I apologize in advance if the following lines sound full of frustration, disappointment, or anger. That is not my nature. I am optimistic; I like to see the light at the end of the tunnel and believe that goodness exists. But, after reading the news this past week, I don’t feel positive. I feel dismayed and heartbroken. I just continue asking myself: Where are the leaders?

Going to medical school and becoming a physician has always been considered a family pride, a big personal and professional achievement: “We have a doctor in the family,” parents used to say with big smiles on their faces. But I don’t think that this is the experience of many physician’s parents anymore.

Year after year, young women and males leave their homes, their families, and sometimes even their countries to follow their dreams. “I want to be a doctor; I want to save lives.” They know that this will be a big commitment. Many years of hard work, long hours, sacrifice, and financial investment. But they go full of excitement, because their motivation is big, and because the goal is worth it. These young future physicians and their parents don’t know that the journey may be more challenging than expected. In some cases, they are full of unfairness, solitude, disappointment, and unhappy endings.

Based on a recent survey, 20 percent of physicians reported suffering clinical depression, more than 40 percent reported being burned out, 13 percent admitted having suicidal thoughts, and 1 percent having a failed attempt. In addition, 400 physicians die by their own hands every year, and suicide is the second cause of death among resident physicians.

Historically long hours, use of electronic records, and other administrative demands have been considered important causes of burnout. However, microaggression, academic bullying, fear of retaliation, and discrimination are also significant contributors. In addition, the lack of support, limited access to mental health treatment, and fear of being stigmatized make the situation even harder.

This alarming anonymous data is even more disturbing when it is transformed into names that you know, into people that you met. It hurts even more when knowing that there are parents that will not be able to see or hug their child anymore. Where are the leaders? What are they doing?

Beyond the hard work, physicians also have personal lives. Many get married and become moms or dads. They try to keep balance while growing their careers and fulfilling their roles. Multitasking is a must to be able to change diapers, play with blocks, take the kids to soccer, help with homework and be always available for your patients and mentees. This is not an easy challenge to deal with but is always done with love and with the hope that someday our children will truly understand that the endless effort and sacrifice were worth it.

Sometimes, however, things get more complicated. Mom or dad get so tired, frustrated, depressed, and so hopeless, that even the biggest love — the love of their child — can’t avoid them from taking their own lives. Where are the leaders? Why are they silent?

Three young residents committed suicide in the same institution in just seven months. Three physician mothers are not there anymore to take care of their children; they could not survive. Where are the leaders? Where are those institutions supposed to advocate and protect our medical trainees and physicians? What are they doing to avoid the next death?

As a mother, a physician, and an educator, I refuse to accept this as normal. It is not! What should we tell the parents of these young physicians? How do we explain to them that their dream of being a doctor became a nightmare with a tragic ending? What do we tell their children when they ask for daddy’s good night kiss, or for mommy’s caring hugs? Where are the leaders? How did nobody notice their sadness, lack of hope, and deep desperation?

Sadly, this tragedy is not isolated. These types of events are happening around the country and in different institutions. The hopes of young physicians are transforming on fears, the excitement on stress, the smiles on tears. Where are the leaders? How did nobody know that something wrong was happening?

The normalization of microaggression, academic bullying, and discriminatory behaviors, the fear of retaliation, as well as the bystander effect are perpetuating these unacceptable situations. The high levels of stress and fatigue keep everyone in a survival mode, where the ability to feel empathy or compassion is almost null. When seeing beyond us is almost impossible.

Victims keep muted to avoid being judged by their peers. Peers do not intervene to avoid becoming victims. Isolation, despair, and lack of meaning invade the soul of those that are suffering in silence. This situation ends up being an unhealthy vicious cycle that results in an unhappy finale: the end of young lives, the end of multiple dreams, and the profound pain of parents, spouses, children, and friends.

While we are confronting major challenges, strategies that involve minor changes could create a deep impact. Physicians and medical trainees need to be empowered to become allies instead of closing their eyes to the reality that the most vulnerable are dealing with. Academic leaders need to be appropriately trained to identify red flags and timely address the situations with kindness, empathy, fairness, and a sense of advocacy for those who suffer. Educational institutions and hospitals need to appropriately develop and apply clear regulations, create an environment free of fear and retaliation while cultivating a culture that promotes respect, inclusion, diversity, and wellbeing. But all these can’t be achieved on an individual level and with isolated efforts.

So, I ask myself again: Where are the leaders?

To three wonderful and caring leaders. Fran, Maureen, and Kim thank you for your efforts in turning on the light on the GME tunnel. 

Miriam Zylberglait Lisigurski is an internal medicine physician.

Image credit: Shutterstock.com