158. Why You Have More Power Than You Think to Change Healthcare

A broken system won’t fix itself, and no one is coming to the rescue. Medicine is fraying under the weight of burnout, misaligned incentives, and systemic inertia. Yet, hope isn’t lost. Change is still possible, but it won’t come from the top down. In this episode, we explore how grassroots leadership, inner work, and community involvement can become the antidote to despair in modern medicine. Finally, we dig into the personal cost of service and the tools we need to heal ourselves while fighting for change.

Guest bio:  Dr. Andrea Austin is the inaugural Emergency Medicine Program Director at Sacred Heart in Pensacola, Florida. As a Navy veteran, her military service taught her how to perform under pressure and lead teams in high-stakes environments. She brings that same focus to her work in medical education, physician well-being, and healthcare systems change. Dr. Austin is the author of Revitalized: A Guidebook to Following Your Healing Heartline and host of the Heartline: Changemaking in Healthcare podcast.

Our 2026 Retreat in Scottsdale, Arizona. March 1-4.

• Awake + Aware 2026

Books mentioned in this episode

• What My Bones Know by Stephanie Foo

We Discuss:

The Case for a New Residency Program

• Starting a residency program in a medically underserved area, like Pensacola, is about training physicians where they’re most needed. It’s not about creating more residencies everywhere. It’s about creating them where they truly matter.
• The program aims to develop not just competent doctors, but system-aware change agents who can think beyond the bedside. “We need change makers that are going to repair the safety net.”

What It Means to Be a Change Maker

• A change maker isn’t just someone who pushes for change. It’s someone who takes intentional, creative, and persistent action with an eye toward the greater good. The term comes from the nonprofit world and emphasizes tenacity, societal impact, and alignment with community values.
• Change-making doesn’t require a formal role or title; it starts with small, local acts—such as flagging a patient safety issue, sending a thoughtful suggestion to leadership, or having an honest conversation with a colleague.
• Emergency departments are full of change agents, but not all change is aligned with community good.
• Change makers see problems not as individual failings, but as opportunities to reconfigure systems in ways that support better care and reduce burnout. “Instead of saying ‘not my problem,’ ask: is there one small thing I can do right now?“

Working Within the Domains of Change

• Burnout operates across three distinct domains: personal, professional, and systemic.
• The personal domain includes mindset, boundaries, and workflow strategies—areas where physicians have the most immediate control.
• The professional domain focuses on local systems: policies, procedures, and daily operations. Even small adjustments, like revising a workflow or improving communication with a charge nurse, can make a difference.
• The systemic domain—healthcare policy, reimbursement structures, staffing models—carries the largest impact but feels furthest from individual influence.
• Hopelessness often emerges when physicians confront the systemic domain and feel powerless to shift it.
• Collective agency is the antidote: “I don’t have to carry this alone. I just have to keep my corner clean and healthy, and then link arms with others.” Participation in organizations like ACEP, AEM, or the Lorna Breen Foundation channels individual frustrations into coordinated action.
• Even modest involvement, like paying dues or attending a meeting once a year, contributes to a larger push for structural reform.

Overcoming Social Loafing in Medicine

• Social loafing is the tendency to do less when working as part of a group than when acting alone, like a tug-of-war where each person pulls less hard once others are pulling too.
• In medicine, this shows up when physicians assume someone else will advocate for them and fix the system. But disengagement has left physicians without influence: “We haven’t been at the table. We’ve been on the menu.”
• The solution is targeted, personal involvement. Instead of blanket calls for group action, individuals must be personally asked and engaged to contribute.
• Even if change feels slow, advocacy has prevented things from getting much worse—a reminder that inaction carries its own cost.

Rethinking Suicide Risk in Emergency Medicine

• Suicidality among physicians is often hidden beneath layers of shame and stigma, leaving many to silently struggle. Importantly, suicidality does not require a formal mental health diagnosis; acute life stressors alone can trigger it.
• Emergency physicians, particularly women, carry a suicide risk that is several times higher than the general population. 
• Complex PTSD is increasingly recognized as an occupational hazard in emergency medicine, with cumulative exposure to trauma and high stress taking a lasting toll. This reality should be taught openly to trainees and acknowledged as part of the profession’s risk profile.
• Recognizing this vulnerability reframes suicidality as an environmental hazard rather than a personal failing, normalizing the need for therapy, coaching, or professional support.

The Call for Psychiatric Fellowships in EM

• Emergency departments are increasingly the frontline for mental health crises, yet the system lacks adequate tools to meet this demand.
• Current solutions—such as telepsychiatry consults, social workers, and nurse practitioners—often leave gaps due to staffing shortages, variable expertise, and difficulties in building trust with patients in crisis.
• Many emergency physicians already anticipate what a psychiatric consult will recommend, but lack the specialized training or authority to act confidently.
• A proposed solution is the creation of psychiatric fellowships within emergency medicine, offering focused training in crisis evaluation, risk assessment, and immediate interventions.
• Specialized training would not only improve patient outcomes but also reduce delays in care, ease ED boarding, and provide physicians with a new sense of purpose and fulfillment.
• Such a fellowship could create a new career niche, enabling physicians to combine their expertise in acute care with leadership in mental health.

Reclaiming Wellness Through the “Heart Line”

• The heart line—the longest horizontal crease in the palm—serves as a metaphor for emotional well-being and a personal reminder to pause.
• Looking at the heart line can become a grounding ritual, prompting the question: “What do I need right now?”
• Needs may be small and immediate: stepping outside for a breath of fresh air, setting a boundary with a patient, or sharing a moment of humor with a colleague. Quick interventions like these prevent escalation of stress and shift attention from overwhelm to action.

The Inner Work is the System Work

• Self-regulation is system change. Emotional stability and self-awareness directly shape team culture, morale, and efficiency. When you become more regulated, you influence everyone around you. 
• Therapy, coaching, mindfulness, and reflective practices turn reactivity into deliberate strategy, allowing difficult situations to be addressed rather than absorbed.
• The aim isn’t perfection but resilience, responding to setbacks with adaptability rather than despair.

Building a Portfolio Career in Emergency Medicine

• Relying solely on clinical shifts for an entire career is rarely sustainable; shifts are intense, physically taxing, and often emotionally draining.
• A portfolio career distributes energy across multiple professional lanes, including clinical practice, medical education, research, podcasting, writing, leadership, advocacy, and innovation.
• Diversification creates resilience. Multiple roles help protect against sudden contract losses or toxic work environments.
• Non-clinical endeavors also provide financial stability, especially during times when clinical work is interrupted by illness, injury, or systemic disruption. Just as importantly, these roles offer intellectual stimulation, creative outlets, and connection to a broader community.
• Emergency medicine doesn’t have to be all-or-nothing. A portfolio approach can make a career not only longer-lasting, but also more meaningful and enjoyable.