The rate among students, residents and physicians is significantly higher than average—but so-called wellness initiatives can help
“First, do no harm,” is what medical students in the U.S. declare when they take the Hippocratic oath at the white-coat ceremony symbolizing their entry into the medical profession. It refers to the patients they will be taking care of. But perhaps it should also refer to themselves.
As a psychologist embedded in the department of pediatrics at a major medical center, I have worked closely with pediatric residents since 1995. In addition to meeting with first-year residents during the first week of orientation, I facilitate a monthly support group where residents have protected time to share concerns in a nonthreatening confidential environment.
These monthly groups have spurred many positive changes, including trying to ensure that rotations with the most demanding schedules are now staggered with rotations that have less demanding schedules.
Yet, many health care professionals don’t often discuss a major occupational hazard in medical training: the high suicide rate among medical students, residents and physicians.
The rates of death by suicide in the general public in the United States are on the increase. The National Institute of Mental Health reported in 2017 that suicide was the 10th leading cause of death for males and the 14th for females. It was the second leading cause of death for young people aged 10 to 34, a common age bracket for medical students and residents.
When compared to the general population, however, the rates of death by suicide are much higher in physicians, and especially physicians who are women. In the U.S., an estimated 300 to 400 medical students, residents and practicing physicians die by suicide annually. Physician deaths not only impact the families and friends of the doctors who end their lives, but impact thousands of patients, nurses, support staff and others.
In January of this year, the Accreditation Council for Graduate Medical Education sent out an e-communication to members wishing everyone a “joyous, happy and healthy New Year.” The note also included a reminder that the third quarter of the academic year, beginning in January, is the second highest period of risk for resident and fellow suicide.
For 2020, the third quarter for the academic year begins shortly. Recognizing that physicians are at increased risk for burnout and depression, the council introduced new standards and in their updated Common Program Requirements defined “well-being” of physicians to include that they “retain the joy in medicine while managing their own real-life stresses.”
The ACGME guide states: “Residents and faculty members are at risk for burnout and depression. Programs, in partnership with their Sponsoring Institutions, have the same responsibility to address well-being as other aspects of resident competence.”
Historically, there have been many mixed messages in residency training, noting that it is insufficient to provide a wellness curriculum without including, as I wrote about the problem in 1992 "the larger working environment …involving the hospital and/or training programs, and the constantly changing health care system.”
Medical schools, residency training programs and hospitals throughout the country are implementing “wellness initiatives” of varying degrees. And many medically affiliated organizations have programs dedicated to addressing wellness, such as the American Medical Association’s Steps Forward: Preventing Physician Burnout; the Mayo Clinic’s Program on Physician Well-Being; Stanford’s WellMD; and the Pediatric Resident Burnout-Resilience Study Consortium.