By Dr. Josh Daily, WCI ColumnistAs physicians, we dedicate years to training for a career that is intellectually stimulating and deeply meaningful. Yet, many of us find ourselves disillusioned, burned out, or simply dissatisfied with our work. When I first chose my job as a pediatric cardiologist, I made many of the same mistakes that most physicians make—we optimize for salary, prestige, or job security but rarely consider the research-backed factors that actually contribute to long-term flourishing.
Through my work directing a medical student course, Personal and Professional Financial Essentials for Physicians, I’ve helped future doctors navigate job selection. In doing so, I delved into the broader research on human flourishing, and what I found surprised me: we rarely prioritize the things that actually matter.
Let's explore the key drivers of long-term happiness at work—backed by research—and apply them to how physicians should select and design their jobs.
What Actually Leads to Happiness at Work
Studies on human flourishing reveal that true and lasting well-being is derived from:
- High-quality relationships
- Autonomy and control
- Purpose and meaning
- Mastery and growth
- Work-life balance
Surprisingly, external rewards like salary and status contribute far less than we think—and they are highly subject to hedonic adaptation, meaning we quickly adjust to financial gains and return to a baseline level of happiness.
So, if money and prestige don’t drive long-term career satisfaction, what does?
#1 High-Quality Relationships
The Harvard Study on Adult Development (The Good Life) found that nothing predicts long-term happiness better than strong relationships. This applies both to our work relationships and those outside of work.
At work, physicians who feel connected, valued, and supported by colleagues experience greater resilience to stress and report higher job satisfaction. Outside of work, a demanding job can either strengthen or weaken our relationships with spouses, children, and friends. If work consistently pulls us away from meaningful relationships, our well-being suffers.
Practical takeaways:
- Prioritize work environments where you enjoy and respect your colleagues.
- Avoid toxic cultures, even if the job is prestigious or well-paying.
- Choose a job that allows you to be present for important relationships outside of work.
#2 Autonomy and Control
Autonomy—the ability to make meaningful decisions about your work—is one of the strongest predictors of job satisfaction.
Physicians often undervalue autonomy when choosing a job, opting instead for higher salaries or institutional prestige. However, having control over your schedule, patient load, and practice environment is far more valuable in the long run. Moreover, a lack of autonomy is one of the leading contributors to physician burnout.
For some, this may mean owning a practice rather than being an employed physician. That said, available data suggest that job satisfaction levels between private practice and employed physicians are similar since each comes with its own trade-offs. Additionally, owning a practice does not always equate to greater control over your life, as administrative, financial, and time demands can offset the perceived autonomy.
Beyond work, control over your life matters even more. If your income allows you to buy back time (by outsourcing chores, reducing clinical hours, or working part-time), your well-being improves.
Practical takeaways:
- Seek roles that allow flexible scheduling, control over patient care, and decision-making autonomy.
- Use financial leverage to gain control over your time, rather than just maximizing income for consumption.
#3 Purpose and Meaning
Work that aligns with your values and contributes to something bigger than yourself leads to greater fulfillment. Medicine is inherently meaningful, but administrative burdens and misalignment with values can erode that sense of purpose.
Research by Amy Wrzesniewski on “job crafting” shows that employees who reshape their work to align with their strengths and values report higher job satisfaction. Meanwhile, physicians who feel disconnected from why they entered medicine are at higher risk of burnout.
Practical takeaways:
- If your job feels unfulfilling, reframe your work’s purpose—mentorship, education, or leadership roles can restore meaning. For me, becoming a fellowship program director and teaching a financial course to medical students has been deeply fulfilling and has increased my enjoyment at work.
- Seek out work that aligns with your personal mission, rather than just chasing the highest salary.
#4 Mastery and Growth
We are happiest when developing expertise and growing in our careers. Flow Theory suggests that engaging in challenging work that stretches but doesn’t overwhelm us leads to deep satisfaction.
That means physicians who keep learning, improving, and developing new skills tend to be more fulfilled than those who stagnate. The craftsman mentality—striving for excellence in your field—increases job satisfaction, and if you become one of the most highly skilled physicians in your specialty, you can leverage that to negotiate for positions that provide the things that truly matter: autonomy, meaning, and strong relationships.
Practical takeaways:
- Continually invest in your clinical expertise, leadership, or a niche skill to gain career leverage.
- If you feel stagnant, seek new challenges through teaching, research, or professional development.
#5 Work-Life Balance and Time Affluence
Burnout is strongly linked to low job control, excessive workload, and lack of recovery periods. Physicians often undervalue time affluence—the ability to spend time on meaningful activities—despite strong evidence that prioritizing time over money leads to greater happiness. Work-life balance allows you to protect your most important relationships and activities, and for most physicians, time affluence matters more than financial affluence.
Practical takeaways:
- Prioritize jobs that allow for time flexibility rather than just income maximization.
- Design your work to allow for recovery, personal pursuits, and relationships.
