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Dr. Andrea Austin recognizes National Physician Suicide Awareness Day and discusses the mental health risks and benefits of pursuing a career in medicine.
Congratulations on your acceptance to medical school! While not required, we’ve elected to provide you with informed consent about the potential risks and benefits of attending medical school and pursuing a career in medicine. You can choose whether to attend medical school or later residency despite internal or external pressures. Even as an attending physician, it’s your choice if you continue to practice medicine. However, read on to see the crushing student loan debt you will likely accumulate that often leaves people feeling trapped by the house of medicine.
Medical school is typically four years. Residency is at least three years and can be as long as seven years, work hours included. Yes, you read that correctly—while you are paying to go to medical school, you will be expected to work long hours as a medical student.
While there’s not great data, one future radiologist recorded her work hours during medical school, averaging 50 hours a week. While there are no clear laws or regulations related to medical school work hours, most schools have adopted work hour restrictions during the clinical years of medical school to mirror residency, in which you may work 80 hours a week, averaging over one month. Call shifts may be 24 hours + 4 hours (28 hours total).
What Are the Risks?
Sleep Deprivation:
The Student Doctor Network is a popular resource for aspiring and current medical students. According to their website, the most common response to “What is the worst part of medical school?” is sleep deprivation. Similarly, residents also feel that exhaustion is one of the most challenging parts of residency.
Sleep deprivation has been used as a torture technique, so it is surprising that the medical system still so casually and commonly runs on the labor of sleep-deprived current and future doctors. As an aspiring or current doctor, you will be sleep-deprived, and likely experience immune suppression when exposed to illnesses. Sleep is also important in memory consolidation, the key to learning, which is ironic, given the large amount of information you’ll be expected to learn. Processing emotional trauma also occurs during sleep. You’ll be exposed to a large amount of trauma during your career and simultaneously deprived of an important way to process that trauma.
Sexual Harassment:
One in three medical students reported sexual harassment by a faculty or staff member. The rate was slightly higher when asked about experiencing harassment by a peer.
Bullying:
The overall prevalence of bullying was 51%. Women residents and residents that belong to a minority group had higher odds of experiencing bullying compared to their peers.
Depression:
Approximately 30% of medical students experience depression, compared with 18% of the general population in America.
Anxiety:
Approximately one-third of medical students have anxiety, compared to about 20% of Americans.
Poor Work-Life Balance:
Most medical students and residents report low to less-than-ideal autonomy over their schedules and miss key life events.
Moral Injury:
Despite taking the Hippocratic Oath, doctors are placed into the American healthcare system with little to no preparation on handling the moral injury they will very likely experience due to a lack of proper staffing and resources, especially in underserved communities.
Suicide Risk:
Physicians have one of the highest rates of suicide of any profession. Male doctors have a suicide rate 40% higher than the general population. Women doctors have a 130% higher suicide rate. Every year, we lose approximately 300-400 physicians to suicide.
Student Loan Debt:
The average amount of student loan debt for US medical students (including undergraduate and medical school debt) is $264,519.
What Are the Benefits?
About 60% of physicians reported high career satisfaction despite the potential downsides. While very challenging, a career in medicine offers meaningful work and the potential to work with like-minded colleagues. While student loan debt rises, physicians earn above the median US income. In addition, even in the era of artificial intelligence, there is a high demand for medicine, and job security is high.
Addressing Mental Health
On National Physician Suicide Awareness Day, we need to recognize the very real risk for suicide that physicians face. While some of these challenges cannot be fixed overnight, we can immediately be honest about the risks. With increased awareness and reduced mental health stigma, we can cultivate more self-compassion to reach out for help and make it more likely that a colleague will check in on others. We must provide information on accessing mental health resources.
In addition, beyond sharing resources, we need to recognize no amount of mental health support counteracts toxic culture. We can hold accountable people who bully, harass, or abuse students, residents, and colleagues. While the hours may continue to be long, and patients will be sick and dying, we can work to create a healthcare culture in which colleagues are kind and support one another.
If you’re a physician in distress, I encourage you to reach out for support:
- Help is available for anyone in crisis, including thoughts of suicide, by calling 988 in the United States.
- From the National Alliance on Mental Illness, healthcare worker-specific resources: nami.org/Your-Journey/Frontline-Professionals/Health-Care-Professionals
- For global resources for physicians, please visit Physician Anonymous.
