The culture of medicine is shaped in quiet ways, by the way meetings begin, the pregnant pauses before a response, and the energy transmitted in emails sent and received. These seemingly insignificant experiences ripple outward, setting the tone for entire teams, shaping what is spoken and what is not, shaping what feels possible and what feels unsafe.

The culture of medicine is not an abstract force. It is built moment by moment, and even, and especially, in the silences. Every decision, every glance, every unspoken expectation from our leaders shapes the emotional climate of our institutions and medicine as a whole.

For years, we have offered physicians wellness apps, burnout surveys, conferences, lunchtime yoga, and holiday gatherings. We have created wellness metrics and dashboards to track physician well-being. We have appointed chief wellness officers to analyze metrics. Although these efforts have value, they are layered on top of a more profound truth that we have been reluctant to address: The wellness of physicians rises and falls with the way we are led and the way we lead.

I first spoke about “leading with a lens to wellness” on an international stage in 2018. In the years since, our understanding of burnout has grown; our leadership culture has evolved much more slowly. Until leaders begin making decisions with the human well-being of caregivers at the center, little will change. This shift is not complex, but it will take training (and retraining) our leaders. It will take mindful leaders at the helm who pay attention to the health and human needs of physicians.

Change will happen when leaders consider whether a new policy will nourish or deplete their teams and they design schedules that allow for restoration rather than erosion. Change will happen when leaders run meetings with intention and respect for time. Change will happen when leaders respond to concerns with curiosity and when they have capacity to hold space for hard conversations without rushing to fix or defend. Change will happen when leaders model boundaries and rest, admit their human limits, and invite and encourage others to do the same. Change will occur when mindful communication, compassion, patience, and presence are not seen as soft extras, but as essential leadership competencies. The health of physicians must matter as much as the health of patients if we are to have a sustainable, high-quality system.

Despite clear evidence that supportive, emotionally intelligent leadership improves engagement and retention, most leadership training in medicine still overlooks the skills required to foster true personal and systemic wellness. As a leader, I was trained to communicate persuasively, to listen, to give feedback, and to create an efficient department that had high patient satisfaction scores and met HEDIS measures. In my leadership training, I was not taught to inspire, energize, and motivate. The focus was not on retention, engagement, and physician health and fulfillment. Leading mindfully, with kindness, compassion, curiosity, patience, gratitude, connection, and intention, was not a focus. I was not taught how to show up for meetings or send emails that emanate a sense of calm and groundedness. I was not taught to lead in a way that supports the health, well-being, and longevity of those impacted by my leadership (physicians, staff, and patients).

One of the most transformative investments any health care system can make is to offer mindful coaching for all physician leaders. Chief wellness officers can advocate for systemic change, but the daily lived experience of physicians depends most on the wellness, attention, and intention of all the leaders who work directly with physicians. We do not need leaders who prove their dedication by working the longest hours, seeing the most patients, or sacrificing their own health and wellness by covering the most undesired shifts. We do not need leaders whose value is measured in dashboard metrics or inbox zero.

We need leaders who are grounded and present, leaders who choose curiosity over fear, leaders who are willing to stop glorifying exhaustion and self-sacrifice so we no longer pass down pain and depletion to the next generation of healers.

A few forward-thinking institutions are beginning to understand that emotional intelligence, self-regulation, mindfulness and self-compassion practices, and attention to one’s personal health and wellness are critical to effective leadership. Leaders must not only be able to create psychological safety, they must also understand the effects of trauma in training, vicarious trauma in our work, and be well versed in personal and structural factors that affect wellness.

For health care to be well, leaders must “lead with a lens to wellness.” Wellness is not a department or a project; it is a way of life. It is a way of leading, a way of being. It begins when leaders themselves are well enough to hold steady in the storms, to listen fully, to choose their words and actions with care.

When leaders choose presence over pressure, compassion over speed, and restoration over depletion, something shifts. The air in the hospitals and clinics is lighter and the work begins to feel human again. In this space, medicine has a chance to be what it is meant to be, a place where healing and health flow in all directions.

Jessie Mahoney is a board-certified pediatrician, certified coach, mindfulness and yoga teacher, and the founder of Pause & Presence Coaching & Retreats. After nearly two decades as a physician leader at the Permanente Medical Group/Kaiser, she stepped outside the traditional medical model to reimagine what sustainable well-being in health care could look like. She can also be reached on Facebook and Instagram.

Dr. Mahoney’s work challenges the culture of overwork and self-sacrifice in medicine. She helps physicians and leaders cultivate clarity, intention, and balance—leveraging mindfulness, coaching, yoga, and lifestyle medicine to create deep and lasting change. Her CME retreats offer a transformative space for healing, self-discovery, and renewal.

As co-host of the podcast, Healing Medicine, she brings self-compassion and presence into the conversation around modern medical practice. A sought-after speaker and consultant, she partners with organizations to build more human-centered, sustainable, and inspired medical cultures.

Dr. Mahoney is a graduate of Dartmouth College and the University of California, San Francisco, School of Medicine.