Original Article

Association of Intrinsic Motivating Factors and Joy in Practice: A National Physician Survey

Authors: Matthew Du, BA, Hyo Jung Tak, PhD, John D. Yoon, MD


Objectives: In response to the need to identify positive measures that more accurately describe physician wellness, this study seeks to assess the validity of a novel joy in practice measure using validated physician well-being measures and test its association with certain intrinsic and extrinsic motivators.

Methods: Secondary data analysis using a nationally representative dataset of 2000 US physicians, fielded October–December 2011. Multivariable logistic models with survey design provided nationally representative individual-level estimates. Primary outcome variables included joy in practice (enthusiasm, fulfillment, and clinical stamina in an after-hours setting). Secondary outcomes were validated measures of physician well-being such as job and life satisfaction and life meaning. Primary explanatory variables were sense of calling, number of personally rewarding hours per day, long-term relationships with patients, and burnout.

Results: The survey response rate was 64.5% (1289/2000). Physicians who demonstrated joy in practice were most likely to report high life satisfaction (odds ratio [OR] 2.75, 95% confidence interval [CI] 1.52–4.98) and high life meaning (OR 2.62, 95% CI 1.41–4.85). Joy in practice was strongly associated with having a sense of calling (OR 10.8, 95% CI 2.21–52.8) and ≥ 7.5 personally rewarding hours per day (OR 3.75, 95% CI 1.51–9.36); meanwhile, it was negatively associated with burnout (OR 0.26, 95% CI 0.14–0.51). Extrinsic factors such as specialty, practice setting, and annual income were not significantly associated with joy in practice in most regressions.

