Abstract
Background
Modern healthcare environments increasingly limit opportunities for physicians to build collegial relationships, contributing to feelings of isolation and disconnection. Commensality has been proposed as a way to restore relational infrastructure within clinical settings. While prior commensality programs have shown modest quantitative effects on burnout, less is known about how physicians experience these gatherings and the cultural functions they serve.
Objective
To explore how physicians participating in a hospital‐based commensality program perceived its impact on community, connection, and culture.
Methods
We conducted a qualitative study of two cohorts of attending physicians participating in a 12‐month hospital‐based commensality program. Open‐ended survey responses were analyzed using inductive thematic coding followed by an interpretive cultural analysis to situate emergent themes within broader frameworks of medical culture.
Results
Fifty‐six physicians participated across two program years. Six themes reflected patterns of connection and constraint: creating community; shared experiences as support; learning new perspectives; bridging professional boundaries; professional growth and mentorship; and structural barriers to connection. Average attendance was 75.5% in 2023–2024 and 59.7% in 2024–2025. Physicians described commensality as restorative and humanizing while noting time pressure and workload as key barriers.
Conclusions
Physician commensality facilitated meaningful connection, cross‐departmental relationships, and informal mentorship within the clinical workplace. These findings suggest that shared meals can support relational aspects of professional life that traditional institutional structures may erode.
INTRODUCTION
For much of the twentieth century, medicine functioned not only as a science but also as a community sustained through conversation, mentorship, and ritual. Yet the increasing pace and digitalization of modern healthcare have eroded many of these informal spaces of connection. Physicians today often describe not only exhaustion but also a deeper sense of alienation. 1 Contemporary hospital practice is marked by the disappearance of the “doctors' dining room,” the loss of unhurried time with colleagues, and the erosion of a sense of belonging to a community grounded in shared values rather than productivity metrics. 2 , 3 This erosion of social infrastructure reflects a broader shift in the moral and relational fabric of medical life.
Commensality, traditionally defined as the practice of eating together, offers a route to reclaim this communal fabric. 4 In anthropological and sociological scholarship, commensality is understood not merely as shared consumption of food but as a ritualized social practice in which conversation, presence, and mutual recognition unfold around the shared meal. 5 , 6 , 7 Shared meals strengthen interpersonal connections, expand social networks, and enhance group cohesion and cooperation precisely because they integrate nourishment with conversation and collective meaning‐making. In the clinical world, such gatherings echo the humanistic foundations of medicine, where care begins not solely with technical intervention but with relationship‐building and mutual regard. 8 Within institutions increasingly structured by speed, administrative pressures, and departmentalization, commensality offers an alternative mode of interaction: a return to embodied and relational presence.
Recent efforts to formally implement commensality in healthcare systems suggest that shared meals may offer modest support for physician well‐being. At the Mayo Clinic, the COMPASS program, a randomized, controlled trial of small‐group discussion over meals, demonstrated reductions in burnout prevalence, depressive symptoms, and intent to leave the organization among participants compared with controls, although mean changes in burnout scale scores, measures of meaning, and social support did not reach statistical significance. 9 A pilot program in Hawai'i found short‐term improvements in emotional exhaustion and selected workplace domains, with benefits diminishing after cessation of the program. 10 While these studies suggest potential value, their quantitative focus leaves unaddressed the relational and cultural mechanisms through which shared meals may exert their influence. Little is known about how physicians themselves experience commensality, how such spaces reshape daily professional relationships, or how shared meals function within the broader social ecosystem of medicine.
At Cooper University Health Care (CUHC), a large academic medical center in Camden, New Jersey, a physician commensality program seeks to reintroduce the communal dimensions of practice by convening physicians for structured shared meals combined with prompted discussion during the workday. In this context, commensality refers not only to eating together but to the recurring ritual of gathering around a shared meal as a space for reflection, conversation, and cross‐specialty connection. Unlike wellness initiatives oriented toward stress reduction or resilience training, this program intentionally centers relational presence, creating dedicated space within the workday for physicians across career stages and departments to engage one another beyond the constraints of workflow. Because the shared meal and the prompted conversation were enacted together as a single recurring gathering, participants' reflections on the commensality program are interpreted as accounts of the commensality experience, rather than as evaluations of isolated program components.
This study examines how physicians perceive and experience commensality within the clinical workplace. Drawing on 2 years of qualitative survey data, we explore how shared meals foster a sense of connection, belonging, and mutual understanding among physicians, and how participants describe the cultural and structural factors that shape their ability to engage in these gatherings. Rather than evaluating commensality solely as a burnout intervention, we consider how it functions as a practice of community‐building within modern healthcare systems. By foregrounding physicians' own words, this analysis aims to illustrate how shared meals may contribute to rebuilding the relational infrastructure that supports both humanistic practice and professional flourishing.
