Is Medical School a Catalyst for Depression, Suicide and Burnout?
It was a Saturday evening, a month away from finishing up my second semester of my masters degree and a 8 weeks away from taking my medical college admissions exam for medical school. That Saturday evening was not a good day. Every question I got wrong, nothing went as planned, I was running on only 4 hours of sleep. After 10 continuous problems wrong, I decided to take a walk. As soon as I sat down outside I cried, it was like I couldn’t control myself, I just kept crying. After about 10 minutes of crying I went back in the library and proceeded to study.
The stressful study sessions, the long nights and emotionally draining meetings, with the car crying sessions in the car, followed by an A in whatever assignment I was working on happened often, more than I like to admit. I ended up giving this cycle a name, the cycle of burnout.
Today, studies have shown that 1 out of 5 students in higher education have debated suicide, with racial, sexual and gender minorities particularly vulnerable to suicidal thoughts (Chen, Liu, Stevens, Wong & Yasui, 2018), with suicide and Motor vehicle Accidents (MVCs) being the top two killers in college students. Among the MVCs, suicide as a motive for unintentional injury was high (Keller, Leno & Turner, 2013). We are also seeing a strong appearance of mental illness in higher education. Studies have seen that 57% of women and 40% of men report overwhelming anxiety and more than 30% of women and 20% of men report severe depression, with 45% of college students reporting emotional or stress related problems during the school year (The College Student Mental Health Crisis, 2014)
Many reasons have been given for these increasing statistics, one of the top reason being the educational system. In this past decade of higher education, students are being pulled in every direction with a notion that failure is not an option, when failure itself is what makes someone a better physician, director, professor, therapist, etc. Alongside that students are held to a higher pressure that they must finish in a certain time frame and put everything aside till they finish, and they better do it right the first time. One great example of this grand pressure is medical school.
Medical school is a long process (in the United States). You are required to obtain a bachelor’s degree with certain pre-requisites. Followed by that you are required to take the MCAT, or medical college admissions test. This is an exam that is approximately 7 hours long, with 4 sections. You are also required to have extracurricular activities, this includes school involvement, clinical and research involvement, and community involvement like volunteering. Supposing you ace most of those classes, get a high score on the MCAT, have all of these hours of extracurricular activities, you may get into medical school and a couple of thousand dollars in savings, you may get in. If you don’t have these you may have to do a post bac for 1–2 years, or a masters degree, retake the MCAT, though the Associations of American Medical Colleges suggest you ace it the first time if you want to get into medical school. Retaking is shows you couldn’t do it right the first time. If you have a family you may need to move to another state, as the competitiveness of medical is fierce. Either that, or you prolong your application. Getting into medical school takes from 4–8 years, including undergrad. After you are in medical school, you are pulled in every direction by a million things, by school, activities, yourself, family and kids, and the list goes on. You then do 4 years of medical school, and so many years in residency, for non-surgical usually 3–5 years, for surgical 5–8 years, not counting years for fellowships.
Medical school is the professional school with the highest suicide rate (AMSA, 2018). Medical students are also more likely to suffer depression, with depression rates 15–30% greater than in any other professional school (Medical School Can Be Brutal, and It’s Making Many of Us Suicidal, 2016). Many of these students are already depressed or burned out before they reach medical school, due to the arduous process. We see this in residency as well, with the depression and burnout from medical school passing on to residency, with doctors being the profession with the highest suicide rate. These rates are intensified for racial, gender and sexual minorities.
This is a public health crisis. Higher education should not be a driver for mental illness and suicide, and while as students we can get together and cheer each other on, this crisis will not change if the system does not change and if politics are not put aside, especially in medical schools. I am a first generation female premedical student and master’s student doing my MPH and I have first handedly experienced this depression, anxiety and panic attacks because of my higher education. My higher education should not break me to the point of suicidal thoughts. Our medical education system shouldn’t be killing us in effort to save other lives, and money.
4. https://www.washingtonpost.com/national/health-science/medical-school-can-be-brutal-and-its-making-many-of-us-suicidal/2016/10/07/faa1a14e-8a4c-11e6-875e-2c1bfe943b66_story.html medical school suicide rate