More information here:
The Radiologist Next Door Takes a Year Off
What We Can Learn About Work-Life Balance and Retirement from the French
What About External Rewards (Salary and Status)?
While money and prestige contribute to well-being, they matter far less than the factors above. Interestingly, a recent Medscape survey found that 48% of respondents believed more money would reduce their burnout. This suggests either that they intended to use the additional income to enhance their relationships, autonomy, sense of meaning, and work-life balance or that this is a case of affective forecasting error—where people consistently mispredict what will truly make them happy.
- Salary: Research by Killingsworth et al shows that money increases happiness at all income levels. However, most of this relationship is driven by how individuals use their income to gain control over their lives—not just to buy more things.
- Status: Recognition is valuable, but prestige alone doesn’t sustain fulfillment.
- Hedonic adaptation: Most external rewards only lead to short-term happiness.
More information here:
It’s a Lifestyle, Not a Vacation
The Bottom Line
To flourish at work, physicians should rethink how they select and design their jobs:
- Foster strong relationships in and outside of work.
- Maximize autonomy to control your life.
- Prioritize meaning over money.
- Continually grow to achieve mastery and gain leverage.
- Value time affluence over financial affluence.
By aligning our work with these research-backed principles of human flourishing, we can design careers that sustain happiness and well-being rather than chasing goals that ultimately leave us unfulfilled.
How is your work-life balance? Have you done anything special to design your work so it'll make you happier overall? Is that something you'd consider? Why or why not?
Wonderful article, Josh–after nearly 40 years as a physician, all of this rings true. Thanks for distilling this wisdom for us.
Jim’s prior post, “The Seasons of Your Life” linked to by this article is also fantastic (think I must have missed it the first time around)–essentially all of the insights of “Die With Zero” boiled down to a single page.
Yes, I think Die With Zero is the best book out there right now for those who are having trouble spending. I certainly found it helpful. It’s not perfect, but it’s a short read and a valuable perspective.
That sounds true for any profession. The people around you, the culture, and wlb make a stressful job more sustainable. On the other hand, what types of settings are more likely to provide such features? Private practice? At least from anecdotal experience, health care providers in local academic hospital and big chain hospitals feel miserable and just show up for the paychecks.
Thanks so much for your comment—you raise a really important and common question. Many readers naturally wonder whether being employed by a hospital or academic medical center is more or less conducive to human flourishing than working in private practice. And while it’s tempting to generalize, the reality is far more nuanced.
There are certainly employed physicians—both in academic and large health system settings—who are burned out, just as there are many who find deep meaning, strong relationships, and a sustainable rhythm of life. The same is true for private practice. It’s not so much the category of employment, but how well the specific environment aligns with your values, responsibilities, and life outside of medicine.
While the research isn’t entirely definitive, several studies suggest that burnout rates are relatively similar between employed physicians and those in private practice. This reinforces the idea that flourishing is driven more by workplace factors like autonomy, flexibility, culture, leadership, and support than by whether one is an employee or a business owner.
It’s also important to note that private practice doesn’t always offer greater autonomy or control. Anecdotally, I have friends in private practice who feel they can’t take a vacation without taking a significant financial hit. Between demanding clinic schedules and the economics of fee-for-service care, they often feel less flexible than some employed physicians.
Personally, when I had a brain tumor a few years ago and needed extended time off, my role as an employed academic physician came with generous PTO and institutional support. I was able to take the time I needed to heal while continuing to receive a full salary—something that would have been far more difficult in many private practice arrangements.
In the end, flourishing is deeply personal. The goal isn’t to find a perfect category of employment, but to find a setting—whether employed or independent—that supports your physical, emotional, relational, and spiritual well-being.
Thanks again for engaging with this topic so thoughtfully!
nice summary Josh on keeping focused on what’s most important when we think about this finance stuff, it’s supposed to maximize our happiness!
Great article. The challenge is comparing job opportunities using these 5 principles. It’s hard to know which job offers you more autonomy or gives you the opportunity to build more supportive relationships until you actually start the job. It can be difficult to know whether the status quo is better than what’s on the other side as so many of the principles and job qualities are relative. My job as a military doc is low in autonomy but high in purpose in meaning. One of my big complaints is lack of autonomy—but, will I really gain that much more autonomy as a civilian, so much so that it outweighs the purpose and meaning I get as a military doc? In practice, it can be very difficult to weigh these job qualities and principles and to predict which jobs will offer them. That said, the article really captures the essence of job satisfaction, and it rings true with my career experiences so far. It takes a lot of reflection and soul searching to know which principles you value the most. Once you have that, I think it becomes a bit easier to know the types of jobs that you will find fulfillment in. Your values also change over time (now with a child, I prioritize work life balance and benefits way more than I did as a single physician without children). Thank you for this great article, gives me a lot to reflect on.
Wonderful article , reminds me of Japanese IKIGA and Kaizen philosophy.