METHODS
The commensality program at CUHC was adapted from the COMPASS initiative at the Mayo Clinic. 9 The study was approved by CUHC's Institutional Review Board, which deemed participation exempt from informed consent. Recruitment occurred via institutional email distribution lists inviting attending physicians across specialties to enroll voluntarily. All attending physicians at CUHC were eligible to participate; residents and fellows were not included in the program. Participants constituted a voluntary convenience sample of attending physicians.
Year‐long groups of 8–10 attending physicians from across specialties were formed through electronic sign‐up. Each group met monthly in the hospital's conference center for 1 h, either for lunch or dinner as designated at registration. The meals were complimentary. Meetings were self‐led, and each group designated a “point person” to take attendance. Sessions began with a discussion prompted by a topic related to physician well‐being distributed by the program director (L.S.W.), with groups agreeing to engage the prompted discussion for at least 15 min before allowing conversation to evolve organically during the shared meal.
Participants completed three online surveys: (1) prior to their first session, (2) after the sixth session, and (3) after the twelfth session. The initial survey gathered demographic data and baseline reflections on professional experience. The second and third surveys included five open‐ended questions designed to elicit participants' reflections on the commensality gatherings and their perceived impact on connection, professional fulfillment, and institutional belonging (Table 1). To preserve confidentiality while enabling longitudinal linkage of responses, participants generated unique numerical identifiers.
Table 1.
Open‐ended questions included in midpoint and final Surveys.
| Question number | Open‐ended survey question |
|---|---|
| 1 | What have you enjoyed the most about taking part in the COMPASS groups? |
| 2 | Do you feel that participating in the COMPASS groups has been beneficial? If yes, how so? |
| 3 | Is there anything you would change to improve the COMPASS groups? |
| 4 | Would you recommend the COMPASS groups to a colleague? Why, or why not? |
| 5 | Is there anything else you would like to share about the COMPASS group experience so far? |
The qualitative analysis draws on survey data from two consecutive program cohorts (2023–2024 and 2024–2025). Two members of the research team (S.S. and I.C.) served as primary coders. Each coder independently reviewed all responses and generated preliminary descriptive codes through repeated reading of the text. The coders identified largely consistent patterns and themes across the dataset. The coders then met to compare codes and candidate themes; discrepancies in wording were discussed and resolved through an iterative process of refinement. Consensus was ultimately reached on both the application of codes and the final thematic framework.
The primary coders did not participate in the commensality groups and held no supervisory roles over participants. Because the program director (L.S.W.) was involved in implementation of the intervention, initial qualitative coding was conducted independently by the primary coders to mitigate potential bias. All quotations were deidentified prior to analysis and publication. S.S. and I.C. assessed thematic sufficiency by comparing patterns across both cohorts. Themes identified in the first cohort recurred in the second, and no substantially new thematic domains emerged in later responses, suggesting stability of the thematic framework across groups.
Following initial coding and thematic development, the primary coders presented the coding framework, thematic structure, and representative quotations to the full research team. The research team reviewed the application of codes to the data and evaluated the alignment between themes and supporting excerpts. Through group discussion, consensus was reached that the coding framework was appropriately applied and that the identified themes were well‐supported by the data. Findings were not returned to participants for formal member checking.
Following inductive thematic coding, an interpretive cultural analysis was conducted. This stage of analysis used an inferential approach to situate the emergent themes within broader anthropological and sociological frameworks of medical culture.
RESULTS
The 2023–2024 cohort consisted of 27 physicians, and the 2024–2025 cohort consisted of 29 physicians, for a total of 56 participants. The vast majority were hospital‐based physicians; the distribution by department and division is shown in Table 2. In the 2023–2024 cohort, the overall attendance rate was 75.5%. Most physicians (62.1%) attended at least 75% of sessions, while only 6.9% attended 50% or fewer. In the 2024–2025 cohort, the overall attendance rate was 59.7%. Thirty‐eight percent of physicians attended ≥75% of their available sessions, while 31.0% attended ≤50%. Across the two program years, the overall attendance rate was 66.9%.
Table 2.
