As someone who left EM after a decade at age 39, I'll try to answer your questions as best I can. And I'll preface that with saying that if anyone tries to tell you EM isn't burnout inducing or that the solutions are easy, they either are lying to you, lying to themselves or have no idea what they're talking about.
Is the major contributor to EM burnout mostly from the administrative burden, or is there a large contribution due to the actual practicing of emergency medicine?
The major contributor to EM burnout (for me) is the shift work circadian rhythm disruption that often leads to a chronic, low grade dysthymia and dysphoria (or worse). What makes this worse, is that many around you (EM residents, attendings, EM leaders/recruiters) will try to tell you you're imagining it, perhaps out of their own denial (self preservation) or self serving reasons (career preservation). The administrative interference is mainly salt in a bad wound. The salt on the wounds is bad enough, insulting, galling, but it's not the 1,000 paper cuts themselves.
Do you find joy in the "undifferentiated diagnosis" and solving it?
I like both, but this question is irrelevant to burnout. Whether you find joy in diagnosis or solving problems has no bearing on whether or not you chronically feel like dysphoric doing so, due to having to constantly force something that's inherently against your biology, which is to ignore your circadian rhythms. I tried to tell myself I could. I lied to myself. It remained a chronic nagging weight on my mood, energy level and not only while at work, it bled into nearly every off day not at work. In other words, "In EM, when you're off, you're off" is BS.
If you're having difficulty what this all means or relating to it, think of jet lag. To choose a lifetime of work in EM, is to choose to be feel at least a little (sometimes tremendously) jet lagged, the majority of your waking hours, for the next 30 years or until you leave EM.
Do you feel meaningful helping patients, despite short-term interactions?
Yes, but again irrelevant to burnout. It would be more appropriate to ask, 'Does the meaningfulness of quickly and efficiently drain a gluteus maximus abscess on a diabetic at 3 am outweigh missing your favorite holiday when you could have picked a line of work where you did the same thing at 3 pm on a Tuesday? Does it outweigh the fact that you felt dysphoric for the first 72 hours of your vacation which included your favorite person in the world's birthday?' That's what you should be asking.
Do you enjoy the day-to-day tasks of reading labs, imaging, consulting other physicians to get to the bottom of the problem?
Again. Sure, all that stuff is great. But do you really need to do all that on your favorite human beings' birthdays? Do you need to do all that at 4 am on Christmas/Ramadan/Hanukka/insert-favorite-holiday-birthday-life-event? Do you need to do all that without having slept? Do you need to do all that at midnight New Year's Eve? Do you need to do all that while feeling dysphoric and jet lagged all the time, or is it good enough to do it while feeling refreshed and rested, alway all the time, while doing something else?
Do you still get a rush of excitement discovering a novel thing?
Nope. Nobody gets a "rush" discovering 'novel things' they've worked long enough to discover before, and when what was novel when you choose their specialty, is now routine. Sure, satisfaction can come from an interesting case, but a 'rush'? No. That sort of initial high doesn't last with drugs and it doesn't last with EM. It only gets you hooked.
Or, a follow-up question to this is: Do you feel the administrative burden is so heavy, it makes your actual practicing of medicine feel worse due to lack of autonomy?
The administrative burden is heavy in all of Medicine. It's most heavy handed in hospital based settings, which makes it worse in EM than it is in some other settings.
I ask because in my mind, administration is "fluid", and therefore in 8 years when I get into practice, the administrative landscape can be different. However, the actual practice of EM in 8 years should be relatively the same in my mind (albeit technological advances).
Currently, and despite our complaining as physicians, no one in healthcare with any power to change anything is talking about lessening "administrative burden." Lessening the burden, is literally not a thing.
But I agree, the practice of EM is extremely similar in different times and locations. It's like nothing else, but EM is EM no matter when or where you find it. And certain things about it will never change, particularly the 24 hr nature of it, and it's effect on one's circadian rhythms. Just remember: Jet lag, all the time, nearly every day for the rest of your working life. If that is not, and never will be an issue for you, then EM might be for you. If that's an issue for you, consider something that allows you to live a normal life. I say this as someone who thought, at age 26 when I chose my specialty, that it would not be an issue for me. Then life happened and I realized I was stuck in a bind countless people warned me about, that I chose to ignore. Now that I've done a fellowship and have a normal life, and EM shift work is an option and no longer a requirement, I'm much happier. If you want to have a normal life, don't do EM. If you do EM, absofrickinlutely make sure you have a pre-planned, well thought out, iron-clad exit plan in place
at the time of residency completion that allows you to get out of most or all of the shift work very easily at any point in your career. Some of the EM fellowships allow this, some don't and putting such a plan in place is easier said than done.
EM never changes. But we do.
