The greatest health care crisis American physicians and other health professionals face today is not AIDS, Ebola, heart disease, or cancer. It’s an epidemic that few outside our profession have heard of and that few within can articulate in a way that gives a true picture of what we are up against.
The statistics on stress, burnout, depression, and, unfortunately, suicide among physicians and other health care professionals are stunning. There is not one day when part of our campus at the University of Nebraska Medical Center (UNMC) and our primary clinical partner, Nebraska Medicine, does not confront these issues. We suspect this is true on most health science campuses. If you believe your campus is different, I encourage you to look more closely.
The numbers nationwide are too stark to ignore. These incidences are tragic not only for physicians, nurses, other health care providers, and health science students who are directly affected, but also for their colleagues, loved ones, and patients.
But I write this not simply to report that the lives of physicians, residents, and medical students can be stressful or that the problem is pervasive across campuses. I write this as a reminder that it is incumbent upon all of us to do something—not only for our own mental health and the benefit of our patients and students, but also for the generations to come. They deserve better so that they can be better.
It is challenging to fully dedicate ourselves to healing, as we have sworn an oath to do, if we are hurting and cannot deliver our best. We therefore have an imperative, in our classrooms and clinical settings, to train our students how to handle stress better, stave off burnout, build up resiliency, and, if necessary, ask for help.
In January, UNMC hosted an interprofessional well-being symposium to discuss how to deal with stress, burnout, and mental illness. During the two-day event, Liselotte Dyrbye, MD, professor of medicine and medical education at Mayo Clinic, reported that students begin medical school with better mental health profiles than their peers. “But then it flips,” she said, “and persists through practice.”
This situation suggests a need for a significant culture change, and that is why we at UNMC recently made mental health wellness and stress management two of our greatest campus emphases.
"We ... have an imperative, in our classrooms and clinical settings, to train our students how to handle stress better, stave off burnout, build up resiliency, and, if necessary, ask for help."
As has the Accreditation Council for Graduate Medical Education (ACGME). I have been honored to serve on the ACGME’s board of directors, and my UNMC colleague, Rowen Zetterman, MD, was recently named its chair-elect.
In November 2015, the ACGME hosted its first Symposium on Physician Well-Being. We were proud to be part of this effort to create a national dialogue and will continue to consult with ACGME leadership for insight and advice.
This topic needs as much exposure as possible. Physician and health professionals’ well-being can be a sensitive subject, difficult for outside audiences and even members of our own professions to grasp. Could highly educated—and often highly compensated—doctors be so stressed out, when so many others are working two and three jobs to keep their families afloat?
The numbing answer, of course, is yes. Medicine is a unique profession. We witness first breaths, and we witness last breaths. We invest so much of ourselves in all the human triumphs and heartbreaks that come in between. It’s no wonder that, as Dr. Dyrbye reports, up to half of all practicing physicians display at least one symptom of burnout. Those numbers are on the rise, while burnout rates in most other professions remain flat.
We fully agree with Dr. Dyrbye’s conclusion: Our nation cannot afford to lose some 400 physicians annually to suicide. We also believe there needs to be additional research so we can completely understand the problem in other health professions and confirm the most effective prevention and treatment strategies.
Changing the culture
There is strong evidence that the potential for such tragedy begins in medical school and continues during residency, with the relentless pressure cookers of constant assimilation of information and testing. This is a time when many first experience episodic cognitive impairment, chronic anger and resentment, discord with family or a significant other, and pervasive cynicism.
Again, this suggests a significant negative effect of the learning environment.
Training is about more than simply making our students and residents tougher. We need to be more cognizant of the famous equation from Kurt Lewin, one of the leading psychologists of the 20th century, who extolled, “Behavior is a function of the person in his or her environment.”
We must change the environment.
At UNMC, we have made significant efforts to do so. A psychologist now serves as campus wellness coordinator, a new faculty appointment within the Department of Psychiatry. Our university has also created and filled the new position of student wellness advocate.
Our UNMC mobile app includes information about services available to help our students maintain wellness and know where to turn when in the middle of a crisis. We have built awareness and resource availability into every student, staff, and faculty orientation.
We have pledged to make stress management and mental wellness part of everything we do at UNMC. But one organization cannot do it alone, and we do not want to attempt to do so.
Darshan Mehta, MD, MPH, medical director of the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, noted at our symposium that studies show a sense of shared purpose and community support are keys to resilience. And that is what we ask of you, our colleagues, today.
Please join us in these efforts to transform health care education and residency training so that they cover not only learning to care for others, but also learning to care for oneself. Let us do this for the benefit of tomorrow’s health care providers and the patients they will serve. Let’s start a national movement. Let’s support the efforts of the AAMC and so many others to confront this epidemic. Let us attack this health crisis as we would cancer or heart disease.
As we know, darkness is inevitable, but it is up to all of us to shine a light.
Contributing authors: H. Dele Davies, MD, MS, MHCM, vice chancellor for academic affairs and dean for graduate studies, University of Nebraska Medical Center; and Juliann Sebastian, PhD, RN, dean of the College of Nursing, University of Nebraska Medical Center.
This article originally appeared in print in the April 2016 issue of the AAMC Reporter (vol. 25, no. 3).