Participants in the two cohorts, by department and division.
| Department | 2023–2024 | 2024–2025 | Combined |
|---|---|---|---|
| Emergency medicine | 1 | 1 | 2 |
| Family medicine | 2 | 2 | 4 |
| Internal medicine | |||
| Addiction medicine | 0 | 3 | 3 |
| Cardiology | 1 | 3 | 4 |
| Critical care | 2 | 0 | 2 |
| Endocrinology | 1 | 0 | 1 |
| Gastroenterology | 1 | 0 | 1 |
| Hematology‐oncology | 0 | 1 | 1 |
| Hospital medicine | 5 | 4 | 9 |
| Infectious diseases | 0 | 2 | 2 |
| General internal medicine | 1 | 1 | 2 |
| Nephrology | 0 | 1 | 1 |
| Palliative medicine | 1 | 1 | 2 |
| Neurology | 1 | 1 | 2 |
| Obstetrics‐gynecology | 2 | 2 | 4 |
| Otorhinolaryngology | 2 | 0 | 2 |
| Pathology | 2 | 2 | 4 |
| Pediatrics | 3 | 3 | 6 |
| Psychiatry | 1 | 2 | 3 |
| Radiology | 1 | 0 | 1 |
| Total | 27 | 29 | 56 |
The final survey response rates for the 2023–2024 and 2024–2025 commensality cohorts were 53% and 69%, respectively. The second and third surveys included five open‐ended questions designed to elicit physicians' reflections on their experience of the commensality groups (Table 1). Responses to these items formed the qualitative dataset used for thematic analysis.
A thematic analysis of open‐ended survey responses from these cohorts identified six recurring themes: shared experiences as a source of support, creating community, learning new perspectives, bridging professional boundaries, professional growth and mentorship, and structural barriers to connection. Each theme was defined through coder agreement using recurring patterns in language and motifs with examples drawn directly from participants' written responses. Representative quotations are included to illustrate each theme (Table 3).
Table 3.
Recurring themes in physicians' reflections on commensality.
| Recurring themes | Notable participant responses |
|---|---|
| Creating community |
|
| Shared experiences as a source of support |
|
| Learning new perspectives |
|
| Bridging professional boundaries |
|
| Professional growth and mentorship |
|
| Structural barriers to connection |
|
Because the commensality groups were structured around a shared meal followed by prompted and emergent conversation within a single recurring gathering, participants' reflections did not distinguish between food‐sharing and discussion as separate experiences. Rather, responses described the enacted communal encounter as a whole. Accordingly, themes are interpreted as reflecting the integrated commensality practice rather than discrete program components.
Across both cohorts, physicians consistently described commensality as a rare but meaningful opportunity to step outside of the routines of clinical life and reconnect with colleagues as people. Six themes captured this experience: creating community, shared experiences as support, learning new perspectives, bridging professional boundaries, professional growth and mentorship, and structural barriers to connection (Table 3).
Creating community emerged as the unifying thread. Many physicians reported that simply gathering in a dependable, low‐pressure space “enhanced my sense of community” and helped them feel more connected across departments. Newer physicians noted that the groups functioned as a point of entry into the broader institutional culture.
Shared experiences as support reflected the relief of hearing others articulate similar frustrations, challenges, and emotional burdens. Physicians described the sessions as “cathartic,” “low stress,” and a welcome reprieve from isolation. Many emphasized the comfort of realizing their struggles were not individual failings but shared experiences embedded within the system.
Learning new perspectives captured how cross‐departmental dialogue broadened physicians' understanding of the institutional landscape. Participants valued hearing how colleagues in other specialties navigated constraints, leadership styles, and patient care challenges. These exchanges expanded physicians' sense of the hospital as a shared ecosystem rather than a set of isolated units.
Bridging professional boundaries describes the formation of unexpected relationships: connections that rarely arise in the workflow of a large academic medical center. Physicians emphasized meeting people they “otherwise wouldn't have gotten to know,” with some describing new friendships or collaborative opportunities.
Professional growth and mentorship surfaced as an unplanned but valued dimension. For younger attendings, the groups offered informal mentorship. Meanwhile, for others the group functioned as a space to exchange advice, troubleshoot departmental issues, and reflect on professional identity.
Finally, structural barriers to connection (time scarcity, workflow intensity, staffing shortages, unpredictable schedules) limited attendance and shaped the texture of the gatherings themselves. Physicians described difficulty protecting an hour for lunch because of inconsistent scheduling as well as feeling pressure to return to documentation and clinical responsibilities. These constraints did not diminish the perceived value of the groups. Instead, they illuminated the cultural and structural forces that make connection difficult in the first place.
DISCUSSION
Physicians' reflections in this study reveal a clear tension at the heart of hospital medicine. On one hand, the commensality groups were described as enjoyable, supportive, and genuinely meaningful spaces where physicians felt connected, understood, and able to speak openly. On the other hand, these same reflections highlight how rare such experiences have become within the everyday routines of hospital life. Time pressure, documentation demands, and the fragmentation of clinical work leave little room for community or reflection. 11 Taken together, the findings reveal that commensality did more than offer a pleasant break. It exposed how much relational connection has been pushed out of the modern hospital workplace.
