Departing the Cave

Consider your employees’ needs when fine-tuning work culture by understanding Maslow’s hierarchy of needs.

By Jon Hoffenberg

A hurricane is headed straight for your house. An armed robber is at the window of your car. A forest fire is nearby, and you hear the winds whistle as it approaches. Are you feeling safe? What does your instinct tell you should be done? You are not thinking about vacation, personal growth, or what book to read next in that moment. Have you ever considered why not? In 1943, psychologist Abraham Maslow laid out his “Theory of Human Motivation,” in the journal Psychological Review, attempting to define how individuals find motivation at different stages and in diverse situations.1 He argued that people, in general, must have physiologic needs sated before being worried about, or motivated to undertake, anything more. From there, individuals would seek safety, then attempt to find a feeling of belonging. Only then could people seek esteem and ultimately self-actualize.

The Cave Life

In more basic terms, let’s pretend you are a caveman or cavewoman. Without food, water, and a cave, very little else matters. You do not seek to find love or to have children. You do not wish to grow personally or decorate your cave. You simply do whatever it takes to find simple sustenance and some rock over your head.

Once that has been accomplished, you realize that, although you have food, water, and a cave, there is a lion in your cave, and you do not feel safe. At this stage, you seek safety—better shelter, a good club with which to beat attacking lions, and perhaps a bucolic lifestyle further from predators.

Finally, when those items are taken care of, you can seek a mate—ideally a relatively well-bathed caveperson with whom to have some cavekids. You meet some cavebuddies with whom to pray to the rain gods on Saturdays, and you even try to improve your hunting skills. You invent a wheel and fire to the surprise and splendor of the cavemunity and ultimately achieve enlightenment. All is right in cave world.


Interesting stuff, sure, but how does it apply to contemporary times and modern business? Consider the employees at your practice. As a physician-leader, you must simultaneously manage a number of tasks: performing surgery, treating patients, seeing consultations, managing emotions, building and retaining a team of workers, and ideally creating a lasting legacy and a comfortable retirement scenario.

One of the great misdemeanors of management is the tendency to confuse your own level in Maslow’s hierarchy with that of each of your employees. You may feel safe, loved, and a part of a team and be seeking self-actualization, but that is often because you have been doing your job for years and cannot be fired. When you consider the mental state of your junior and senior employees, you can use Maslow’s hierarchy of needs to tease out common mistakes many physician-leaders make.

Level 1: Physiologic Needs

Mistake = Hiring People Who Are Desperate

Often, practice leaders confuse a desperate job seeker with a hungry go-getter. The latter is ideal, as nobody wants a lazy or unmotivated employee. If you hire someone desperate, however, who is simply seeking food for the family table, shelter, or to save his or her home, then he or she may be dangerous. Indeed, imagine if you could not pay your mortgage or feed your family. What would you resort to? Would you want someone like that in an office with cash? I recommend picking only hungry people to join your team to avoid desperate acts by desperate people. Sometimes, bad things are done by good people, often out of desperation.

Level 2: Safety

Mistake = Joking About Employment Status

Many times, I have heard doctors or managers jokingly say, “Good morning. You are 2 minutes late. I guess we need to start looking for a replacement.” Yes, behaviors such as tardiness should be addressed, and certainly chronic mistakes can and should lead to loss of employment. That said, remember that even nonchalant threats to someone’s employment status can immediately take that employee down from the more self-actualized levels of Maslow’s hierarchy and back to questioning his or her safety. If job safety is threatened, you can bet the employee will be looking online for new jobs that night and not thinking about how he or she can grow personally and professionally within your organization.

Level 3: Love and Belonging

Mistake = Not Having Fun

Is your workplace a joy to come to? Are there occasional surprises, parties and cakes for birthdays, and traditions that are repeated annually? If not, your employees may not feel they belong. Once you provide fair wages and a safe environment, you can start to create culture. Culture begins with rules and expectations but thrives with traditions and a bit of joy. Have a holiday party. Take people to lunch occasionally. Think of something silly that makes people feel a part of the team. (At YellowTelescope, we make a bobblehead doll in the image of each employee and present it on his or her second work anniversary.) Part of culture is establishing work ethic, expectations, and rules, but part of it is also creating the feeling of belongingness.

Level 4: Esteem

Mistake = Not Offering Opportunity for New Challenges

As your team matures, let’s assume all members are feeling safe, loved, and a part of the culture. To avoid boredom, which leads to the desire to find a new outlet for personal growth, simply provide that prospect. Invest in your employees’ personal growth. Esteem and confidence come from learning. Buy your team a book to read together on leadership or service. Invest in a seminar or conference for your team to attend. Consider hiring consulting services to challenge your whole team to become better. Contests do not hurt, either, and having fun with it helps at every level.


As John Berry, director of client management at Yellow Telescope and SEOversight, once said, “Self-actualization means you turn into a beam of light, so it is pretty hard to achieve.” There are, however, many lessons that can be easily learned and implemented as you go from being a caveperson in the managerial sense to a self-actualized visionary leader. Start by hiring hungry but not desperate people. See your results soar by creating a safe environment, new challenges, and a culture based on both results and the concept of family fun. n

1. Maslow, AH. A theory of human motivation. Psychol Rev. 1943;50(40):370-396.

Section Editor Derek Kunimoto, MD, JD
• managing partner, Retinal Consultants of Arizona; director, Scottsdale Eye Surgery Center, Scottsdale, Ariz.

Jon Hoffenberg
• president, YellowTelescope and


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About New Retina MD

New Retina MD delivers cutting-edge content to retina specialists in their first 15 years of practice. Each issue provides fresh insight from younger physicians plus established mentors on clinical and nonclinical issues affecting ophthalmologists in the earlier stages of their careers. NRMD features surgical pearls, clinical research endeavors, practice management, medical reimbursement and policy, continuing educational requirements, financial planning, innovations, and more.