CHICAGO — Graduating from medical school and moving on to residency should be a time of elation for fledgling physicians, not despair and despondence. And yet, some docs-in-training are falling into deep depression during this critical portion of their careers, with some even taking their lives, as was the case with two New York City medical residents who leapt to their deaths in separate incidents last year.
One study estimated that about 12 percent of medical students and residents surveyed suffered from major depression, and 9.4 percent had contemplated suicide within the past two weeks. Another study last year by the Accreditation Council for Graduate Medical Education — detailed Friday during a session at the American Medical Association's annual meeting — found that 16 percent of residents said they had been belittled or humiliated at least once at work in the past two weeks.
Outgoing AMA President Robert Wah, M.D., told the same room full of medical students Friday that addressing physician well-being is a top priority for the nation's largest association of docs. "Healthy physicians are critical to the healthy provision of care and we should never lose sight of that."
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"The exhilaration you felt when you graduated from medical school was pretty tremendous. It was for me," Wah said. "And so, to think that somebody would go from that exhilaration point, the end of medical school, to within eight to 12 weeks, feeling so despondent that they would throw themselves off a 20-story building is a remarkable swing, and it's amazing that can happen in such a short period of time."
Both the AMA and the World Medical Association are taking steps to respond to those concerns. Three major initiatives highlighted in the AMA’s strategic plan — improving health outcomes for patients, professional satisfaction for physicians and medical education for tomorrow’s docs — all tie into that burnout concern. The AMA just unveiled AMA STEPS Forward, an interactive practice transformation series offering strategies designed to allow physicians and their staff to work smarter, not harder.
Wah also said that the World Medical Association has initiated a committee dedicated to physician wellness, which he is chairing. The group plans to craft recommendations on the topic, which he hopes will hit the streets in the next year or so.
Nick Yaghmour, a research analyst with ACGME, told attendees that, following the completion of its most recent survey, the organization plans to further explore ways to help sponsoring institutions alleviate some of the unnecessary stresses on residents, and foster a more "humanistic" learning environment. He also urged hospital leaders dealing with resident burnout to check out the organization's Clinical Learning Environment Review Program, which helps to assess your institution based on six focus areas, including duty hours oversight and management of fatigue. No resident can avoid the tremendous amount of work that goes into becoming a doctor, but fostering an environment with proper supervision of students, a focus on professionalism, and an eye toward quality and patient safety all go a long way toward helping students alleviate such feelings as this anonymous student:
"I love working with patients and I have truly learned a great deal," Yaghmour read from ACGME's survey. "However, I have also never been more suicidal in all of my life as the stress from residency increasingly makes me want to die. I cannot continue to take the personal persecution that is allowed in our program and that targets one to two residents a year; [it] is actually criminal, and there is no recourse because one simply must endure or quit."
Wah urged residents to tune out any unnecessary distractions that take away from their learning, identify tools that can help them to better manage their workload and, above all, make sure to take care of at least one very important patient every day.
"This is an issue that we have all faced as physicians for many, many years," he said. "I always start the conversation by saying, as busy as we are with patient care, we as physicians must remember that one of the most important patients we see every day is the one we see in the mirror, which is us, because if we don't keep ourselves healthy, we will not be able to keep our patients healthy."