Implications of Physicians’ Deteriorating Mental Health
By: Zaina Sharqawi
Despite how heavily we depend on physicians to maintain the wellbeing of individuals in society, there is something wrong about how physicians are being treated, including residents. They are experiencing increasingly high burnout rates, leading to heightened rates of suicide, substance abuse, and depression; one doctor dies in the US everyday due to suicide.
The Lancet conducted a systematic review and meta-analysis in 2019 that revealed a standardized mortality rate of 1 to 44 for suicides among physicians. Notably, female physicians seem to face a higher risk, as a 2020 meta-analysis indicated their suicide rate to be significantly greater than that of women in the general population [1]. This, along with the fact that physicians are 42 percent more likely to experience symptoms of depression or anxiety [2], underscores the heightened susceptibility of doctors to suicide compared to the broader population. The irony is apparent — those trusted with saving lives are disproportionately affected by mental health challenges, jeopardizing their own well-being.
Furthermore, the field of surgery in particular has historically been harsh on its practitioners. Surgeons contend with elevated rates of burnout, ergonomic injuries, and reproductive challenges such as miscarriages and infertility [3]. These adversities contribute to a demanding and often unforgiving professional environment for those dedicated to the practice of surgery.
With the rising rates of anxiety and depression, this of course leads to higher chances of substance abuse, making physicians more likely to turn to drugs like cocaine or morphine. This is especially because a lot of physicians believe that opening up about mental health is a form of weakness, heighted by the pressure from society that they are expected to be super humans who save lives. Multiple physicians have admitted to feeling emotional turmoil, guilt, and shame which is why they choose to hide their suffering.
“Part of the ethos of that is you don’t complain … You just do your work and shut up and have discipline to be strong and pretend you’re OK when everything’s not.”- Michael Maddaus, a retired surgeon who developed a narcotics addiction while working as a professor of surgery at the University of Minnesota.
To reduce suicide rates and alleviate anxiety, it is essential to initially identify indicators of suicide risk. This involves increasing awareness about mental health and promoting coping strategies in hospital settings, thereby challenging the negative stigma associated with mental health. Encouraging open discussions about mental well-being in the workplace can also help physicians recognize that they are not isolated in their emotions, diminishing any potential shame or guilt.
Additionally, in a hospital setting, dealing with death is inevitable. Of course, this can create a traumatic work environment, as many physicians may blame themselves. Research shows students may adopt the negative mindset of doctors who consider any patient death to be a personal failure [4]. Hence, fostering awareness about end-of-life issues and promoting effective coping mechanisms is crucial to shape a work environment that can instill a constructive mindset in medical students navigating their initial encounters with patient mortality.
The journey to becoming a physician is undoubtedly an extended and arduous process. Residency, renowned for its demanding and lengthy hospital shifts, often overworks residents with inadequate compensation. A straightforward solution to this challenge involves reevaluating the hours allocated to residency training. Overworked individuals are prone to retaining less information and experiencing a diminished attention span, thereby increasing the likelihood of making mistakes. Notably, Libby Zion’s tragic death at New York Hospital involved the care of two overwhelmed residents. In response to such incidents, New York implemented the Bell regulations in 1989, restricting residents to 80-hour work weeks. However, this remains a substantial workload and 35 years later, should be reconsidered.
Some argue that reducing work hours may diminish residents’ exposure to managing complex cases, potentially compromising patient safety. Nonetheless, Kunal Sindhu, an MD specializing in radiation oncology, contends that “sleep-deprived residents rarely gain much of anything from seeing another patient in their 100th hour of work in a week.” Subjecting young physicians to such a grueling residency experience may foster early resentment, dampening their motivation and enthusiasm for their future roles as healthcare professionals. A new study conducted by Harvard Medical School evaluated the impact of limiting residents to no more than 16 consecutive work hours and its effect on patient outcomes. Findings concluded that when the 16-hour limit was in place, resident-physician-reported medical errors dropped by more than one-third, and errors resulting in patient death were reduced by nearly two-thirds. [6] This comes to show how shortening the hours of residents to a more manageable number will allow residents to process information more efficiently, leading to a stronger understanding of what they learn with the limited time they get in the hospital.
The mental health of physicians and residents are depleting annually, which demonstrates the urgency for change. Therefore, proposals to reevaluate residency training hours will reduce burnout and decrease the likelihood of mistakes. In return, this would also lower rates of suicide and substance abuse. Improving the healthcare system environment will not only improve the wellbeing of our physicians, but also our society as a whole.
Zaina is a second year psychology student and THINQ fellow.
[1] Mental illness and suicide among physicians, (Samuel Harvey, Ronald Epstein)
[2] 42 percent of physicians in Goa show symptoms of burnout: IMA study, (News Nine)
[3] US surgeons are killing themselves at an alarming rate. One decided to speak out (Christina Frangou)
[4] How doctors are taught to deal with death (The Conversation)
[5] When Are We Going to Rethink Residency Training Hours?(Sindhu, Kenal)
[6] 5 ways medical residency programs can improve students’ well-being (Wolters Kluwer)
