On/Offcall: How Emergency Medicine Pay and Work Hours Impact Physician Burnout

Welcome back to On/Offcall!

What happens when emergency physicians lose control over their own work?

This week on How I Doctor, we feature a raw and honest discussion of the challenges of emergency medicine in 2025. Offcall co-founder Dr. Graham Walker sits down with Dr. Alison Haddock, the immediate past president of the American College of Emergency Physicians and one of the leading voices in the fight to protect emergency physicians.

ACEP has prioritized ED boarding, workplace violence, and physician autonomy, and Dr. Haddock has been steadfast in her approach: be candid, fight for transparency, and push for policy change – even when it means challenging some of the most powerful forces in healthcare.

In the episode, they cover:

👉 Why physician autonomy (not “pizza party wellness”) is the real burnout fix
👉 How ED boarding exposes hospital-wide dysfunction, not just ER capacity
👉 Why unionization and transparency may be the next frontier for physician empowerment

And more! This episode isn’t just about the ED, it’s about the future of healthcare, autonomy, and resilience in a system stretched to its breaking point.

🎧 Listen to the entire episode here

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Most Talked About On Offcall

Independent Physician Spotlight: Meet top Ohio allergist and immunologist Dr. Basil Kahwash!

Also read Dr. Kahwash’s Offcall op-ed on the surprising challenges of private practice here.

Offcall’s data featured on KevinMD! Why women ER doctors earn $21,000 less than men
Thanks to Dr. Kevin Pho for the feature, see the original data set here.

How pay and work hours impact job satisfaction for ER physicians
See what Offcall’s data shows on the connection between pay, work hours, and burnout.

Physician Builder Spotlight: Ferdinando Mirarchi

We’re shining light on MD-entrepreneurs! Each week, we feature an entrepreneurial doctor who’s building a cool product, company, or working on a big idea that you definitely want to know about. This week, meet Ferdinando Mirarchi, Chief Executive Officer/CMO of MIDEO Health (more on the company’s mission below!). You can connect further with Ferdinando on LinkedIn.

1. Ferdinando, what inspired you to become a physician entrepreneur? I never planned on it. I saw a patient safety need when it came to advance directives and DNR orders and all of the horribly unreported medical errors that happened. Then, I started to do the TRIAD research and low and behold, an idea formed on how to do it more safely and in a way I believe is better. As we designed a TRIAD VIII study, the concept for MIDEO was formed.

2. Tell us what your company does and what problem you're trying to solve. MIDEO Health performs Advance Care Planning in a way that is both medically sound and patient-focused. We evaluate and medical risk stratify patients, and then create a prescription for their medical care. We utilize our proprietary platform called MIDEO to record the patient reading their prescribed advance directive and then make it transportable and available anywhere in the world in 5 seconds or less. We have taken advance directives into the 21st century, which is where patient safety requires us to be.

3. What's your advice to anyone who's thinking about entrepreneurship or a nontraditional career in medicine? Take a breath and brace yourself. It is not easy. Never give up your income producing job and never forget your family. You will experience hurdle after hurdle and your existing income and the love of your family will maintain and sustain you. Also, pick your battles. There will be so many naysayers and there will be times to battle vs. times to just navigate around them and find like-minded people to work with.

4. How can a physician overcome their biggest fear to start a company/organization? Look for mentors that have done it and succeeded to a degree. Plan for it. Plan for time and resources. Doing this will make the decision to jump in much more feasible. Lastly, plan your goal. Are you planning for purpose or a big financial outcome? It’s just my own experience, but those that have a plan based upon purpose tend to be able to withstand the hurdles better.

5. What's the #1 lesson you've learned since building your company that wasn't obvious to you before? You can’t forget your family. This is so important; you can’t get that time back. The number two lesson is that your family, no matter how much time you think you are giving them, will still feel the need to need you more.

6. How can other physicians support you? Lead by example and do your own advance directive with MIDEO. Then, tell a friend or family member to do the same and your patients as well. Paper advance directives and DNR order = patient safety risk. They equate with medical errors waiting to happen. As far as investment, we are always open to the right investors. If you are an investor who wants to make change and see gains both by impact and financially, then we’d love to speak with you. If you are an investor that can drive change then we want to speak with you. If you are an investor who just wants a 10X return, then we don’t want to speak with you.

Read the full article here. Know someone else who should be featured? Reply or tag them and their company in the comments!

From Our Partners: Are You Attending the XPC Idea Fest?