The significance of these gatherings becomes clearer when viewed through the lens of anthropological theory. By stepping outside the “realm of routine,” physicians enter an anti‐structural or liminal space, one that temporarily suspends the hierarchies and efficiencies that normally govern hospital practice. 12 The predictability of the monthly meeting and the embodied act of sharing a meal created a setting that felt distinct from clinical obligations, allowing participants to interact on more equal footing and with fewer performance pressures.
Within this liminal space, physicians experienced what Turner calls communitas: a sense of horizontal solidarity rooted in shared humanity rather than institutional position. 12 The relief physicians expressed when discovering that their challenges were widely shared shows how the meal enabled forms of emotional validation rarely available in hospital environments. This sense of “I am not alone” illustrates how commensality facilitates new ways of being with colleagues, opening spaces for vulnerability, humor, and mutual recognition.
These relational experiences align with what anthropological scholarship has described as “performances of care”: small, often informal acts through which individuals contribute to the success and warmth of a shared gathering. 13 Participants described listening closely, offering mentorship, exchanging support, and creating space for one another, practices that reflect these forms of care, even if not explicitly named as such. In this sense, commensality creates opportunities for attentiveness and mutual regard that are often constrained within routine clinical workflows.
The structural barriers physicians described (difficulty protecting time for lunch, pressure to return to clinical responsibilities, inconsistent attendance) should not be understood as limitations of the study alone. Instead, they reflect the institutional conditions that make connection difficult in the first place. Physicians' difficulty securing even an hour for communal eating illustrates how strongly contemporary medical culture prioritizes productivity over relational life. Taken together, the data depict commensality as deeply valued yet structurally fragile: a meaningful practice whose benefits highlight the absence of similar spaces in the everyday culture of medicine.
From an institutional perspective, feasibility and sustainability are important considerations. The commensality program required participants to protect time within their schedules and modest institutional financial support for meals but did not depend on external personnel or complex infrastructure. Compared with more resource‐intensive wellness initiatives, structured shared meals may represent a relatively low‐cost relational intervention warranting further organizational evaluation. While this study did not formally assess return on investment (ROI) or return on value (ROV), prior work suggests that physician burnout can carry substantial organizational costs. Shanafelt and colleagues estimate that physician turnover and reduced clinical productivity associated with burnout may cost health systems approximately $500,000–$1,000,000 per physician. 14 In this context, even modest relational interventions that strengthen community and professional connection may warrant further evaluation from both organizational and economic perspectives.
Viewed together, these findings suggest that commensality offers more than brief relief: it represents a small but meaningful site of cultural change. By setting aside time for shared presence and reflective conversation, the program models an alternative vision of medical practice: one in which community, mutual support, and humanistic values are woven into the fabric of daily work. While commensality alone cannot resolve systemic contributions to burnout, it provides a foundation on which broader cultural transformation might take root, reminding institutions that sustaining the social and moral life of physicians is essential to the practice of high‐quality hospital medicine itself.
This study has several limitations. First, participation was voluntary and inherently subject to self‐selection. Physicians who value relational connections may have been more likely to attend and respond. Second, the cohorts were relatively small, and attendance varied, limiting the generalizability of experiences across all hospital physicians. Third, data were drawn from a single academic medical center, and organizational culture may differ across organizational settings. Finally, written free‐text responses, while rich, offer less depth than interviews or ethnographic observation. These limitations should be considered when interpreting the findings.
Future research should explore how commensality or other structured relational practices can be scaled, sustained, and embedded into workflow without relying solely on voluntary participation. Mixed‐method or longitudinal studies could examine whether regular opportunities for physicians to gather influence burnout trajectories, consultative teamwork, interdisciplinary collaboration, or broader team culture. Additionally, future work could assess downstream institutional outcomes, including retention, workplace engagement, and patient care dynamics, to better understand the organizational impact of relational interventions.
CONCLUSION
In this study, physician commensality functioned less as a traditional wellness intervention and more as a cultural counterbalance to the fragmentation of modern hospital practice. Shared meals created structured yet informal spaces where physicians experienced connection, mutual recognition, and cross‐departmental conversation that are increasingly absent from routine clinical workflows. Although modest in scale, these gatherings highlight the importance of institutional practices that sustain the relational foundations of medical work. Reintegrating opportunities for communal presence into the professional environment may be a necessary step toward strengthening both physician well‐being and the culture of hospital medicine itself.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
ETHICS STATEMENT
This study was reviewed by the Cooper University Health Care Institutional Review Board and was deemed exempt from deemed exempt from full review; informed consent was waived.
ACKNOWLEDGMENTS
We thank the physician participants for their time and reflections, and the administrative staff who supported coordination of the commensality sessions.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.