Self-Determination – Physician Success and Career Satisfaction

I’ll admit it.  As an organizational psychologist I get a little too excited about psychological theory – and even more-so when I can incorporate it into our work. The challenge is always making it practical and easy to understand.

Self-Determination Theory

Recently an interesting framework keeps creeping into our work with physician leaders and healthcare teams – Self-Determination Theory (“SDT”)  It’s been around since the 1970’s, but has recently become more prominent in the literature. The theory focuses on three important concepts that drive motivation and engagement– Competence, Autonomy, and Connectedness….or, simply, “CAC.”

Blog: Now’s Exactly the Time to Invest in Physician Success!

An example:

We are, frequently, tasked with helping to get a group of physicians to engage in the work of improving department performance, and to function as a team.  Sometimes it presents as an “engagement” problem – physician engagement scores have declined. Other times, it’s just an inability to make progress on initiatives outlined in a strategic plan.

Alan Friedman, M.A.
Founder and CEO

Invariably, we find that physicians are frustrated.  They may not be able to succinctly articulate the source of the frustration.  They know they don’t feel aligned with the organization, supported by the organization, or a sense of cohesion, even amongst themselves.  They feel changes are happening TO them and that they have little control over their world.

[Physicians ]know they don’t feel aligned with the organization, supported by the organization, or a sense of cohesion, even amongst themselves. 

Self-Determination and Engagement

What the hospital calls “engagement” scores may have declined.  We might argue that often the physicians are plenty “engaged.”  They are just not happy!

These situations are more and more common as organizations face new challenges.  Physicians have changes foisted on them that they would prefer to not have to deal with.  They feel these changes take them from the work they love – and make their career less rewarding.

Here’s where self-determination theory comes into play.  If we want people to be motivated and engaged in their work – to find satisfaction in it, research shows they need to feel three things intrinsically:


This does NOT refer to physician clinical or technical competence.  This gets at whether or not a person FEELS competent to perform in their role. There are many variables erode this sense of confidence.  A surgeon not having the sutures she/he is used to, or new staff in the operating room.  A physician may be  forced to write a prescription for a drug she’s not be familiar with because it’s the only choice on formulary.  These are examples of how this FEELING of incompetency can be destabilizing.

Similarly, COVID forced some physicians to work well-outside their normal area of expertise.    One of the frustrations physicians often have with EMR systems, or other technology, is this lack of feeling competent with the new tool. Another area where we see it is when a physician takes on a leadership role and realizes she might not be fully equipped to be successful.  For people who are used to feeling completely competent in their clinical and technical roles, these situations cause angst and stress.


Everyone wants to feel he or she has a sense of control over their situation. This is, particularly true with physicians. Professional autonomy is a hallmark of the field.  Control over your knowledge base, over your clinical skills, how you manage patients, and even the way you approach your day and the work – these have, historically, been the expectation.  

[A]n eroding sense of autonomy is linked to burnout.

When they feel this autonomy being eroded, physicians often fight to maintain some sense of control, anywhere they can. It’s well documented that an eroding sense of autonomy is linked to burnout.  In our work, we don’t traditionally focus on wellness or burnout, but on engagement. If people feel that they have some control (and it doesn’t need to be “complete” control) over their work environment, they are inherently more positively engaged.


People, instinctually, want to feel connected to their organization, their team, their people.  Some, more or less depending on individual personality traits, but overall, people thrive when they feel that sense of connection. Many physicians feel disconnected from their hospital, health system, or group.  They do NOT feel like part of the team. Often they feel they are on the outside looking in.  Sometimes they don’t even feel a sense of connectedness to their most immediate colleagues or department.  The challenges related to COVID 19 have further isolated many physicians.

Blog: Re-Thinking Physician Success.

Applying These Concepts

When we start working with physician leaders, we focus on these three areas.  First we remind people of their goals and that these goals are still, largely, attainable. 

Where can we help people to regain a sense of competence?  Then we work to provide a sense of autonomy by engaging them in productive work in areas where we can give them control over how care is delivered and how their work is managed.

We have to get them less focused on the changes we can’t control or influence – Then get them focused on what they CAN control. Where can we eliminate confusion or provide sufficient support so they feel they understand what’s happening and their ability to influence it?

Structure, Skills and Support

Key, though, is that we provide physicians the structure, tools and skills to do this work.  Most importantly, all of this needs to be tied to what matters to them.  The only way we can facilitate behavioral change is if we connect to what people value.  People, including physicians, need common goals to rally around – to collaborate on – to feel a sense of team and connectedness.

People want to come to work each day knowing there is cohesion among their immediate team and their mission is bigger than themselves. In fact, research routinely shows that what most influences “engagement” are not organization-wide, top-down efforts – but work on the ground, building a sense of team (connectedness), competency and autonomy.

People want to come to work each day knowing there is cohesion among their immediate team and their mission is bigger than themselves.

The Challenge

During challenging times, you need people to function as teams, to be innovative, to be positively engaged, and to lead. They can’t implement strategy, though, if no one is attending to the “people” component. How can you, as a leader, leverage this concept to engage your people – to give them a sense of competence, autonomy and connectedness? This is how you’ll and drive department performance, and ensure career success and satisfaction.

To learn more about our unique approaches, including ourdepartment transformation” process, visit us at