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.
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.
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.
