How can physician suicide and medical school student burnout be combated?

Comprehensive Strategies to Combat Physician Suicide and Medical Student Burnout

A multipronged approach addressing mental health stigma, implementing pass/fail grading systems, and creating supportive institutional environments is essential to combat the epidemic of physician suicide and medical student burnout at every stage of training.

Understanding the Problem

• Burnout affects approximately 39.8% of U.S. physicians across all specialties, with significant impacts on physician mortality, morbidity, and quality of life 1
• More than one-quarter of physicians report burnout and almost 50% report being stressed, with only 23.7% reporting that they enjoy their work 1
• Medical students experience particularly high rates of burnout, with studies estimating that at least half of all medical students are affected during their education 2
• Personal ramifications of burnout include higher rates of alcohol abuse, substance use, dysfunctional relationships, depression, and suicide 3, 1

Interventions for Medical Students (Pre-clinical Years)

• Implement pass/fail grading systems for preclinical courses - All studies show that a preclinical pass/fail grading system improves medical student well-being without compromising academic performance 3

  • P/F grading is associated with reduced anxiety, depression, stress, and improved group cohesion 3
  • Students in 3+ interval grading systems report significantly more stress (β=1.91; 95% CI, 1.05–2.78; P<.001) and burnout (OR=1.58; 95% CI, 1.24–2.01; P<.001) 3

• Introduce mind-body wellness programs - Mind-body programs teaching stress-reduction skills show significant benefits even in condensed 4-week workshops 3

  • Mindfulness programs demonstrate significant reduction in stress after intervention and increased self-compassion that persists at follow-up 3
  • These programs must balance benefit with time investment to avoid adding to student workload 3

Interventions for Clinical Years and Residency

• Balance clinical and non-clinical learning environments - Medical students report less burnout and stress when clinical time is increased 3

• Implement formal faculty advisor/mentor programs - Small group-based mentoring models are highly regarded by students as a method of promoting wellness 3

  • Keep mentors' roles separate from assessment to foster open communication 3
  • Use competitive selection for faculty mentors to ensure quality 3

• Increase control over work - Lack of control over workload is a primary driver of burnout 1

  • Enable physicians and trainees to devote 20% of their work activities to the part of their medical practice that is especially meaningful to them 4

Mental Health Support Across All Stages

• Develop comprehensive mental health programs - Multipronged programs aimed at improving awareness, reducing stigma, and improving access to mental health professionals are associated with lower depression and suicidal ideation rates 3

  • In one study, significantly smaller proportions of students exposed to such a program reported symptoms of mild or probable depression (24.1% vs. 59.1%; P<.01) and suicidal ideation (3.0% vs. 30.2%; P<.001) 3

• Address barriers to seeking help - Key barriers include:

  • Concern about stigma and lack of confidentiality 3
  • Fear of documentation in academic records 3
  • Concerns about career implications 3
  • Time constraints, inconvenient office hours, and financial costs 3

• Provide mental health services outside of student affairs offices - Students report preferring help from mental health specialists rather than medical school personnel, and accessing services through locations other than student affairs offices 3

Institutional and System-Level Interventions

• Align individual and organizational values - Misalignment between personal and organizational values is a significant contributor to burnout 1

• Create supportive work environments - Social support and community at work are critical to mitigating burnout 3, 1

• Address workload and efficiency issues - Hectic work environments and insufficient documentation time contribute significantly to burnout 1

  • Reduce administrative burdens and improve electronic health record systems 5

• Regularly assess burnout and its drivers - Conducting surveys is a critical step to understanding factors that need to be addressed 3

Special Considerations for Vulnerable Groups

• Support women physicians - Women report burnout more frequently than men, due to additional stressors including lack of career promotion, inequalities in resources, and disparities in mentorship 3, 1

• Target interventions for mid-career physicians - This group reports burnout more frequently compared to early-career physicians, fellows-in-training, or late-career physicians 1

Pitfalls and Caveats

• Individual-focused interventions alone are insufficient; systemic workplace improvements are more effective 6
• Burnout is not simply the absence of well-being - it exists on a spectrum and can coexist with other mental health conditions 3
• Medical license applications often include questions that reinforce the stigma of psychological stresses and discourage physicians from seeking appropriate care 7
• The benefits of wellness interventions may be time-limited without ongoing support and reinforcement 3