The Hidden Psychological Costs of Medical School

October 15, 2020

Physician well-being is an important, yet underappreciated topic. 


During a recent AMSA Activism Update, medical student Thomas Pak moderated a discussion between Dr. Mona Masood, founder of the Physician Support Line, and Dr. Srijan Sen, associate professor and medical researcher at the University of Michigan, as they talked about the unique issues faced by future physicians in regards to their mental health and wellbeing.


Issues Affecting Medical Students’ Well-Being


The problem is real. For 13 years, Dr. Sen has studied cohorts of interns and tracked rates of depression. He has found that the rates of depression are higher among medical students and physicians than the general population, indicating systemic problems with how medical education is delivered. 


This is more apparent considering that only about three or four percent of fourth-year medical students report feeling depressed, but the number reaches about 30 percent during their internship year. “There are other transitions like that, where we know it’s going to be a huge increase in stress and depression,” said Dr. Sen. “The underlying problem is a systemic problem, and we shouldn’t have a system where 30 percent of people get depressed. But while those problems are being solved, there’s things we can do to help keep ourselves healthy.”

Why the Burnout? 

Dr. Masood concurs that the root issues affecting physician well-being are systemic. She suggested that physician burnout is due to a discrepancy between why physicians enter the field and what they actually do as physicians: 


“When it used to be just the doctor and patient, it all of a sudden has become the doctor, patient, insurance company, health care system, the hospital administrator, the electronic medical records, the pharmaceuticals – and all of these different kinds of players start filtering in, also demanding the physician’s attention. But the problem is, your patient is only seeing you. They’re not seeing all of these invisible players, and so when they’re not able to get their med, when they’re not able to afford their surgery, or when they’re getting overwhelmed, you’re going to be the person who’s receiving all of that.”


Those pressures lead doctors to feel helpless and resentful about the position they find themselves in, she says: 


“Our empathy gets compromised. Our investment gets compromised … we all of a sudden feel stuck. And when people feel stuck, they get anxious. When people feel stuck, they get depressed. When people feel like they don’t have control over their next steps, they feel trapped. You feel like there’s no way out. And then you start seeing things like depression rates go up … You’ll start seeing all of these different statistics showing up when a person feels like they don’t have a say in the trajectory of their life decisions. So that’s kind of my worry for medical students right now.”


The COVID -19 pandemic put a spotlight on this already systemic problem. For example, the way in which physicians are portrayed as heroes can have negative effects on their mental health if it reinforces the idea that they have all the answers. “[The label] heroes comes with an expectation, and I worry that this expectation is actually creating more pressure for doctors,” she said. “They’re all of a sudden responsible for allaying everyone’s fear. How are they supposed to be feeling? … If we don’t allow people to be humans instead of heroes, we risk very bad outcomes.”


A Path Toward Better Well-Being

Because of COVID, Dr. Sen expected depression rates to be high among interns this year, but recent data shows that they’re the lowest rates since the study began 13 years ago. Anecdotally, this may be the result of less administrative burden. Prior to the COVID-19 pandemic, physicians spent three to four times as much of their time on documentation and insurance administration, but many of those requirements had been waived, leaving physicians with more time to spend with patients.


“A lot more people feel like they’re making a difference instead of being a cog in the wheel. Cutting down the admin burden is something people talked about a long time but never happened, but then it happened,” he said. “Before March you couldn’t give a verbal order to a nurse, you had to write it. That got waived. There’s a hundred other things like that we have to make sure stay. That won’t solve all the problems, but hopefully that’ll help as we get through the pandemic and into future phases.”


The Importance of Talking About Mental Health 


Dr. Masood said that the best thing medical students can do to influence systemic-level attitudes about mental health is to talk about it with each other and to start conversations with their medical school leadership. 


She emphasized that these aren’t one-time conversations. “Consistency is what matters is bringing about wellness. It’s seldom about breakthroughs. As humans, we need to practice things to make them perfect,” she said.


Another piece of advice: Ask someone how they are doing as a matter of routine, not just when you suspect something is struggling. 


“I think talking about it is really important. There’s a culture in medicine to put on a brave face. Almost every med student and resident I treat feels like they’re the only one struggling initially,” she said, but then they hear that many medical students are depressed and they realize they’re not alone. “Once you have those conversations, everyone realizes it’s not really a ‘me’ problem It’s a system problem, and people stop blaming themselves,” she said.


Watch the recorded video for the panelists’ entire unedited conversation.

AMSA Activism Update: The Hidden Cost of Medical School from AMSA on Vimeo.




About AMSA Activism Updates


AMSA Activism Updates this year are led by our 2020 AMSA-KP Education and Advocacy Fellow, Mattie Renn, with the support of our leaders across all of the various AMSA Action Committees and Campaigns. Join us for panels, Q&As, and just enlightening discussion around the topics that AMSA is working on this year—at the intersection of medical education reform, civic engagement, COVID-19, and health justice, equity and access. Sign up to join our next sessions!