Every year roughly 400 physicians take their lives: a group of physicians greater than the size of two graduating classes at my medical school. Let’s be clear, physician suicide and medical professional mental health awareness is a neglected issue in medicine. We are twice as likely to commit suicide than our non-physician counterparts. Women physicians are up to three times as likely to take their lives than their non-physicians peers. Medical students have rates of depression 15 to 30 percent higher than the general population. A 2009 study by the AAMC reported that 9.4 percent of fourth-year medical students and first-year residents reported suicidal ideation in the previous two weeks. Several studies have suggested that 50 percent of medical students will experience burnout by graduation.
Shockingly one of these studies found that when students entered medical school, they actually had lower rates of burnout and a higher quality of life than age-matched college graduates that weren’t enrolled in medical school. I could reference the literature ad nauseam about this topic, but the main point is that one of American Medicine’s greatest and most sinister health disparities rests within the profession itself. Given the fact that such huge disparities currently exist in suicide and other mental health outcomes amongst medical students and physicians, I am surprised that within my knowledge, this topic is not explicitly addressed in either the pre-clerkship or clerkship curriculum at my medical school.
My medical school’s curriculum is one of few that provide in-depth experiences in social medicine: Introduction to Social Medicine and Global Health is a required course for pre-clerkship students at my medical school. The course aimed to explore the causes of health disparities in both national and international contexts. Admittedly, it did a fair job, but fell short in providing a forum to discuss mental health. In a 4-month sequence, mental health was only given 1 week of consideration and during that week, it was only explored from a global health perspective. I was perplexed by this decision; given that mental health is a huge concern domestically both for non-physicians and physicians alike.
Most schools are lucky to even have that. It is a shame that we’re not even at the point of requiring formal education in social medicine, let alone a full-fledged course on mental health for medical professionals in medical school. Reducing health disparities is a cardinal mission of our profession, and whether we like it or not, these issues are a part of it. They deserve more attention; starting from the first day of medical school.
Learning in medical school is often equated to trying to drink out of a firehose. There is a lot of information presented in a very short amount of time. One can easily become overwhelmed, overworked, and isolated from their peers in trying to make the adjustment to the pace and rigor of medical school.
Medical school provides invaluable opportunities to learn from people that genuinely believe in our potential as physicians; however these experiences can be also very emotionally and mentally taxing, even when successful. Success isn’t always guaranteed either. Failure and the emotional weight it bears on the soul is abound in medicine — from having to remediate a course, to watching a patient expire, to not even matching. The latter being something an ever-increasing number of U.S. MD graduates is experiencing by the way: over 6 percent of U.S. MD graduates failed to match in 2015.
New medical students need to develop a system of support mechanisms in order to effectively deal with the multitude of stressors that they will face in medical school and their professional career. Formal, required, in-depth discussions about the mental health disparities facing our profession and ways to cope with mental illness in medical school is one way of doing so. Samuel Shem asked in his seminal work The House of God, “How can physicians care for others if no one cares for them?” Today I ask, how can we care for others if we can’t take care of ourselves?
Michael McClurkin is a medical student.
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