Personal resilience is one of the three core components of the Stanford model of physician professional fulfillment, used across institutions to inform provider well-being strategy. Yet, limited data suggest only a minority of physicians view personal resilience initiatives as beneficial to their well-being, and physicians have expressed resistance and frustration toward organization-based individual resilience promotion.

I have led and participated in workplace meditation courses, stress management talks, and chair yoga. I’ve also directly and indirectly heard frustration and complaints from colleagues. As one physician wrote, “[Resilience trainings] are an absolute slap in the face for all physicians who are just barely getting by, digging deep for every ounce of empathy and compassion they can muster.”

What if organizational promotion of physician resilience inadvertently hinders well-being efforts, divides physicians and their organizations, and unintentionally worsens physician morale? Should we cancel resilience as a physician well-being strategy?

As a leader of clinician well-being work, I’ve been living this question, and yet hesitant to ditch the resilience concept entirely. I connect with the frustration and anger of my colleagues. But I think it’s our inaccurate conceptualizations of resilience—both implicit and explicit—that are the problem.

Problem #1: The general conceptualization of resilience isn’t well-being-centered

Resilience is the ability to adapt to and weather change and challenge. This broad definition is at the root of our conflict over resilience, particularly because it does not name well-being as the intended outcome. We may be good at meeting change and challenge but become immensely burned out, depressed, or depleted in the process. We may be resilient but meet a challenge that is so big we change rather than bounce back.

Non-specific conceptualizations of resilience can perpetuate resilience approaches that neglect the personal cost of meeting challenge. During the height of the COVID-19 pandemic, many physicians in emergency medicine worked through increasing patient loads and were “resilient” in their ability to care for patients in a global crisis. Yet, a meta-analysis found these same physicians experienced higher rates of post-traumatic stress disorder; “resilience” came at a personal cost. The largest study investigating physician resilience found that while physicians are more resilient than the general population, even the most resilient physicians can experience burnout. “Resilience” in the classic sense does not always result in well-being.

Problem #2: We have falsely aligned resilience with productivity

Some physicians conceptualize resilience as putting in more effort, time, and self-sacrifice to overcome challenges in the health care work environment. Within this framework, it isn’t surprising that organizational resilience promotion might be met with resistance; physicians may feel that they are being asked to be more productive under the banner of well-being promotion.

The conflation of resilience with “pushing through” is defined by Soraya Chemaly as productivity resilience. In The Resilience Myth, she defines productivity resilience as “The ability to withstand immense stress, and get the job done.” Short term, particularly in times of acute crisis, this type of resilience may be necessary, but it may not equate to greater well-being. Helping people be more productive does not automatically make them more well and may do the opposite.

Problem #3: We have overemphasized the importance of individual resilience

Resilience in health care has become synonymous with personal responsibility. The self-sufficient resilience paradigm risks blaming individuals for system issues. It also conflicts with research that describes health and well-being as an ecosystem phenomenon. The ecosystem lens understands that health is based not just on individual factors but also the interaction of an individual with their environment.

The ecosystem model aligns with the original resilience studies performed in children. In addition to individual modification of stressors, the resilient children had supportive and caring adults, family warmth and cohesion, and access to community resources. The interconnection between internal resilience resources, coping pursuits, and external resources is critical to the well-being of older adults. Many studies demonstrate that social relationships buffer stress and reduce the likelihood of depression. And in the natural world, diversity, redundancy, and symbiosis characterize resilience for ecosystems and the species they contain. This evidence base invites us to shift the frame of resilience toward an interconnected, rather than individualized, conceptualization. Instead of canceling resilience, we can reframe and reclaim it.

Reframing resilience

An ecosystem-based understanding of resilience does not abandon individual responsibility and choice but decenters it as one aspect of the resilience ecosystem. Identification of our personal strength and agency, development of skillful coping mechanisms, and belief in ourselves to meet challenges and make choices is incredibly important and beneficial. But we are never doing these things in isolation. We are supported by friends, family, and therapists; we use financial resources to create ease. We are driven by our compassion and sustained by meaningful contribution. We rely on institutions to provide the resources we need for patient care, and time off for rest. We are resilient together.

Nature points us to a final crucial missing component of resilience: Sustainability. A sustainable model of resilience recognizes that keeping people in health care is more resourceful than losing them to burnout. Those short-term, push-through skills we learn in training are likely to lose efficacy over the length of a career. Sustainable resilience is the ability of the system and its members to adapt to and weather change without depletion of resources—financial, material, human, and emotional—over time. It means making choices to protect health care workers rather than tell them how to take on more. It recognizes that individuals are only one part of the resilience equation, interconnected with leaders, colleagues, culture, and institutional resources, policies, and practices.

Doctors, patients, and health care leaders agree that system transformation is necessary. To do this, we must recognize that our ecosystem and our resilience are inextricably linked. That individually we have power and choice and collectively we thrive when we recognize our interdependence. Shifting our lens of resilience to a sustainable ecosystem model requires embracing new values and recognizing both our strengths and our finitude, our possibilities and our humanity.

Sarah Webber is a pediatrician.