The ordinary is often overlooked in the rush to define what matters most in medicine. For decades, the focus has been on burnout, moral injury, and the relentless demands of training—all critical concerns, but ones that can obscure the quieter, more human dimensions of the profession. Two recent essays in the New England Journal of Medicine, published in January 2024, challenge the field to look closer at what it means to thrive in medicine, not just survive. They ask: What if the key to sustaining excellence isn’t just managing stress, but reclaiming agency, belief, and even joy in the work itself?
The essays, “Beyond Moral Injury — Can We Reclaim Agency, Belief, and Joy in Medicine?” and “Being Well while Doing Well — Distinguishing Necessary from Unnecessary Discomfort in Training,” pivot from the familiar narratives of physician suffering to a more nuanced exploration of well-being. The first argues that the current emphasis on “well-being” in medical training may inadvertently undermine the very professionalization that medicine seeks to preserve. The second calls for a sharper distinction between the discomforts that are part of growth and those that are simply harmful, urging institutions to rethink how they support trainees.
At the heart of these essays is a provocative question: What if the ordinary moments—the daily interactions, the small victories, the sense of purpose—are the very things that sustain physicians over the long haul? Both pieces suggest that medicine’s obsession with crisis and trauma may be blinding it to the ordinary, the everyday experiences that define the profession’s humanity and resilience.
The Crisis of Well-Being in Medicine
The medical profession has long grappled with the paradox of high stakes and high stress. Burnout, depression, and moral injury have become almost expected outcomes for physicians in training, with studies consistently showing that the majority of residents and fellows experience significant emotional distress. Yet, the essays in the NEJM argue that the focus on these crises may be misplaced. They propose that the current conceptualization of well-being—often framed as the absence of suffering—can actually interfere with the very professionalization that medicine values.
The first essay, published on January 24, 2024, contends that the push to eliminate all discomfort from medical training may be counterproductive. It suggests that the pursuit of well-being, when defined solely as the absence of stress or trauma, can lead to a hollowed-out version of medicine. The author writes that reclaiming agency, belief, and joy in the profession requires a more holistic approach—one that acknowledges the inherent challenges of medicine while fostering a sense of purpose and fulfillment.
Distinguishing Necessary from Unnecessary Discomfort
The second essay, released just days earlier on January 17, 2024, takes a different but complementary angle. It asks why it is so difficult to distinguish between the discomforts that are part of professional growth and those that are simply harmful. The author points out that medical training has always involved hardship, but not all hardship is created equal. Some discomforts are necessary—part of the process of learning, adapting, and improving. Others are avoidable, even unethical, and should be remedied.
This essay highlights the need for medical institutions to create environments where trainees can experience the necessary challenges of their profession without being overwhelmed by unnecessary burdens. It calls for a cultural shift, one that values both excellence and well-being, and recognizes that the two are not mutually exclusive.
The Ordinary as the Foundation of Resilience
Both essays underscore the importance of the ordinary in medicine. They argue that the profession’s focus on extraordinary crises—moral dilemmas, life-and-death decisions, and systemic failures—can obscure the power of the everyday. The small moments of connection, the sense of accomplishment in mastering a skill, the joy of making a difference in a patient’s life: these are the bedrock of a sustainable medical career.
For many physicians, it is the ordinary that provides the resilience to weather the storms. A resident who takes pride in learning to take a patient’s history with empathy, a physician who finds satisfaction in teaching the next generation, or a clinician who derives meaning from the routine check-up—these experiences are the lifeblood of a fulfilling medical practice. The essays suggest that medicine must reclaim these ordinary moments, not as secondary to the extraordinary, but as the very foundation of its vitality.
Who Is Affected and How?
The implications of these essays extend far beyond the walls of academic medical centers. They affect every physician, from the newest intern to the most seasoned attending. For trainees, the message is clear: well-being is not just about avoiding burnout; it’s about finding meaning and joy in the work. For institutions, it’s a call to action to rethink how they support their trainees, ensuring that the discomforts of training are necessary and purposeful, not just exhausting.
Patients, too, stand to benefit. A physician who is engaged, fulfilled, and resilient is more likely to provide compassionate, high-quality care. The essays argue that when medicine focuses on the ordinary—on the relationships, the learning, and the small victories—it creates a culture that benefits everyone.
What Is Known vs. Unknown
While the essays offer a compelling vision for the future of medical training, they also highlight the gaps in current knowledge. How exactly can institutions distinguish between necessary and unnecessary discomfort? What specific interventions can foster agency, belief, and joy in medicine? And how can these ideas be translated into actionable policies and practices?
Research in this area is still evolving. Some studies have explored the role of mindfulness and resilience training in medical education, while others have looked at the impact of mentorship and supportive work environments. However, more work is needed to understand how to systematically integrate these findings into medical training programs.
Why It Matters
The stakes could not be higher. The medical profession is facing a crisis of attrition, with many physicians leaving the field due to burnout and dissatisfaction. At the same time, the demand for healthcare providers continues to grow. The essays in the NEJM offer a path forward, one that prioritizes the ordinary—the moments of connection, learning, and fulfillment that keep physicians engaged and motivated.
By reclaiming agency, belief, and joy, medicine can create a culture that values both excellence and well-being. This, in turn, can lead to a more sustainable and resilient medical workforce, one that is better equipped to meet the challenges of the future.
Where to Find Official Updates
For those interested in exploring these ideas further, the New England Journal of Medicine provides a wealth of resources. The two essays discussed here are available online, along with their associated disclosure forms and supplementary materials. Professional organizations such as the American College of Physicians and the Association of American Medical Colleges regularly publish updates on medical education and physician well-being.
Looking Ahead
The next checkpoint for this conversation will likely be the release of further research and policy recommendations from medical education leaders. Institutions are already beginning to implement changes, such as revised residency programs that emphasize well-being and mentorship. The coming months and years will be critical in determining how effectively these ideas can be translated into practice.
As the medical community moves forward, the essays in the NEJM serve as a reminder that the ordinary is not to be overlooked. It is the foundation upon which a resilient and fulfilling medical career is built.
What are your experiences with finding joy and purpose in medicine? Share your thoughts in the comments below, and help shape the conversation about the future of physician well-being.
