Although researchers describe eudaimonia as the practice of virtues like courage, wisdom, good humor, moderation and kindness, some have translated the writings of Greek philosopher Aristotle to mean achieving deep wellness and purpose. Certainly, if Aristotle says so, it must be true! Practicing medicine is certainly a “purpose,” but the quest for “deep wellness” has been lost over time and instead we are left with burnout for which we hope that wellness and resilience programs can lead us to happiness and eudaimonia. What does this mean for the modern physician, particularly for those employed by large organizations or groups? And is a healthy culture essential for happiness and well-being?
Bruce L. Gewertz, MD, a senior member of our society, expressed his thoughts on the importance of happiness and joy in a very thoughtful piece titled “Life, surgery, and the pursuit of happiness.”1 The Dalai Lama agrees. He explains that Buddhism believes that joy is humanity’s elemental nature and, therefore, our goal should be to return to it.
Most of us associate happiness with success. In truth, success likely follows happiness. Research studies show a direct relationship between life satisfaction and successful business outcomes.2 In turn, McKinsey has shown that employees life satisfaction greatly depends on their relationships with management. The share of satisfaction on the job depends 39% on interpersonal relationships and the share in interpersonal relationships at work depends 86% on relationship with management.3 The study also pointed out that 75% of those surveyed said that the most stressful aspect at work was their immediate boss leading to a toxic culture.4
In a survey by the Katzenbach Center, 84% of respondents pointed to culture as critically important. However, less than half reported that companies did a good job of managing culture in that it was not a priority initiative.5
Culture reflects the values of an organization and, if a “healthy” culture, ambiguous as it may be, is one of their values, it is seen as emphasizing employee satisfaction. In the longer term, we know that happier employees tend to be 12–20% more productive.
Furthermore, unhealthy “microstresses” from a culture of little autonomy, excessive workload, and mismatched values are setting people up for burnout.
A culture of well-being at work, to include not just the usual policy prescriptions such as evaluation of workloads, working hours, family-friendly policies etc., but an emphasis and monitoring of a healthy interpersonal organizational milieu is essential for people to thrive. It also helps to identify areas of moral distress and cognitive dissonance. A 2022 study showed that 66% of physicians perceived that their organizations do not prioritize physician well-being.6
Being mortals, we all struggle with being happy. Add to that a workplace with a culture that is driven by some leaders who are unaware or overlooking the impact of culture on employee happiness and burnout. There is therefore a continuous loop of damaging culture, unhappiness and burnout. By now we are aware of the conditions, including long work hours that lead to burnout in physicians, especially vascular surgeons who work some of the longest hours. A review of 47 multinational studies of physicians found that longer work hours were a strong predictor of burnout.7 It is also true that burnout is more correlated with a lack of enjoyment or fulfillment at work. However, deep happiness and hard but meaningful work, even with longer hours, makes us more resilient and able to deal with stress.
The work ethic responsible for hard work and efficiency has transformed itself into an “overwork culture,” which exists in many if not most institutions and practices driven by productivity incentives leading to financial rewards. A challenge to the ‘pursuit of happiness’ has been the push by employers, including academic institutions to enshrine productivity incentives in employment contracts. It may succeed in the short term until we experience time poverty and even ‘“famine”—a collective cultural failure to effectively manage our most precious resource, time.”8 The bet is that working harder to earn more will make physicians happier. An institutional culture of pushing working harder may make physicians (and the institution of course) richer but counteracts simultaneous efforts to prevent burnout. I have mentioned previously that “time affluence” is at a low and some claim there is ‘famine’ based upon a Gallup survey of 2.5 million Americans showing that 80% declared insufficient time each day to accomplish what they wanted to do.
Purpose or meaningful work is the second component of eudaimonia. That does not necessarily mean profitable work. If sage leaders constantly model the purpose, rather than profit alone, organizations thrive and grow 5–7% more than the market.9 In 2014, CEO Satya Nadella affirmed Microsoft’s purpose
as to “…empower every person and every organization on the planet to achieve more.” So, purpose, strategy and culture have often been identified as the triad leading to success, which means better relationships, kindness, and psychological safety among other elements.
Finally, in an increasingly VUCA (volatility, uncertainty, complexity, and ambiguity) world with increasing workloads and physician shortages the most critical parts of the eudaimonia equation are being overlooked. A balance between working harder, i.e., increased productivity and physician well-being is surely needed. Now. Ahora!
- Tallas T, Schaninger B. The boss factor: Making the world a better place through workplace relationships.
- 2022 Well-Being in Healthcare: Trends & Insights.
- E Amoafo, N Hanbali, A Patel, P Singh. What are the significant factors associated with burnout in doctors? Occup Med (Lond) 2015 Mar;65(2):117-21. doi: 10.1093/occmed/kqu144. Epub 2014 Oct 16.
- https://hbr.org/2019/08/181-top-ceos-haverealized- companies-need-a-purpose-beyondprofit.
BHAGWAN SATIANI, MD, is a Vascular Specialist associate medical editor.