years from various sources and so are not referenced. This is NOT to suggest that we can kale & yoga our way out of the health care crisis: the fixes needed are clearly systems-level. AND, while we are working on that, some of these tips may help you enjoy your shifts more. These are our times.

Louise Rang and Rodrick Lim

Please post any other ideas on twitter (#CAEPWW23)

Pre- Shift

  •   play a fave song while getting into scrubs (+ dance around if the locker room is empty :-))
  •   keep a running list in your locker of reasons why you love this job
  •   set an intention for the shift eg “who do I want to inspire today?”
  •   pluck eyebrows at red lights
  •   if working an evening shift, then don’t “work” during the day. protect this time the same way you wouldn’t do paperwork in the evening had you worked during the day.
  •   pack some snacks that you love, or alternatively, pack the same snack every shift to take the guesswork out of the prep (eg ham & cheese sandwich & 2 cookies)
  •   embrace the caff-nap: drink caffeine immediately before your 20-40 min pre-shift nap and it will be better than either thing alone.

On- Shift

  •   actively complain less – it only brings everyone down.  One loud complainer can wreck everyone’s day, and all groups seem to have at least one or two of them.  As my grandma always said ” if you don’t have anything nice to say, don’t say anything at all.”
  •   bring a few micro-kindnesses to work – can you say thanks to someone for a job well done?  Can you smile at one extra person?  Tiny moves make it all a little brighter.
  •   make sure to take a break part way through for food, calories, bathroom – even a 5 min break makes a difference
  •   savour & appreciate your work relationships: even if the day sucks, we all get along and enjoy working alongside each other
  •   do something to truly connect with someone. eg buy a patient a cup of tea, sit down and joke with them, share something about yourself.
  •   stop & watch for a moment: remember when you were a medical student, and it was amazing how things in the ED just flowed? Bring that lens back for a few minutes. You will be amazed by your colleagues.

Post- Shift

  • keep a full water bottle in the car to drink on the way home to help with the post-work parch
  • take melatonin 20 mins before getting home from an evening shift so more inclined to go straight to bed. Pro tip: keep it in the car
  •   At the end of shift (or daily), write down something that you learned, something you initiated, some way you helped someone and one way you could have made the day better. Consider sharing this with a friend over what’s app.
  •   Create a post-shift ritual: eg post-shift checklist (one thing that was hard; 3 things that went well; check in with self; switch attention to rest & recharge)

At Home

  •   Create a “Happy 10” list each week-10 simple pleasures to enjoy that week. Consider both quiet time and social connection.
  •   eg luxurious cream and brown sugar in coffee, a walk, call a family member or friend, write and mail a physical letter>>TV/scrolling


  • stock a communal fridge with snacks and drinks – consider paying for a weekly grocery delivery. Can an administrative assistant help
  • fund mindfulness training or group psychotherapy
  • fund non-clinical leadership work
  • introduce a physician in triage shift
  • make in-person socials a seasonal priority
  • create an informal buddy system for individuals to reach out or similarly provide support in times of need
  • start a camaraderie group program! Click here for the Camaraderie Groups Wellness Toolkit.

From the CAEP Wellness Committee: Drs Rod Lim, Sara Gray, Lisa Fischer, Miriam Mann, Louise Rang, Brittany Cameron

Interested in joining the CAEP Wellness Committee? Email jgale@caep.ca to get involved.

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