Self-Determination Theory – Physicians In Clinical Medicine

Self-Determination Theory is based on the research on motivation done by Edward l. Deci and Richard M. Ryan. The theory describes there are motivation sources, either intrinsic (from within an individual) or extrinsic (from outside factors), which drive us to meet the three basic needs of an individual.

The three basic needs are:

Autonomy – You feel that you have control in your life in general. Or in the context of work, you feel that you have a certain extent of control or freedom to do things they way you desire.

Competence – you have the knowledge and the skill to meet the challenges at work.

Relatedness – you feel connected with other people, either with your family and friends, or at work with patients and coworkers.

This is a very simplified summary of the Self-Determination Theory. For more details, please refer to the original research.

I would like to share my take on this theory in relation to physicians in clinical medicine.

Out of the three basic needs, the most common issue in clinical medicine these days is autonomy, or lack thereof. Many physicians feel that they are trapped in their job. There are many set rules and regulations. There are limitations on how to practice medicine, either because of financial reasons or institutional-based regulations. Physicians feel that they are not able to practice medicine the way they want to.

While this may a problem at an organizational level, I believe there is something we can do on an individual level. It is helpful to be curious and always question your mind. When you think that there is no choice and that you “have to” continue to work in that same job – is that true? The answer is, there is always a choice. Your mind is closed to other options, probably because they are options you do not want to explore. For example, if you quit this job, the other job may be much less pay, or you may have to work twice as much to earn the same pay. You equate undesired consequences with no options.

What if you look at it at another angle? Since there are actually choices to work at your current job or not, why not decide that you are choosing to stay where you are? When you are open to look at it as a choice in your life, you will likely find more things you get to control at work. The more autonomy you have the more job satisfaction you will have. This will likely lead to better performance.

The second issue is competence. After years of school and clinical training, most physicians think that they are competent in patient care. Most people do not have a big problem to use their medical knowledge to care for real life patients. However, many physicians are facing the challenge of not going home at a decent hour. Or they bring work home. The hours they are supposed to work and the actual hours they spend doing work are very different. This causes frustration, stress and resentment. The work flow is undoubtedly being interrupted to a certain degree.

I was that physician. The physician who thought she had no choice but to stick with a job she did not enjoy. The physician who was working 50%, if not more hours, than stated in her contract. The physician who did not see any other way other than to quit her job, yet quitting was not an option she wanted to entertain, because other jobs in the area would be similar.

The autonomy was not satisfied. The competence was lacking. As much as I was a relator who cherished personal connections, this third basic need of relatedness was also affected. I was not able to fully engage in connecting with people, and this affected me more outside of work.

In order to restore and satisfy the basic needs, without knowing that was I was doing, I consciously and deliberately chose to think that I had a choice about my job. I chose to stay at work for financial reasons, for familiarity, for the people I work with, etc. I was gaining back some control in my life.

Then, for the need of competence, I worked with my coach on how to think differently about my work day, on my ultimate goal to go home on time to see my family, and to finish my clinical day at a decent hour. The challenges of a typical work day did not change. The number of patients did not change. Yet I changed. With a new found set of skills that I did not know I had, I was able to cut down by work hours - by 10 hours a week, if not more.

I am sharing this with you so that, before deciding to quit your job in clinical medicine, you get to explore opportunities to meet the basic needs of a person. Can you somehow change the autonomy? Can you cut down on the number of patients you are seeing? Or are there ways to elevate your skills to improve competency?

After the above analysis and exploration, you may still decide to leave that job, and that is alright. It is your choice and you are in control of that. You have every reason to own your decision, based on your values. There is always room to improve your clinical skills, your competency, to make your day more efficient.

As we are not designed to be lone dwellers on Earth, the need of relatedness is best satisfied with meaningful connections with other people. All of the three basic needs are different yet interconnected. As clinical physicians, if you are able to identify which need is the most lacking and find a way to change that, repeat the process until all three basic needs are met – then you will be functioning optimally.

To my physician friends, if you are struggling with any of the basic needs at work, I am here to help you – as a physician life coach, and as someone who has experienced this. If you are ready to have more autonomy, go home on time and enjoy life again, message me to find out how to work with me.