We all know the toll of physician burnout: medical errors, reduced empathy, and doctors leaving the field entirely. About 45% of US physicians report at least one symptom of the condition.

Researchers have devoted thousands of studies to the problem, but a compelling solution is gaining traction in the literature — one that views burnout through the lens of a decades-old psychology framework known as self-determination theory (SDT). The idea: When a person’s core psychological needs are met, they are more motivated, engaged, and effective. In medicine, this makes for happier doctors and better patient care.

“Medicine has long operated as though clinician well-being and patient care are competing priorities,” said Adam Neufeld, MSc, MD, CCFP, a family medicine physician and clinical lecturer at the University of Calgary in Calgary, Alberta, Canada, who studies the application of SDT in healthcare. “SDT helps us see that supporting clinicians’ basic psychological needs is not a luxury or reward — it is a prerequisite for the high-quality care that patients deserve.” 

A gap remains between theory and practice, but SDT’s principles are being used more in medicine, not just in how residents are trained but also in how doctors communicate with patients. Medscape Medical News spoke with SDT researchers to understand how this framework works — and how to put it into action.

The Case for SDT

Dating back to the 1970s, SDT offers a way to understand human motivation and personality. It centers around three core psychological needs: autonomy (feeling ownership over one’s actions and alignment with values), competence (feeling capable), and relatedness (a sense of belonging).

The assumption is that people have a natural propensity to flourish — but environment matters. According to Neufeld’s new study in Perspectives on Medical Education, medical workplaces that fail to support these needs can foster burnout, disengagement, and diminished patient care.

“When you support basic needs, people go from a defensive mindset to a discovery mindset,” said Gregory Guldner, MD, MS, chief wellness and retention officer at HCA Healthcare Clinical Services Group in Brentwood, Tennessee. “They’re much more likely to be open thinkers and learn. Whereas if you frustrate their needs, they go into a defensive mindset. That’s a psychological safety and patient safety issue.” 

That doesn’t mean they’re not motivated. Someone can be highly motivated from a place of anxiety, guilt, or worry about performance or approval. “That can be powerful but not very stable and not good for well-being,” Neufeld said.

In a 2024 study co-authored by Guldner and involving 721 residents, a sense of meaningful work was the strongest and most consistent predictor of engagement, lower burnout, and intent to stay. Autonomy-supportive leadership plays a significant role in creating that meaning.

Implementing SDT into Medicine

Applying SDT to healthcare is still in its infancy, but clinicians can put its principles into practice with colleagues and patients. Guldner’s employer, HCA Healthcare — the largest provider of graduate medical education in the country and the largest healthcare hospital system — is actively translating the theory from academia to practice. 

Helping people become intrinsically motivated is key, and autonomy is essential to that, said Greg Malin, MD, PhD, an associate professor at the University of Saskatchewan College of Medicine in Saskatoon, Saskatchewan, Canada. Autonomy is about internalizing and “psychologically owning things,” said Malin — helping people make choices they can endorse. “This provides a more relational and humane foundation for shared decision-making and ethical care,” said Neufeld.

Guldner offered a 5-point system for supporting autonomy in both medical education and patient care:

Consider others’ point of view. For educators, this could be as simple as asking students and young doctors, “What’s in the way today?” Having hospital leaders put on scrubs and work alongside their team helps staff feel understood, making them more likely to embrace what they’re being asked to do, Guldner said. In patient care, shifting your perspective can be as simple as putting the keyboard aside, making eye contact, and listening.

Validate emotion. With learners and patients alike, you might say, “I can see this is frustrating you,” or “You seem upset — tell me more.” Validation lays the groundwork for patients and teams to accept a work strategy or treatment plan, said Guldner.

Provide rationales. Explaining boundaries and thought processes, involving people in decisions, asking questions, and respecting people’s sense of agency all support autonomy. An educator might explain that a certain policy is regulatory or related to patient safety. A physician might tell a patient, “I want to put you on a statin to protect you from a heart attack,” vs just saying “your cholesterol is high.”

Allow choice where possible. When appropriate, consider giving a range of treatment options. Guldner said he often falls back on the phrase, “What do you want to do?”

Favor invitational language. Do this instead of telling people what they can or cannot do. In patient care, a provider may say, “Would you be willing to try medication alongside dietary changes?” Guldner’s team audits hospital signs to ensure they don’t provoke a sense of being controlled. (Instead of a sign that says, “Residents cannot take water from this refrigerator,” signage could point out where residents can find water.)

For competence, Guldner trains attending physicians to give feedback that connects residents’ hard work to tangible progress and real patient lives. “Think back to the first time you saw that procedure. You could never have done that then, but look at you now — you can do it on your own,” or “Putting in that transient pacemaker saved Mrs Brown’s life. Her family is meeting her in the ICU now because of you.” 

In patient care, he recommended tying treatment plans to things that matter to patients — for example, how a medication might mean more time with a spouse or how losing weight could mean keeping up with grandchildren.

Relatedness is usually the most intuitive need to support: Distributing Match Day gear, checking that meal options accommodate dietary restrictions, or simply asking how things are all reinforce a sense of belonging. 

Ultimately, SDT offers a framework for understanding others’ experiences — and for aligning teaching, supervision, and communication in ways that benefit both clinicians and patients. “Psychological needs are at stake at every turn,” said Neufeld, “and whether clinicians, leaders, or administrators know it or not, they’re being supported or frustrated all the time.” 

Guldner reported being an employee of HCA Healthcare, which has funded some of his research. The other experts cited in this article reported no relevant disclosures.