Physicians worldwide face relentless clinical demands, balancing critically ill patients, distressed families, and administrative burdens.1,2 Many of us recognize this daily tension. Paradoxically, though, society expects physicians to safeguard public health, even while workforce shortages, bureaucracy, and documentation undermine our own well-being, leadership, and autonomy. It is no surprise that morale collapses under chronic stress, burnout, stalled careers, and eroded autonomy. 

If heath systems are to remain resilient, physicians must be supported not only as clinicians, but also as leaders in terms of both their professional growth and mental health. The future of public health depends not just on policy or scientific breakthroughs but also on whether physicians remain resilient enough to guide health systems through turbulence. It is also crucial that leadership extends beyond just ‘doing’ but also ‘fitting’ within a broader ecosystem of global and planetary health to explore and adopt the core values and traits of sustainable and compassionate systems. 

Leadership theory offers useful models, from psychological safety to organizational resilience, but these often sit separately from physician well-being initiatives. Instead of focusing only on burnout reduction or leadership skills in isolation, we propose a simple, practical framework: the ‘Six Rs’. This approach is not a new theory but a way of combining everyday clinical realities with leadership development. Each ‘R’ can translate into tangible action within the healthcare settings as follows. 

1. Replace biases with sound judgment: Physicians make thousands of decisions each year, and none of us is immune to cognitive bias. Errors or over-confidence often reflect system pressures as much as individual gaps. Structured reflection, peer discussion, and mentoring can strengthen clinical judgment. For instance, incorporating bimonthly peer case-review sessions that are tailor-made to address specific cognitive biases can both ‘tone-down’ diagnostic error and promote open, trust-based dialogue. Regular case reviews and open conversations about decision-making not only improve patient care but also build leadership maturity and trust within team.3
2. Refine medical education: Medical sciences evolve rapidly, but education often lags. Learning must stay closely tied to real clinical work. For instance, simulation-based training, now supported by artificial intelligence, enables physicians to rehearse rare or high-risk scenarios in psychologically safe settings, while incorporating up-to-date clinical guidelines into their work and preparing them to lead in complex environments.4
3. Reduce stress and restore balance: Medicine demands physicians to be both alert and composed, a balance that chronic stress erodes. Individual strategies, such as mindfulness or coaching, can help, but only when organizations create space for recovery. Practical measures, such as mandatory 30-minute protected recovery breaks between intensive clinical or surgical rotations, realistic workload caps, and visible leadership support, are associated with reductions in burnout and improved patient satisfaction. To this end, protected time, realistic workloads, and supportive leadership, far from being luxuries, are vital foundations for safe patient care and sustainable development.5
4. Recover from medical error and its trauma: Every physician makes mistakes. Without support, these moments can lead to guilt, isolation, and defensive practice. For instance, peer-based ‘second victim’ support programs and structured coaching pathways provide confidential spaces for reflection and psychological recovery.6,7 When openly acknowledged and constructively addressed, medical errors become a catalyst for learning rather than a source of silent suffering. Recovery processes can strengthen accountability, reinforce psychological safety, and cultivate resilient leadership. When medical error is well handled, recovery from medical error strengthens accountability and fosters leadership. 
5. Research with safety and sustainability: Innovation must not compromise safety or resilience. Borrowing from laboratory science’s ‘5Rs’ principles (‘replace, reduce, refine, reuse, and rehabilitate’), we can aim to reduce unnecessary risk, refine protocols, and use resources wisely. For example, AI-driven simulations are an increasingly realistic substitute for some high-risk procedures on vulnerable patients, reducing the risk of adverse events while preserving both educational quality and research output. Research and quality improvement efforts should strengthen both patient outcomes and workforce stability, given that sustainable practice protects patients and the professionals who serve them. 
6. Retire with purpose: If planned well and strategically, retirement preserves institutional memory and leadership continuity. Re-orienting senior physicians into advisory, mentorship, and governance roles could assist in preserving institutional memory, and it strengthens the leadership pipeline. Senior physicians can continue contributing through mentorship, advisory roles, and knowledge. In so doing, retirement becomes part of leadership succession rather than loss of expertise.8

Collectively, the ‘Six Rs’ are not a checklist but a way of reframing physician well-being as a leadership imperative. Burnout should not be regarded as an individual failure or inevitable endpoint but as a signal of systemic imbalance requiring structural and cultural repair. Instead of treating burnout as an endpoint and an individual problem to fix, we propose a remarkably different perspective: physician well-being is foundational to leadership, team performance, and system resilience. To achieve a stronger health system, we must invest in both policies and technologies but also in physicians as reflective, supported, and evolving leaders who are valued for who they “are” as much as what they “do”.

References: 

1 Day, F.J. (2021), “Covid-19: public health leaders have been exceptional, but we need a whole new approach to society”, BMJ, Vol. 373, n959.

2 Krijgsheld, M., Tummers, L.G. and Scheepers, F.E. (2022), “Job performance in healthcare: a systematic review”, BMC Health Services Research, Vol. 22 No. 1, p. 149. 

3 Schippers, M.C., Kepp, K.P. and Ioannidis, J.P.A. (2025), “Biases and debiasing in policy decision-making”, European Journal of Clinical Investigation, Vol. 55 No 5. e70064.

4 Ruzycki S, Desy J, Lachman N, et al. Medical education for millennials: how anatomists are doing it right. Clin Anat. 2019;32(1):20-25. 

5 Panagioti M, Panagopoulou E, Bower P, et al. Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis. JAMA Intern Med. 2017;177(2):195-205

6 Hodkinson A, Tyler N, Ashcroft DM, et al. Preventable medication harm across health care settings: a systematic review and meta-analysis. BMC Med. 2020;18(1):313.

7 Ozeke O, Ozeke V, Coskun O, et al. Second victims in health care: current perspectives. Adv Med Educ Pract. 2019; 10:593-603

8 Xie L, Shen Y, Wu Y, et al. The impact of retirement on mental health. Int J Healt Plann Manage. 2021;36(5):1697-1713. 

Author:

Alexios-Fotios A. Mentis, M.D., Ph.D.
Alexios is a physician and public health scientist with an interest in health equity, social and environmental determinants of health, and medical leadership. He has served as a technical expert for the World Health Organization and as a member of the Global Burden of Diseases Network. 

Declaration of Interests:
None.