Kelly D. Holder, PhD, and I first met at the Dr. Lorna Breen Heroes Foundation Health Care Worker Well-Being Day in Washington, D.C., where she was a presenter. I was impressed with Kelly’s work, focusing on helping health care professionals and leaders co-create a culture of well-being, which is so critical in medicine today.

This resonates deeply with Sarah Hollander, MD’s belief that the culture of medicine must change, starting in medical school. Together in conversation, we explored powerful stories, and tangible steps that can be taken to begin transforming health care culture, in the context of joy.

Sarah Hollander, MD

The next generation of joy

The exodus is real. Physicians are leaving traditional medicine in growing numbers, worn down by administrative burdens, moral injury, and a system that mistakes endurance for excellence. Burnout drives early retirement, turnover, and declining workforce participation, eroding not only the system but the spirit of medicine itself.

Yet every July, something remarkable still happens. A new wave of residents walk through the hospital doors, white coats still stiff with hearts still open, and carrying hope.

We often speak of burnout as inevitable, as if exhaustion were an accepted stage of training. However, evidence tells another story. Studies in Academic Medicine and JAMA Network Open show that the most effective burnout prevention begins early in medical education through programs that cultivate self-awareness, reflection, and a sense of meaning in work. Curricula emphasizing mentorship, emotional regulation, and well-being reduce emotional exhaustion and enhance empathy long after rotations end.

Joy can be taught.

Joy is not the opposite of burnout. It is the alignment that returns when what we do reflects who we are. When students are encouraged to pair clinical reasoning with reflection on purpose, they develop resilience that is relational rather than performative. They learn that healing is not only technical but also human.

As more colleagues leave academic medicine, I have begun to see their departures differently. They are not only losses but also signals of adaptation. Systems require structural reform, but culture evolves through inheritance. The next generation will absorb what we transmit, whether that is fatigue or fulfillment, cynicism or courage.

Those of us who stay and teach carry a responsibility greater than the curriculum. We are shaping the internal architecture of the profession. When we model presence, humility, and curiosity, we make joy possible again.

Early intervention cannot reside solely in mindfulness electives or wellness seminars. It must be integrated into the identity of being a physician. The American Academy of Pediatrics describes this as “whole-career prevention,” embedding reflection, mentorship, and meaning at every stage of training, not as remediation but as culture.

The next generation will inherit not only our systems but also our state of being. If we want them to build something better, joy must become part of the handoff.

To those stepping into the wards for the first time: May you never confuse fatigue for devotion. And to those of us guiding them: May we remember that teaching joy is not a luxury. It is how medicine remembers its soul.

Kelly D. Holder, PhD

The quiet work of joy

We’ve been talking about burnout in health care for more than 50 years, and while we know many strategies that reduce it, we have not been able to eradicate it. Physician burnout harms patients, clinicians, and communities, and its intersection with depression raises the risk of significant impairment and loss, including suicide. These issues become even more complex in academic medicine, where roles and demands multiply and gaps in our understanding persist. There is good reason we continue to talk about burnout, and why many focus on joy as one antidote.

As a psychologist privileged to support people in health care, I’ve been reflecting on how joy shapes a culture of well-being. Merriam-Webster defines joy as “the emotion evoked by well-being, success, or good fortune,” a state of happiness and a source of delight. While useful, this definition feels incomplete when we consider how joy is embodied or guides decision-making. A recent review on joy in medicine notes that “If burnout literally means to extinguish a flame, rekindling joy is to focus on strategies that stoke the embers of motivation and professional fulfillment.”

Joy, when invited, meets us in the most vulnerable parts of our humanity. Ross Gay asks in Inciting Joy, “What if joy is not only entangled with pain, or suffering, or sorrow, but is also what emerges from how we care for each other through those things? What if joy is what effloresces from us as we help each other carry our heartbreaks?” What would it mean to weave this understanding of joy into the culture of medical education and health care?

So many of our darkest challenges, the quiet sorrow, the moral injury, the moments when we push on caring for others while slowly losing parts of ourselves, rarely find words. What demands our silence? How might we begin to speak these truths aloud, not to dwell in sadness, but to create space for community, healing, and the kind of joy that can reshape culture?

What if honesty, grace, and courage helped us articulate the contradictions inherent in healing work? How might we help students and learners understand that many truths exist at once, not only through lectures but through how we live? When we give and receive support, rest, experience delight, leave roles that suppress our joy, or name our longings beyond medicine, we demonstrate another way.

These aren’t new policies, though policies matter. They’re shifts in presence, modeling, and culture. If we shared the heartbreaks of medicine more openly and supported each other in carrying them, joy (that’s real, grounded, and communal) might become part of our cultural DNA.

Could joy help catalyze the culture change we crave, and that our students deserve?

Sarah Hollander is a psychiatrist. Kelly D. Holder is a clinical psychologist. Kim Downey is a physician advocate and physical therapist.