Dave
Love the concept of Ikigai.
https://www.whitecoatinvestor.com/ikigai/
Fantastic article! I was missing 4/5 with my first job. Paradoxically, I have found all 5 through 100% locums even though initially you might think it would be difficult to have any of them through the reputation of the job.
High-quality relationships- I spent memorial day at 2 different cookouts from clinic staff that I have connected with at one of my facilities. I had very few interactions outside of work before when I was in academia. At home, the quality of relationships with my kids and wife have flourished with me being home over half the month. In both cases, I think the key is that I am able to be myself and have more time to meaningfully connect and listen with the lack of inbox/inability to control my schedule.
Autonomy and control: You mentioned a tradeoff between employment and owning your own practice. With locums, I own my schedule without any overhead or admin tasks. The downside is volatility of job opportunities but this can be mitigated by contracting with multiple hospitals and being completely open to geographic arbitrage
Purpose and meaning: Providing care at facilities that have no other current options definitely adds meaning that I didn’t realize when I started that brings a high sense of purpose. Patients are so grateful they don’t have to travel sometimes 3+ hours to get care. Having time to sit and listen to them re-aligns me with my medical school vision of focusing my career on helping patients, not inevitably focusing on RVU requirements and quality metrics (what was gradually happening before) with patient connection becoming pushed to the back burner
Mastery and growth: While I may not be progressing in mastery of new procedures or hospital leadership/teaching, being a 1099 shifts my focus on learning core business skills and growing as an entrepreneur which is exciting and translates into almost any profession outside of medicine.
Work-life balance: Time freedom is the biggest boon I have realized and using that to focus on the 4 above have led to a truly balanced life. Catching up on my favorite blog at a cafe during my “summer break” (42 day planned break between shifts while kids are out of school) is a lifestyle I didn’t think I would experience until retirement.
I’m not surprised you’re doing well with locums. I have run into many docs who love it. Early in their career. Mid career. Late career. Semi retirement. A sabbatical year. Their entire career. Whatever. If employers want to treat docs like labor, we’ll act like labor and that means going where we’re treated and paid best. Your skills/knowledge are still rare and valuable. If you’re going to trade them and your time for money, you might as well get the best deal you can.
Thank you so much for sharing your experience—it’s incredibly encouraging to hear how your journey with locum tenens has brought all five determinants of flourishing into focus. Your story aligns beautifully with what the research supports, and it’s fascinating to see how each element plays out in a locums role. I especially appreciated your reflections on purpose and high-quality relationships. Honestly, your comment would be a fantastic start to a guest post—I’d encourage you to consider writing one, as I think many readers would benefit from your insights and perspective, and may even consider locum tenens when they previously had not.
Great article, Josh!
I teach a personal finance course for law students. We focus on similar concepts as they relate to the legal profession. Unfortunately, lawyers as a profession tend to be up there in many negative categories, like divorce, substance abuse and death by suicide. I try to address the career choices we make to prevent these things from happening to my students
What I’ve found is that most people inherently agree with the principles you laid out, but then still end up chasing the wrong things in their careers (prestige, money, bigger office, etc.)
I’m curious if you run into the same thing when you teach med students? Essentially, that people agree with what you’re saying and then still end up chasing the wrong type of jobs.
Have you found success with certain methods in trying to show people that there’s another way to go through life? Or, is it more of a “lead a horse to water but can’t make them drink” type of thing?
Thanks for sharing a great post!
Matt
Thanks so much, Matt—I really appreciate your thoughtful comment. I completely agree that physicians and lawyers share a lot of the same challenges when it comes to career choices, burnout, and overall well-being. Like you, I’ve found that most people intellectually agree with the principles we teach—but actually living them out is another matter, especially in systems that subtly (or not-so-subtly) push them toward prestige, income, and status at the expense of everything else.
One thing I’ve noticed in medicine is that there are certain key transition points where physicians are more open to reevaluating their priorities and setting goals aligned with what truly matters. In particular, the transition from med school to residency, and then again from training into attending life, are windows where behavior change is most likely. These are moments of identity shift and a “fresh start,” which research shows can be powerful for change. And importantly, at those points, most haven’t yet locked themselves into lifestyles or spending habits that are hard to unwind. If we can reach people then—before they accept the job based solely on status or salary—we have a real chance to help them choose differently.
Thanks again for engaging—sounds like your law students are lucky to have you.
Josh
Thank you, Josh- very kind of you to say!
I agree with your assessment and like how you approach those key transition points. I think that works well in the legal profession, as well. The equivalent transitions in law may be something like associate to partner, and then again from partner to equity partner. For a typical career path, that first transition occurs for people in their early 30s and the second transition in their 40s.
I like working with law students and young lawyers so they are thinking about these key transitions before they occur. Like you said, it’s much more difficult to convince someone who’s already dedicated 15 years towards accomplishing a certain goal to unwind that behavior.
I’ll be sure to continue reading your posts and will share with my students- love the messaging.
Thanks again!
Matt
Great article Josh! I liked the practical takeaways. It’s good to think about how to apply this information in real-life job scenarios.