X = Primary Care is throwing a virtual idea fest on Nov 1 @11AM ET. Featuring guest speaker Dr. Alexandra Ristow, the event will center around hands on problem solving with everyone who has a stake in reimagining good care. Who should apply?

• Patients & Caregivers – Share lived experiences that highlight what truly matters in care
• Clinicians – Bring frontline insights from delivering care every day
• Payors – Help shape sustainable, value-driven models
• Healthcare Organizations – Add system-level perspectives on challenges and opportunities
• Policymakers – Contribute to the policy frameworks that enable change
• Tech Companies – Discuss how your innovation can better support care delivery

We’re thrilled to be sponsoring this event! To learn more and sign up, see here and reach out to Dr. Paulius Mui directly: paulius@xprimarycare.com.

3 Things to Read This Week

The great telehealth rollback: How Oct. 1 changed patient access (Medical Economics)
From Olga Khabinskay: The nation is in a test of whether we’ll embrace the lessons of the pandemic or retreat to pre-2020 norms (h/t Dr. Lyle Berkowitz here)

Why physicians are joining unions (The Conversation)
From Dr. Patrick Aguilar: And why that trend appears likely to continue (Bonus: Also see this special feature on Physician Unionization for Anesthesiologists from Dr. Joseph Maxwell Hendrix, Dr. Alyssa Burgart, Dr. Brooke Baker, Dr. Richard Wolman, and Dr. Joseph Kras.)

State of claims denials in 2025 (Experian)
Claim denials are rising, and while AI optimism is high, uptake remains surprisingly low.

Highlights From Our Community

Each week, we celebrate career milestones, launches, & other goings-on in the physician community. Have something to promote? Reply and we’ll feature you.

❗Big week for pediatrics, Paul Tran!
Dr. Paul Tran, Dr. Zhen Chan, Dr. Alok Patel and many more were at the American Academy of Pediatrics National Conference this week, see his takeaways and learn more here.

📢 Not to mention, family physicians!
The American Academy of Family Physicians also hosted their annual meeting this week, see a write up from Dr. Jhaimy Fernandez, Dr. Kristian Sanchack and Lorena Gonzalez here.

👉 Follow this space, Aditi Joshi
Dr. Aditi Joshi announced the launch of her new organization Ardexia to help health systems and health companies drive clinician adoption. Learn more and follow her here.

💯 Important post, Mark D. M. 
Mark Miller opened about the projected nursing shortage and high levels of burnout and the need for a policy response to close the gap, see his solutions here.

💯 Important work, Ali Chaudhary
Dr. Ali Chaudhary reflected on the troubling rise of physician suicide, and why locums is a path that could be part of the solution. Read it here.

👌 Also thanks for speaking out, Srijan Sen
On the same topic, Dr. Srijan Sen was featured on Medscape for his work to stop young physician suicide. Read more here.

✅ Keep speaking out, Harpreet Tsui
Dr. Harpreet Tsui created a social media video about fighting insurance companies for what her patients deserve, watch it here.

🙏 So true, Elisabeth Potter
Dr. Elisabeth Potter was featured in a HealthFluence video about how being outspoken on social media has helped her gain MORE trust as a physician with her patients. Watch it here.

🔥 Here’s another great video, Alexis Parcells
Dr. Alexis Parcells shared her views on burnout and why so many doctors are leaving medicine in a spot-on social media video. Watch it here.

🎉 Congrats, Vyshak Chandra
Dr. Vyshak Chandra is starting a new position as Neurosurgeon at Lyerly Neurosurgery @ Baptist Health Jacksonville! Congratulate him here.

🎉🥳 More congrats, Tulay Aksoy
Dr. Tulay Aksoy is starting a new position as Chief Medical Officer at Abington Hospital - Jefferson Health. Congratulate her here.

🎉👏🎊 Even more congrats, Lara Zibners
Dr. Lara Zibners is starting a new position as Advisory Board Member at Women’s Health Horizons (WHH). Congratulate her here.

🎉🥳🎉🥳 Still more congrats, Dong-han Yao
Dr. Dong-han Yao is starting a new position as Clinical Assistant Professor, Emergency Medicine at Stanford University. Congratulate him here.

Be Sure to Sign Up for Offcall!

At Offcall, we believe physicians deserve to be heard, valued, and treated fairly. Everything we do is driven by our commitment to empowering doctors with accurate, reliable, and trustworthy data — to advocate confidently for themselves and ensure their compensation truly reflects their worth.

Learn more and sign up here

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