What type of person comes to mind when you think of the characteristic of resilience, the ability to continuously bounce back from adversity? I think of Tom Hank’s character Chuck Noland in the movie Cast Away, a man who was able to survive all alone on an island for four years with only the company of his soccer ball Wilson. I think of Russell Crowe’s character Maximus Decimus Meridius, in the movie The Gladiator, a stoic General whose home is destroyed, and family killed, after which he is sold as a gladiator slave. He perseveres and fights to his death to restore the Roman Republic. Better yet, I think of the movie Rudy, a story of a young man’s relentless desire to attend Notre Dame and play football, despite a learning disability of dyslexia and an average athletic ability. Rudy may be the best example, because it is based upon a true story and he eventually achieves his goals, carried off the field on the shoulders of his fellow football team members during the last football game of his senior year.
What do all these characters have in common and what does this have to do with the practice of medicine? They all have grit, a passion fueled by their own personal “why”, and non-stop perseverance. They just don’t give up. They embody the definition of resilience, the ability to adjust to and recover from major hardships, to keep getting up off the ground to move forward toward their goal.
Resilience is a core characteristic of healthcare workers. It’s there deep inside, driving physicians, nurses, and therapists to keep showing up day after day, particularly during this pandemic. And the grit started long before the pandemic, before professional training even began. In 2020-21, there were just over 53,000 medical school applicants, with only 42% of them getting a coveted medical school spot. According to the National League of Nursing, 33% of qualified applicants are denied entry into nursing programs. It’s also just as challenging to get into physical therapy school. In 2020-21, the average acceptance rate for physical therapy schools was 37%. These spots are so difficult to get into, students not only have to have stellar grades, they also need to show altruism, community service, creativity, and anything else that allows them to stand above the crowd. Resilience is expected and many students apply year after year after year until they get in.
It’s no surprise to anyone that works in healthcare that resilience is part of the reason we not only got into our training programs, but also how we survived them and how we continue to do the work of taking care of patients. Getting into our professional training was just the beginning of the climb up the mountain. The road is long and rigorous. For physicians, four years of medical school is followed by a minimum of three years of residency, with up to seven years of residency to become a neurosurgeon. And it is not just the accumulated years of education that are evidence of grit and resilience. It is what is witnessed by healthcare workers day in and day out, for so many years in a row: suffering, pain, trauma, and often times, death. And often, once one is many years into the process, backing out is no longer an option, especially if one has accrued a significant amount of educational debt.
It should also come as no surprise that physicians with the highest amount of resilience (as measured by the Connor-Davidson Resilience Scale) have the least amount of burnout. What is revealing is that 29% of physicians with the highest possible resilience score still report burnout. How can this be? Isn’t resilience supposed to be protective of burnout, in the same way that higher compassion can be an antidote to compassion fatigue? This evidence suggests what we already know while working on the front lines in medicine. Yes, there are things we can do as individual healthcare providers to protect ourselves from burnout, things like healthy life choices, sleeping, exercise, faith, meaningful connections with others. But there also many external factors contributing to our burnout: the environmental surroundings at work (excessive patient loads, unsupportive leadership, inefficient work processes), not to mention the institutional challenges of regulatory and documentation requirements, the bane of our medical practices. These things need to change at the same time that we are learning how to be more resilient, something that will be addressed in future blog posts.
So, while healthcare workers may not be as gritty at Rudy, Chuck Noland, or Maximum Decimus Meridius, we do have buckets of resilience. We keep showing up and will continue to do so. Underneath the pressure and stress and burnout is the WHY we do what we do: the passion to take care of patients is the fuel and is what brings us back to the hospital or clinic each and every day.