I’m no doctor, but I can recognize a prescription for disaster when I see one. What would you predict as the prospects of a profession where one practitioner commits suicide every day, the highest percentage of any profession in the U.S.? More than half of those studying for careers in this profession can expect to experience symptoms of depression. An estimated 56% reported feeling “burned out” before their training was completed.
I’m talking about medical doctors. According to findings presented in 2018 at the American Psychiatric Association’s annual meeting, doctors who die by suicide often have untreated or undertreated depression or other mental illnesses.
While experts are trying to unravel just why the rates are so high, the study also shows some of the most common diagnoses are mood disorders, alcoholism and substance abuse. One study estimates that depression affects approximately 12% of male doctors and up to 19.5% of female doctors. Depression appears to be most common among medical students and residents. About 15% to 30% have symptoms of depression. These mood disorders among health care professionals are not restricted to North America.
According to a 2014 study from the Mayo Clinic and Stanford University, medical students were two to five times more likely to have clinically significant depression than similarly aged college graduates pursuing other careers. Indeed, a 2016 meta-analysis showed that the rate of depression in medical students in 47 countries was 27%, far higher than rates of depression in the general population.
With all this talk about health care, where’s the necessary conversation about the crisis in the health care profession?
Consistent with previous reports, new research by the Association of American Medical Colleges shows we are increasingly experiencing physician shortages in both primary and specialty care. It’s estimated that the United States could see a shortage of up to 120,000 physicians by 2030 — including an estimated shortfall of 14,800 to 49,300 primary care physicians — dramatically affecting patient care across the nation. In other specialties, there is also expected to be a shortage of 33,800 to 72,700.
This shortage flies in the face of increased demand from a growing, aging population. While the U.S. population is estimated to grow by nearly 11% by 2030, the over-65 population will grow by 50%. This aging population will affect physician supply. Within the next 10 years, one-third of all currently active doctors will be older than 65.
So how are we responding to this urgent need for more doctors? According to Dr. Augustine M.K. Choi, dean of Weill Cornell Medicine and provost for medical affairs at Cornell University, before being certified as a doctor, medical students are being subjected to an education that turns smart, gifted, enthusiastic applicants into exhausted and unhappy students who become interns, residents and physicians at increased risk of depression and burnout.
Choi raises concerns about how effectively medical students with psychological distress will take care of future patients. More immediately, he raises questions of how medical education contributes to this disturbing trend.
This is happening while most medical students face demands to take on a crushing amount of debt. Students’ need to borrow a significant amount of money to attend medical school has been a reality for many years, but the scale of the debt has skyrocketed. According to “60 Minutes,” the average medical student now graduates with a debt burden as large as a home mortgage.
According to a new study by Weatherby Healthcare, student debt is a persistent problem that can hinder financial success for years. Weatherby Healthcare surveyed more than 500 actively practicing physicians across the country to better understand how student debt has affected their lives over time.
The stress of schooling combined with the weight of debt overwhelms a number of frustrated respondents. Nearly two-thirds of respondents (65%) are still carrying debt from medical school. Of that group, 80% had more than $100,000 in remaining debt, with 32% carrying more than $250,000 in debt. A third of indebted respondents (34%) expected to spend at least 10 years paying off student loans. More than a third of physicians (36%) who graduated in or before 2005 still carry debt. Of respondents who graduated in 2014 or later, only 9% have paid off their student loans.
Dr. Rafael Rivera, a pediatric radiology specialist, explained to “60 Minutes” that the expected shortage of primary care doctors is likely to cause distortion of the medical profession directly linked to the mountains of debt. He points out that more than half of all medical students come from the richest 20% of American families, only about 5% of medical students from the poorest 20%. And there are no more African American men in medical school today than there were 40 years ago. Rivera says, “This means that wealthy areas have lots of doctors, and lower income areas don’t.”
Some medical schools and professional societies are apparently now taking steps to improve students’ well-being by integrating comprehensive wellness and mental health support into their learning environment. In April, one of America’s top medical schools, New York University, took a radical step by replacing the current patchwork system of scholarships and financial aid with a no-tuition model (the subject of the “60 Minutes” report). Other approaches to loan forgiveness may soon follow. It’s said steps are being taken to unburden primary care doctors from spending nearly two stress-inducing hours typing into electronic medical records per every one hour of direct patient care. Is any of it enough for a needed recovery?
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