In January, the National Academy of Medicine is launching a new committee to address the high rates of depression and suicide among physicians and other health care workers in the United States. They plan to bring together medical professionals, educators and hospital administrators, and I hope they will also bring to the table professionals who have experienced burnout, and who may have attempted suicide due to burnout. I say this because I am well aware of their pain, and I believe they can best shed light on helping to find the best solutions.
I have the important job at my medical institution of working with others to create a campus culture where the aim is to prevent, recognize and treat problems like burnout and depression before it is too late. Those of us who are physicians, or who work with faculty and students, know that the prevalent culture in medicine today needs to change from the traditional “get the job done, don’t show emotion, don’t ask for help” to one where physicians and doctors-in-training can speak openly and seek help when needed without fear of having their professional careers jeopardized. Physicians also must come to appreciate that just like the patients whose suffering they are called upon to relieve, that they too are only human.
Pressures have never been greater in the medical profession and in the high-stakes arena of medical research. And with the looming possibility that the Affordable Care Act may be repealed or radically changed, bringing in yet more change and challenge for hospitals and health care professionals, it will only get worse.
In the past few months, a Mount Sinai College of Medicine medical student close to the end of her training and no doubt in despair purposefully jumped to her death from a building on campus. I believe it more likely than not that burnout, exhaustion, and frustration played a role in this tragic event. She joined an all too long list of other medical students, residents, and physicians who took their own lives. Her tragic death was only the latest public example in a pattern that is unfortunately all too common today in all academic medical institutions throughout our country and well known to those of us working in academic medicine.
Sadly, because stoicism and silence are the norm when it comes to feelings of despair among the medical community — the so-called “silent crisis of physician burnout” — this problem often goes undiagnosed by faculty, hospital professionals and medical students alike.
Tragically, in the United States, physicians are much more likely to commit suicide than the general public according to the American Foundation for Suicide Prevention. Male doctors have suicide rates 70 percent higher than other men; female physicians suicide at a shocking 250 to 400 percent higher rate than other women. That’s 300 to 400 MDs each year that take their own lives, over twice the size of an average entire medical school class. Medical students have rates of depression, a major risk for suicide, 15 to 30 percent higher than the general population. A 2016 article in Medical Education reported a global prevalence of depression in medical students of 28 percent with the overall mean frequency of suicidal ideation being almost 6 percent in medical students. While often called an epidemic, steps to address this dreadful reality seem to be too little too late.
Burnout is the loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. It is the very snuffing out of the flame that burned as idealism in those called to medicine and science discovery in the first place. There are multiple costs due to burnout in addition to the personal including its affect on patient safety, patient and staff satisfaction, overall productivity, and increased acts of physician incivility.
We can wait for the National Academy of Medicine report recommendations, but health care institutions and centers for medical education and research need to take a very close look at a root cause of this problem now: the very culture of medical practice and medical education. Identifying and addressing burnout on our medical campuses as soon as possible is one important prevention intervention for suicide. This applies to everyone, but certainly to physicians — half of whom reveal they feel the symptoms of burnout. We need to make it OK to talk about stress, anxiety, and depression — and even about having thoughts of suicide. Doctors and all health professionals need to talk about this for ourselves so we can be there for the patients who may be suffering from the same thoughts and feelings. This topic should be a discussion in departmental grand rounds and journal clubs. It should be raised often with faculty and students. We need to begin to openly discuss how our burnout is affecting us — and our families, institutions, and patients. We need to show concern for our colleagues whom we know or suspect of being burned out and/or depressed. Let us provide the education and support that encourages and permits our colleagues to ask for help. In New York State, the Committee for Physician Health can provide guidance, support, and assistance in arranging treatment without penalty to anyone’s career.
And if we are in positions of leadership and able to implement programs on our campuses to provide education and support for our students and colleagues, let us do so now and show the leadership necessary to beat this epidemic as we have previous epidemics including smallpox, cholera, polio, tuberculosis, and AIDS.
We cannot afford to lose another 300 to 400 of our colleagues this year. Let our collective efforts change our relationship with burnout and suicide from one of being its victim to its vanquisher.
Joseph P. Merlino is a psychiatrist and fellow ambassador, the New York Academy of Medicine.
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