By Charles J. Lockwood, MD, MHCM
From our own experience in academic medicine, Dr. Ed Funai and I can vouch for the fact that most medical students are going into medicine for the right reasons—to help others via a career wedded in both science and humanity. We can also attest to the intense desire that today’s students have to make the world a better place reminiscent of the heady days of President Kennedy’s Peace Corps. We have seen medical students clamoring to go into harm’s way in parts of the globe decimated by natural disasters and threatened by emerging pathogens, all in the hope of making a difference. Ironically, those same medical students are also experiencing record levels of burnout, substance abuse and depression as they enter their third and fourth years.
Burnout among medical students
In a survey of over 12,000 medical students, 80% reported burnout, alcohol abuse/dependence, or depressive symptoms. Another survey found that, compared with general population controls, medical students, residents/fellows, and early career physicians were more likely to be burned out and depressed. A carefully performed systematic review by Rotenstein and colleagues indicated that this is a global phenomenon.These authors found a prevalence of depression or depressive symptoms among medical students of 27.2% while the percentage of medical students seeking psychiatric treatment for their depression was 15.7%. Most worrisome, the overall pooled crude prevalence of suicidal ideation was 11.1%.
The origins of this epidemic of trainee burnout, substance abuse and depression are unclear and likely multifold. The sheer volume of material to be mastered continues to grow near exponentially while the time to learn it remains stagnant. Record levels of indebtedness appear to play a role as, we suspect, does growing competition for residency slots. And while there may also be ascertainment bias in these reported prevalence figures because we only began searching for evidence of these problems recently, we can’t help but think that burnout has an infectious-like quality and that third- and fourth-year students become exposed to burned out residents while on their rotation and the residents, in turn, are exposed to burned out early and mid-career attending physicians.