As irrepressible storytellers, internists crave purpose. We spend an inordinate amount of time sketching the countless connections between the moments of our lives. That purpose drives the joy and engagement we bring to our careers.1 Purpose brings life satisfaction and well-being. Unfortunately, our modern profession’s reality has painted a sometimes-stark contrast to that idealism. Up to 63% of physicians report at least one symptom of burnout and only 30% are satisfied with their work-life integration.2 No doubt, the causes and solutions for burnout are complex.3 We propose the concept of Ikigai as a piece of the solution—an approach to identify purpose and, in turn, joy in our careers.
Ikigai combines two Japanese concepts, iki (life) and gai (worth or value). It is loosely translated as the “reason for being” or raison d’etre.4 Ikigai is a state of well-being that arises from devotion to activities that bring joy and meaning to life. Japanese culture places great emphasis on the mind-body connection. As such, Ikigai is considered one of the key ingredients to longevity and a healthy and happy life. While broadly applicable in all aspects of life, applying the concept to evaluate our careers and opportunities in medicine can reduce burnout and improve the longevity of our careers.
Ikigai exists at the intersection of four vital overlapping questions:
- What are you good at? This may be known or innate. It may require self-exploration to investigate further, for example by tools such as Strengthfinders 2.0.5 Or it may be something you can cultivate with the appropriate time, support, and resources. You may ask: “What am I good at, and what can I be good at?”
- What do you love? Think about the things that energize you and make you smile. It certainly doesn’t have to be related to medicine.
- What does the world need? The world can be defined differently—your patients, communities, division, department, institution, or, quite literally, the world itself. You live and work in a variety of different micro- and macro-environments. Sometimes you know where attention and efforts are needed; other times, you must assess and reflect more formally upon the gaps. This question is crucial in connecting your purpose beyond the individual self.
- What can you get paid for? Getting “paid” can be defined differently— internal satisfaction, resource allocation, budgeting, time, or financially. Instead of thinking of being “paid” as solely financial, think about the ways in which you can be “compensated.”
To achieve Ikigai, finding where these areas overlap is crucial. These four questions are represented as circles overlapping in a Venn diagram, with Ikigai being the center—a point of equilibrium and resonance: Ikigai. Asking these questions identifies what provides meaning while balancing where and how others value you. Not everything you do for your career fits in every area (nor does it have to). To work towards achieving Ikigai, focus on the individual questions first, answering from your unique point of view. Some find it helpful to list skills, activities, or elements for each domain. Others focus on larger domains such as medical education or research. Include both clinical and non-clinical elements of your life (e.g., music, cooking, poetry, research, travel). After exploring these questions, evaluate how to harmonize your answers; find the area(s) of overlap and think creatively about incorporating them into your work. If you love music, explore whether you can develop a “Music in Medicine” elective for students or work with the hospital on integrating music into the wards to improve the patient experience. Think about what piece(s) might be missing from your ideal state, one that can provide a state of balance. Maybe you want to be a medical educator, have a passion for global health, or are suited for a C-suite role. Whatever the answer, understand its present state, and assess steps to combine these four pillars to bring satisfaction and purpose to what you do. However, know that those answers may change over time, and careers can and should adapt and evolve to continue a fulfilling career that provides lasting joy. Importantly, finding your Ikigai isn’t so much about the destination but about enjoying the journey and experience along the way to find who we are and what provides us meaning.
Doctors and leaders can use Ikigai to guide critical and periodic reflections on current state, growth, and career trajectories. There may not be a single Ikigai, but sometimes multiple things that fulfill your purpose. This process can allow us to be present and intentional in our search for meaning, guiding us through inevitable ebbs and flows of work and of life. Seeking Ikigai could be the first step to reclaiming what we desire and deserve: medicine as a source of joy and purpose.
- Perlo J, Balik B, Swensen S, et al. IHI framework for improving joy in work. IHI White Paper. Cambridge, MA: Institute for Healthcare Improvement; 2017.
- Shanafelt TD, West CP, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life integration in physicians during the first 2 years of the COVID-19 Pandemic. Mayo Clinic Proceed-ings. 2022;97(12):2248-2258. doi:10.1016/j.mayocp.2022.09.002.
- Addressing health worker burnout: The U.S. Surgeon General’s advisory on building a thriving health workforce. HHS. https://www.hhs.gov/surgeongeneral/priorities/health-worker-burnout/index.html. Published 2022. Accessed October 15, 2023.
- Mitsuhashi Y. Ikigai. UK: Kyle Books; 2018.
- Rath T. StrengthsFinder 2.0. Washington DC: Gallup Press; 2007.
Dr. Concejo (Bruno.email@example.com) is an assistant professor of medicine and the internal medicine clerkship director at Ochsner LSU Health Shreveport. Dr. Molitch-Hou (firstname.lastname@example.org) is an assistant professor of medicine and the director of the hospital medicine subinternship and core faculty for the internal medicine residency program at the University of Chicago. Dr. Shin (email@example.com) is an assistant professor of medicine at Emory University in Atlanta, GA, and serves as the associate chief of hospital medicine at Emory Midtown Hospital. Dr. Patel (firstname.lastname@example.org) is an assistant professor of medicine at Northeast Ohio Medical University (NEOMED) and Ohio University Heritage College of Medicine and associate program director for internal medicine at Riverside Methodist Hospital (OhioHealth) in Columbus, OH.
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