There is absolutely no way someone could say that doctors have stress-free jobs. In between the long hours providing care for their patients, prescribing medications, constantly keeping themselves up-to-date with the latest medical research, and bureaucratic necessities like managing medical records, it is unfathomable to think that someone working in the medicine could realistically have any time to care for their own family, friends, or own health while meeting the demands of their profession. Being a doctor means working long hours, going into debt to obtain a medical degree, having incredible amounts of financial, social, emotional pressures to contend with, not excluding the feeling of loss when a patient does not recover. It is not a wonder when we hear statistics such as 21% of medical students will experience mild to moderate major depression during their residency, and 5.7% of that population will have suicidal ideation according to Dr. Dominic King, while presenting the TED talk “Physician Suicide: What medical students need to know”. [3 ] There is a sobering statistic that about 300–400 physicians will pass away each year due to suicide in the United States, according to a 2018 American Psychiatric Association statistic. Doctors are supposed to have it all- the prestige, the money, the intellectual ability to pass medical school-, it is hard to connect with the idea that a medical doctor may not have anything going wrong. As if someone who appears so competent could cave under all of their work’s pressure, by having to compromise their own persons for the nature of their work. But there is no redo, no reversal, no possible way to backtrack the decision to work in medicine. It is worthwhile wondering why as a society do we fail to support medical professionals who offer one of the most crucial services in the workforce?
It is worth exploring what support is put in place at the beginning of a doctor’s training in medical school. Judging from popular YouTube channels such as “Make a Difference: , #SaveOurDoctors, Mayo Clinic, there does not seem to be a lot of mental health support for medical students, save what someone vlogs onto the media platform. That may be considered too informal for consideration in a medical journal. But to understand the pressure medical students face, a description seemed to sum up the experience well, “studying for medical school is like taking a sip of water out of a firehose” (King, time 3:43). [1] Getting a position in medical school is already fraught with rejection, added to the stress of learning anatomy, biochemistry, microbiology, pathology and pharmacology that has to be learned in a very short amount of time. Only to be thrown into medical school rotations, and residency work. It is hard to imagine someone working in the field ever feeling well-rested or felt as though they have met the demands of their graduate program.
Working in medicine must feel like a very powerless position to be in. There is a lack of autonomy with how someone’s time is spent. The University of Wisconsin states that the average workday for its family physicians had grown to eleven and a half hours. The result has been epidemic levels of burnout among clinicians. Forty per cent screen positive for depression, and seven per cent report suicidal thinking — almost double the rate of the general working population.” On top of having a very poor work-life balance and a career that will pervade into a medical student’s personal life, there is an added pressure of having student debt to contend with. The compound interest that stacks from obtaining a medical degree adds to the mounting pressure, and financially obligates a student to finish through their medical degree with no way out (least the suffer the consequences of paying off the debt and having no degree).
The long work hours, the financial strain, progresses to the feeling of having no control. If there isn’t a support system in place, that is a recipe for occupational burnout and mental illness.
An important question that hasn’t been asked, is why as a society do we find it acceptable to push crushing debt, high expectations, and lack of support on our doctors? While the statistics may not seem all that high at a 6% physician suicide rate, it is morally problematic to let medical professionals “slip through the cracks”, particularly when an insane amount of time and resources have been spent into training and educating someone working the medical field. While it is not unreasonable to put high expectations on medical trainees given that they are in a position where there are consequences if a careless medical medical error is made. It may be worthwhile questioning whether the path to obtaining a medical career, as the process is now, worth sustaining if there are a fairly decent number of physicians who report low satisfaction and high occupational burnout.
In a neuropsychiatry paper, titled “suicidal ideation in medical students”, there was a suggestion that there were certain behaviors, environments, and habits that could put medical students (and workers) at risk of suicidal ideation. Behaviors like coping with stress with substance abuse, heavy curricular burdens (taking on too many commitments), low self-esteem, neuroticism, and low social function scores-when a medical student does not pursue social activities due to physical or emotional constraints. There were further mentions of depersonalization and feelings of disconnect by several sources, an experience someone in the medical profession could offer insight towards. With being able to catagorize qualities that put individuals at risk for mental illness, is it worthwhile to make systematic changes the current treatment of medical workers, is not working?
A telling conclusion of the neuropsychiatry paper states:
“In recent years, integrated medical curricula aimed at improving the well-being of medical students have gained popularity in some countries. These initiatives have focused on students’ mental health, improving antiquated curricular structures, and offering systemic support…..
Such kind research is still progressing, but one direction it seems to be heading is the conflict between the vast amount of research on the topic and the lack of response from medical schools to combat suicidal ideation.
The strong association between mental health and suicidal ideation has been emphatically pronounced on the research level, yet this has not yet translated to a similar interest among medical educators [5,21].”
It appears the concern over the extreme pressure put on medical professionals have been raised in the past, judging from the conclusion of the research paper. But with a suggestion that simply putting mental health resources on university sites appear to be more of a way to avoid liability for any preventable harm that may befall on a deteriorating (mental health wise) doctor. It could create an unfortunate environment where the doctor is to blame for not utilizing resources provided by an institution on top of working with their overloaded schedules. There is more medical organization could be doing to care for their students and staff.
It should be possible for the medical community to have systemic changes. Such as review how many hours a physician, surgeon, medical student, or nurse could reasonably work and stay within a reasonable limit. Medical communities need to advocate for a work-life balance, create excelling and providing care should not be incompatible with individual well-being. Should medical communities train their own staff to recognize signs that a colleague is not doing well? There needs to be a sense of community within a very hard work field and encourage medical professionals to support and collaborate with one another rather than create a hostile competitive environment medical schools can sometimes foster “known as gunners”. But as it stands now, it seems medical professionals are in service of a very apathetic system that has limited interest in their well-being.
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Works cited:
- Kosik, Russell O, et al. “Suicidal Ideation in Medical Students.” Neuropsychiatry, International Journal of Clinical Skills, www.jneuropsychiatry.org/peer-review/suicidal-ideation-in-medical-students.html.
- Gawande, Atul, et al. “Why Doctors Hate Their Computers.” The New Yorker, www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers.
- King, Dominic. “Physican Suicide: What medical students need to know.” YouTube, uploaded by TEDx Talks, Jan 4, 2019, https://www.youtube.com/watch?v=ChGxcYLwKDw
“Physicians Experience Highest Suicide Rate of Any Profession.” Medscape, 7 May 2018, www.medscape.com/viewarticle/896257.
