Abstract
Just as emergency physicians apply the ABCs of resuscitation to stabilize critically ill patients, Self-Determination Theory offers a parallel framework for resuscitating physician morale. First developed by Deci and Ryan in the 1980s, this foundational psychological theory identifies three universal human needs, Agency/Autonomy, Belonging, and Competence, whose fulfillment is essential for motivation, well-being, and burnout prevention. This article applies each dimension directly to the emergency medicine context, examining how institutional failures in autonomy, belonging, and competence drive physician dissatisfaction, and what physicians can do to address these needs proactively, even within imperfect systems. The central argument: pizza parties and wellness apps are insufficient; meaningful burnout prevention requires attending to the ABCs of self-determination.
Key Findings:
- ● Self-Determination Theory (Deci & Ryan, 1985) identifies three universal needs, Autonomy, Belonging, and Competence, whose depletion reliably predicts burnout, disengagement, and attrition across professions, including medicine.
- ● Physicians who experience genuine autonomy at work, where feedback is received and acted upon, and clinical judgment is respected, are more loyal, more engaged, more productive, and less likely to leave their positions.
- ● Workplace belonging is associated with reduced likelihood of departure from an institution; key factors include feeling able to freely share thoughts and believing there is an opportunity to thrive professionally (Schaechter et al., Journal of Healthcare Leadership, 2023).
- ● Women physicians face specific, compounding threats to belonging, including microaggressions, slowed career advancement, and inadequate family-friendly policies, that organizations must address deliberately.
- ● A single poor outcome or negative patient satisfaction score can rapidly erode a physician's accumulated sense of competence, making how institutions frame metrics and outcomes a significant lever for morale.
When dread helps, and when it harms
✓ Useful dread
Prompts preparation or action
- ● Sign up for a clinical refresher course
- ● Have a needed difficult conversation
- ● Address a systemic issue proactively
- ● Plan ahead for a known challenge
⚠ Harmful dread
Loops without useful output
- ● Sitting in the parking lot unable to go in
- ● Doomscrolling during time off
- ● Daydreaming about early retirement
- ● Pre-living the shift before it happens
Four strategies to break free
- 🧠 Practice metacognition
You are the watcher of your thoughts, not the thoughts themselves. Notice dread ("Oh, hello there again") and let it pass without engaging or suppressing it. This is mindfulness in practice.
- 🌿 Return to the present moment
The past only exists when you think about it. The future is undetermined. Use sensory grounding questions to anchor yourself in the only thing that is real, right now.
- 🤲 Self-regulation: Mel Robbins' technique
Hand on heart, repeat: "I'm okay. I'm safe. I'm loved." Then ask: "What if it all works out?" When dread isn't generating useful action, this reframe feels better, and is equally plausible.
- 💪 Trust yourself and live it only once
You're an EM physician. When something goes wrong, you'll handle it, you always have. Make a deal: live each challenge when it arrives, not in advance. Pre-living it only steals your recovery.
Five sensory grounding questions to return to now
- 👂 What noises can you hear right now?
- 👥 Who is physically with you right now?
- 👁️ What haven't you noticed yet in your field of vision?
- ✋ Can you feel any textures on your skin?
- 👃 Are there any smells in this space?
"You're not your thoughts, you are the watcher of your thoughts. Pre-living what you dread only distracts from everything you love. Trust yourself to handle what comes. Until then, go do something that lights you up inside."
Publication details:
JOURNAL
Common Sense (AAEM)
VOLUME / ISSUE
Vol. 31, No. 2, pp. 25–26
PUBLISHED
March/April 2024
AUTHORS
Amanda Dinsmore, MD; Kendra Morrison, DO; Laura Cazier, MD
SERIES
The Whole Physician
PUBLISHER
American Academy of Emergency Medicine (AAEM)