Conclusions: The joy in practice measure shows preliminary promise as a positive marker of well-being, highlighting the need for future interventions that support physicians’ intrinsic motivators and foster joy in one’s practice.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood) 2008;27:759–769.
2. Friedberg MW. Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy. Chicago: Rand Health/American Medical Association; 2013.
3. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc 2015;90:1600–1613.
4. Dyrbye LN, West CP, Satele D, et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med 2014;89:443–451.
5. Swensen SJ, Shanafelt T. An organizational framework to reduce professional burnout and bring back joy in practice. Jt Comm J Qual Patient Saf 2017;43:308–313.
6. Remen RN. Recapturing the soul of medicine. West J Med 2001;174:4–5.
7. Serwint JR, Stewart MT. Cultivating the joy of medicine: a focus on intrinsic factors and the meaning of our work. Curr Probl Pediatr Adolesc Health Care 2019;49:100665.
8. Perlo J, Balik B, Swensen S, et al. IHI framework for improving joy in work. http://www.ihi.org/resources/Pages/IHIWhitePapers/Framework-Improving-Joy-in-Work.aspx. Published 2017. Accessed July 10, 2021.
9. Grimes PE. Physician burnout or joy: rediscovering the rewards of a life in medicine. Int J Womens Dermatol 2020;6:34–36.
10. Anandarajah AP, Quill TE, Privitera MR. Adopting the quadruple aim: the University of Rochester Medical Center experience. Moving from physician burnout to physician resilience. Am J Med 2018;131:979–986.
11. Sinsky CA, Willard-Grace R, Schutzbank AM, et al. In search of joy in practice: a report of 23 high-functioning primary care practices. Ann Fam Med 2013;11:272–278.
12. Schaufeli WB, Salanova M, Lez-Roma VG, et al. The Measurement of Engagement and Burnout: A Two Sample Confirmatory Factor Analytic Approach. J Happiness Stud 2002;3:71–92.
13. Prins JT, van der Heijden FMMA, Hoekstra-Weebers JEHM, et al. Burnout, engagement and resident physicians’ self-reported errors. Psychol Health Med 2009;14:654–666.
14. Rao S, Ferris TG, Hidrue MK, et al. Physician burnout, engagement and career satisfaction in a large academic medical practice. Clin Med Res 2020;18:3–10.
15. Linzer M, Sinsky CA, Poplau S, et al. Joy in medical practice: Clinician Satisfaction In The Healthy Work Place Trial. Health Aff (Millwood) 2017;36:1808–1814.
16. Robinson C, Lee J, Davis K, et al. Findings from FMAHealth’s Bright Spots in Practice Transformation Project. Fam Med 2019;51:137–142.
17. Scheurer D, McKean S, Miller J, et al. U.S. physician satisfaction: a systematic review. J Hosp Med 2009;4:560–568.
18. Epstein RM, Krasner MS. Physician resilience: what it means, why it matters, and how to promote it. Acad Med 2013;88:301–303.
19. Zwack J, Schweitzer J. If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians. Acad Med 2013;88:382–389.
20. Stevenson AD, Phillips CB, Anderson KJ. Resilience among doctors who work in challenging areas: a qualitative study. Br J Gen Pract 2011;61:e404–e410.
21. Jensen PM, Trollope-Kumar K, Waters H, et al. Building physician resilience. Can Fam Physician Med Fam Can 2008;54:722–729.
22. Sinsky CA. Designing and regulating wisely: removing barriers to joy in practice. Ann Intern Med 2017;166:677.
23. Tak HJ, Curlin FA, Yoon JD. Association of intrinsic motivating factors and markers of physician well-being: a national physician survey. J Gen Intern Med 2017;32:739–746.
24. AMA Physician Masterfile | American Medical Association. Available at: https://www.ama-assn.org/about/masterfile/ama-physician-masterfile. Accessed July 27, 2021.
25. Konrad TR, Williams ES, Linzer M, et al. Measuring physician job satisfaction in a changing workplace and a challenging environment. Med Care 1999;37:1174–1182.
26. Remen RN. Growing new eyes: The 3 question journal. http://www. rachelremen.com/growing-new-eyes. Published July 15, 2013. Accessed June 12, 2020.
27. Shanafelt TD, Noseworthy JH. Executive leadership and physician wellbeing: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc 2017;92:129–146.
28. Hutchins M. Medicine as a job, not a calling? Health Aff (Millwood) 2009;28:927–928.
29. Andrews M. A psychiatrist reflects on medicine being less of a calling than a job. https://www.washingtonpost.com/national/health-science/a-psychiatristreflects-on-medicine-being-less-of-a-calling-than-a-job/2016/05/27/5319cc8e21ca-11e6-9e7f-57890b612299_story.html. Published May 28, 2016. Accessed June 8, 2020.
30. Ratanawongsa N, Howell EE, Wright SM. What motivates physicians throughout their careers in medicine? Compr Ther 2006;32:210–217. .
31. Yoon JD, Daley BM, Curlin FA. The association between a sense of calling and physician well-being: a national study of primary care physicians and psychiatrists. Acad Psychiatry 2017;41:167–173.
32. Landon BE, Reschovsky J, Blumenthal D. Changes in career satisfaction among primary care and specialist physicians, 1997-2001. JAMA 2003;289:442–449.
33. Leigh JP, Kravitz RL, Schembri M, et al. Physician career satisfaction across specialties. Arch Intern Med 2002;162:1577–1584.
34. Bergus GR, Randall CS, Winniford MD, et al. Job satisfaction and workplace characteristics of primary and specialty care physicians at a bimodal medical school. Acad Med 2001;76:1148–1152.
35. Kane L. Medscape National Physician Burnout, Depression & Suicide Report 2019. https://www.medscape.com/slideshow/2019-lifestyle-burnoutdepression-6011056. Published January 16, 2019. Accessed June 8, 2020.
36. DeVoe J, Fryer GE Jr, Hargraves JL, et al. Does career dissatisfaction affect the ability of family physicians to deliver high-quality patient care? J Fam Pract 2002;51:223–228.
37. Gunderman R, Hubbard M. The wages of healing: ethical issues in the compensation of physicians. Med Sci Monit 2005;11:SR5–SR10.
38. Epstein RM. What’s the opposite of burnout? J Gen Intern Med 2017;32:723–724.
39. West CP, Dyrbye LN, Sloan JA, et al. Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. J Gen Intern Med 2009;24:1318–1321.
40. Grisham S. Medscape Physician Compensation Report 2017. https://www.medscape.com/slideshow/compensation-2017-overview-6008547. Accessed June 7, 2020.
41. Kjeldmand D, Holmström I. Balint groups as a means to increase job satisfaction and prevent burnout among general practitioners. Ann Fam Med 2008;6:138–145.
42. Epstein RM. Mindful practice. JAMA 1999;282:833–839.
43. Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med 2003;114:513–519.
44. Buetow SA, Aroll B. Doctor gratitude: a framework and practical suggestions. CMAJ Can Med Assoc J 2012;184:2064.
45. Geller G, Bernhardt BA, Carrese J, et al. What do clinicians derive from partnering with their patients? A reliable and valid measure of “personal meaning in patient care.” Patient Educ Couns 2008;72:293–300.
46. Emmons RA, McCullough ME. Counting blessings versus burdens: an experimental investigation of gratitude and subjective well-being in daily life. J Pers Soc Psychol 2003;84:377–389.
47. Karches KE, Sulmasy DP. Justice, courage, and truthfulness: virtues that medical trainees can and must learn. Fam Med 2016;48:511–516.
48. Hawking M, Curlin FA, Yoon JD. Courage and compassion: virtues in caring for so-called “difficult” patients. AMA J Ethics 2017;19:357–363.
49. Daaleman TP, Kinghorn WA, Newton WP, et al. Rethinking professionalism in medical education through formation. Fam Med 2011;43:325–329.
50. Yoon JD, Ham SA, Reddy ST, et al. Role models’ influence on specialty choice for residency training: a national longitudinal study. J Grad Med Educ 2018;10:149–154.
51. Huber MT, Ham SA, Qayyum M, et al. Association between job factors, burnout, and preference for a new job: a nationally representative physician survey. J Gen Intern Med 2018;33:789–791.