The old adage of “do what you love, and you’ll never work a day in your life” may have misled an entire generation.

While researching individuals with high career satisfaction, psychologists Ryan and Deci found that the introspective “follow your passion” approach was rarely a major factor. Instead of relying on some intrinsic passion, people who loved their jobs were found to have work that fulfilled three specific psychological needs: autonomy, competence, and relatedness. They condensed decades of research into one overarching theory on what makes someone love what they do, called self-determination theory.

This theory provides meaningful insight into why so many doctors and health care workers are struggling with their own job satisfaction despite working in what is generally considered a highly rewarding line of work.

Autonomy: Control over how you fill your time

While doctors may have some decision-making autonomy when it comes to patient care, they actually have very little control over what their day-to-day work looks like.

Ryan and Deci found that workers were more motivated when they had control over their tasks, goals, and approach to work. In the clinic, appointment intervals are set by organizational powers, and schedules are filled to the brim despite the actual time patients require. In the hospital, task priorities are set by the most urgent fires that need to be put out, and much of clinical decision-making is limited by the constraints of the health care system.

Through this lens, medicine lacks the type of autonomy that brings workplace motivation and contentment.

Competence: Progressive skill development and ability to effect change

At least doctors can find satisfaction in their abilities to care for their patients, right? Well, that depends.

While a high degree of skill is a factor in work satisfaction, Ryan and Deci also found that a sense of ongoing skill mastery, a high level of efficacy at work, and the ability to overcome challenges are essential for motivation and satisfaction. While some health care organizations offer various types of career development and continuing medical education, direct feedback on doctors’ work is sparse and rarely constructive. Doctors are also constantly trying to align what they know is the medically appropriate thing to do for a patient with what they are actually able to accomplish within the constraints of the medical system, leading to moral distress and moral injury among health care workers.

Despite being highly competent in the underlying medicine they practice, it can be argued that medicine does not support the type of progressive and effective competence associated with motivation and satisfaction at work.

Relatedness: Feeling of connection to others

This one should be a slam dunk for medical work, but again it’s not quite cut and dry.

Medicine provides an unparalleled opportunity to interact with and care for other human beings. Unfortunately, one of the impacts of the previously discussed moral distress and injury is a self-protective tendency for depersonalization of patients, reducing doctors’ ability to appreciate the value of the human interactions that make up much of their work. Additionally, Ryan and Deci describe a positive relationship with colleagues and superiors as a strong driver of motivation, and the degree of contentiousness both vertically and horizontally within health care organizations these days is palpable.

While medicine may be falling short at the moment, none of this is unfixable.

With intentional organizational and systemic changes, we could create a work environment that fosters wellness for health care providers and allows them to take the best possible care of their patients. Understanding where we are falling short is merely the first step.

Kent McCann is an emergency physician.