An excerpt from Boundaries For Women Physicians: Love Your Life And Career In Medicine.

When I openly share my experiences with friends and colleagues, I am amazed by how many other women physicians tell me they have had similar ones. They admit to feeling so low that suicide or self-harm seems the only way out. They tell me they’ve experienced this countless times, especially during their training. Many of them say they feel so alone, as if they’re living in their own hell. My heart breaks when I hear these stories.

As I was researching this book, I learned that my experience, and that of so many others, is reflected in overwhelming data:

• Female physicians are 60 percent more likely to suffer from emotional exhaustion and burnout than male physicians.
• Women physicians are at as much as a 400 percent increased risk of dying from suicide compared with women in the general population.
• Women physicians are quitting medicine at alarming rates, with 40 percent either going part-time or quitting medicine altogether within 6 years of completing their residency training.

Even though I had been on a track to become a physician since I was 18 years old, spending twenty years immersed in medical training and culture, this was the first time I had ever heard these statistics. I wondered, why the secrecy.

The conversation we need to have about burnout, suicide, emotional exhaustion, and the mental health crisis in medicine is just beginning now. For too long our profession has made practitioners feel ashamed of their own suffering, suppressed in a centuries-old culture of silence. As physicians, we are taught not to show weakness, doubt, or vulnerability. We are told that we must be strong for our patients, families, staff, and everyone else, even if it is at the expense of our health. It seems almost heretical to admit weakness or to need help. Our medical culture glorifies overwork. It is considered a badge of honor to be the first one to arrive in the morning and the last one to leave at night. For years I have heard physicians state with pride that they worked all evening and all weekend. I too believed this was exemplary behavior and modeled it myself, until I couldn’t do it anymore.

As doctors, we are used to sucking it up. We had to in order to make it through all those late nights as medical students and the exhaustion of residency and fellowship training. But sucking it up as our only coping mechanism has led us to the crisis in medicine we are experiencing today.

Fighting for our lives

This medical mental health crisis doesn’t affect only female physicians. Physicians overall have the highest rate of suicide among all professions and have a significantly higher risk of suicide than the general population. In the United States, 300 to 400 doctors commit suicide each year, more than double the rate in the general population. As many as one in five physicians has considered dying by suicide.

Physicians are fighting for their lives. In the 2018 documentary Do No Harm: Exposing the Hippocratic Hoax, director Robyn Symon exposed the epidemic of physician suicide and burnout, and the dark secret that many doctors are struggling and suffering in silence. When several physicians committed suicide during the COVID-19 pandemic, the stories were widely profiled in the media—the first many had heard about the problem. Health care organizations all across the country are scrambling to find solutions to this mental health crisis.

Causes

Many of the underlying causes of this crisis are factors out of the practitioner’s control, such as relative value units (RVU), productivity pressures, patient satisfaction scores, publication pressures, financial limitations, complicated billing codes, and the increasing requirements of electronic medical records, charting, and bureaucratic tasks. A lack of budget for support staff forces doctors to do what had been the work of medical assistants, administrative assistants, and nurses. And inadequate physician staffing can result in unsafe patient care loads and/or being forced to work additional call hours, nights, and weekends. Our health care system has changed rapidly and dramatically in the past two decades. Research shows that 80 percent of burnout is due to systemic factors and is not caused by a lack of individual resilience and stress management on the part of physicians.

The result of this crisis is that the profession’s life and legacy are in jeopardy. In a recent study, 60 percent of 13,500 physicians polled would not recommend pursuing a career in medicine to their children or other young people, and more than one-third reported that they would not select medicine as a career if they had to choose again.

What we can control

In the face of a rapidly changing health care landscape, with so much that is out of our control, what can we do? As physicians, we have the power to change and reframe our situation much more than we realize by altering our response to adverse external pressures. No matter how overwhelming or oppressive these pressures are, no matter how powerless or small we feel, the key to our empowerment is to develop a strong sense of internal boundaries and to prioritize our self-care. If we say “no” to unreasonable demands and expectations, the perpetual cycle of systemic burnout due to our broken health care system and dysfunctional culture of medicine will come to an end.

We alone can do this. No one can do it for us. No one will do it for us. From this place of strength, we have the power to not only survive but thrive. The key to loving our lives and our careers starts with us.

Tammie Chang is a pediatric hematology-oncology physician and co-founder, Pink Coat, MD. She can be reached on Instagram @tammiechangmd and at her self-titled site, Tammie Chang, MD.

Image credit: Shutterstock.com