Importance <p>The well-being of emergency medicine (EM) physicians significantly impacts health care systems, and patients. Understanding the interplay of factors contributing to EM physicians’ mental health issues and burnout is essential for developing targeted support mechanisms.</p> Objective <p>To investigate the individual, environmental, and structural factors influencing the mental health and burnout experienced by EM physicians, thereby informing potential strategies for intervention and support.</p> Design <p>A qualitative study using recorded and de-identified semi-structured interviews.</p> Setting and participants <p>Twenty EM residents and faculty physicians at a large urban academic health system.</p> Measures <p>Interviews followed a semi-structured interview guide focusing on clinical work experiences and factors influencing well-being and mental health. Thematic analysis was applied. The study outlined underlying themes from the participants’ responses, utilizing a general inductive approach.</p> Results <p>Four primary themes emerged with subthemes: (1) Individual Coping – detailing strategies for managing stress during and outside shifts, including long-term adjustments; (2) Interpersonal Factors – examining the interactions with patients, peers, and family; (3) Environmental Factors – highlighting the challenges posed by patient boarding and workload; and (4) Systemic Issues – addressing stigma in mental health, confidentiality, and the strain from public health crises.</p> Conclusions <p>The study underscores the complex challenges impacting EM physicians’ mental health and career longevity. It highlights the need for comprehensive interventions that move beyond resilience training and build upon interpersonal support and systemic health system reforms. Fostering a culture of workplace safety and implementing targeted resources to manage capacity strain are essential approaches for supporting the well-being of EM physicians.</p>