Motivation is a certainly such a strange bedfellow! It waxes and wanes with time and with the changing of the seasons. It can be our best friend or our worst enemy. It can be the key to our success or to our failure. Psychologists have many different theories of what motivates human behavior.

The first is the intrinsic theory of motivation, which states that evolution and intrinsic traits such as anger, shame and love drive motivation. The second is the incentive theory, which states that people are motivated due to external rewards. The third is the drive theory, which postulates that human behavior is motivated by the desire to reduce the internal tensions caused by unmet needs.

The fourth is the humanistic theory, which means people are motivated by a desire for self-actualization, while the fifth is the expectant theory, whereby formulation of expectations about the future drives behavior. Then, there is the theory that all motivation is a result of either reward or punishment (the carrot or stick theory of motivation). And the list of theories goes on and on...

Do you ever stop to wonder what motivates you? Which of these theories applies most to you? In cardiology, when the long call nights and grueling clinic days take a toll on our motivation, what is it that really keeps us going?

Although I love my patients and if asked any day of the year what my primary motivation is for all I do, I would immediately answer with "taking good care of patients," I know that in reality my motivation is likely to be much more complex and multifactorial.

I'm a firm believer that due to the significant demands of clinical medicine, it is often our nonclinical activities (in the office or outside work) that keep us most engaged, motivated, innovating and growing – characteristics that incorporate all the theories of motivation listed here.

For some, these activities include time with their families/friends or hobbies that keep them going. For others, the desire to push the frontier of medicine forward and leave a lasting impact with their research keeps them burning the midnight oil.

For those administratively inclined, it is doing programmatic development for their practices or hospitals. And for many others, it is a desire for lifelong learning and their engagement with community and leadership activities within professional organizations such as the ACC that becomes their motivation. I can't even begin to tell you how many lifelong career connections (and friendships) I've personally made through ACC communities such as Early Career professionals and Women in Cardiology – I am sure it is the same for you!

So, how then does one balance the eternal desire to engage in activities outside work that keep us motivated with the practical logistical constraint that there are only 24 hours within each day? And, do we really "make time" in our lives for the things that are important to us or is it a zero-sum game, whereby committing to one activity automatically detracts from another?

For those of you who say that it is a zero-sum game, I challenge you to change your thinking! The wonderful thing about motivation is that it makes you happier, more efficient, more organized and more effective in every facet of your life. So, if you find the right things that motivate you, not only could you take on more but you would perform better at each of the additional tasks and feel happier. Win-win situation!

Despite all the theories of motivation out there, perhaps the oddest thing of all is that we must realize how much control we have over our motivation. Unlike the many activities in our life we have no control over, the choices we make every day significantly influence our short- and long-term motivation.

We must also acknowledge that what motivates us may change on a daily, weekly or monthly basis and is a multifactorial mix of all the theories of motivation that exist. And, the more we understand about our motivations, the less the likelihood of physician burnout and the more fulfilling our careers will become.

But, just like the tide, motivation ebbs and flows. There will be days when your motivation wanes or is weakened and that's when "keeping your eye on the ball" and understanding the complexities of this strange bedfellow will help you to find it again. And, motivation is contagious! If you surround yourself with positive, motivated individuals, your own productivity and motivation levels automatically increase.

So, I urge you to get out there and find your "muse" outside the exam room. Whether it's signing up for an ACC committee or painting a mural outside work, find a few minutes each day or each week where you can make uninterrupted time for something important that keeps you motivated. Trust me… the payoff will be far more than you had ever imagined!

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Payal Kohli, MD, FACC, practices at the Heart Institute of Colorado in Denver, where she treats a variety of cardiovascular diseases. She is also the lead physician of the Women's Heart Center.

Keywords: ACC Publications, Cardiology Magazine, Motivation, Alprostadil, Leadership, Friends, Daucus carota, Hobbies, Burnout, Professional, Achievement, Choice Behavior, Learning, Reward

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