MD NEJM: Dean responds to MD student suicides / expectations

[Affiche]

As for time crunch, people always find time for the things they deem important, e.g. Facebook, Netflix, SDN, Tinder, etc. While the medical profession is very judgmental and harsh towards their own, it is possible to see a therapist, social worker, across or out of town professional, etc. for most issues.

I hope you don't legitimately believe it's this simple.

Addressing mental health issues isn't quite like "oh, I'll have to give up 2 hours of netflix today to fix my depression, *sigh*". To actually address it, it usually takes consistent meetings with a therapist, actually practicing healthy behaviors/coping mechanisms addressed in those sessions, possibly experimenting with different medications that can induce debilitating side effects, and in some cases, removing self from stress-inducing environments completely until the response to triggers is under control. It can be really, really hard to manage something like this while balancing the unforgiving pace of medical school.

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[cbrons]

No offense dude, but you really should read the links before you post them. The first one is incredibly technical, but shows that the match INCREASES salaries. The second is a lay article that despite spending most of it's space ranting about the decreased pay admits that this is far from clear (and even reference the first article). It's evidence that wages are depressed is because someone sued, which is crap.

If you read the conclusion it states that the entire system works to suppress what residents would otherwise earn sans "the Match System". It also says the Match process in and of itself per say is not the primary reason (though does contribute).

Why should a nurse practitioner or a PA straight out of NP or PA school draw 2-3 times the salary of a resident? Curious what your answer is to this. I won't be arguing any counter-point most likely, just find it strange that for someone with (what 6-8 years?) of residency training thinks he is worth less than a newly graduated mid-level provider.

 

[WingedOx]

If you read the conclusion it states that the entire system works to suppress what residents would otherwise earn sans "the Match System". It also says the Match process in and of itself per say is not the primary reason (though does contribute).

Why should a nurse practitioner or a PA straight out of NP or PA school draw 2-3 times the salary of a resident? Curious what your answer is to this. I won't be arguing any counter-point most likely, just find it strange that for someone with (what 6-8 years?) of residency training thinks he is worth less than a newly graduated mid-level provider.

because without a completed residency, mimelim's entire medical education can't be put to any real meaningful use to an employer. An NP on the other hand can go out and negotiate a salary because they're fully licensed and have options.

 

[cellsaver]

I hope you don't legitimately believe it's this simple.

Addressing mental health issues isn't quite like "oh, I'll have to give up 2 hours of netflix today to fix my depression.

You are taking a one size fits all approach for all mental health issues. Youre also making it into a bigger deal than it really is. Consistent meetings with a therapist is a no brainer. You do what you gotta do. Its not like having a craniotomy. Practicing coping mechanisms isnt all that debilitating or paralyzingly. If anything they are liberating. You make it sound like such a burden when it fact practicing the injurious behaviors are far more burdensome! The therapist can be a guide / coach and you practice privately developing new skill sets. Its not like going cold turkey from breaking heroin or fentanyl addiction (analogy here, I dont have addiction disorder).

Our school had a faculty medical school psychiatrist who saw herself more as coach than prescriber. She would not prescribe anything and she was really popular with the MD students. She was awesome and we hated to see her leave for retirement.

I saw the medical school social worker once q two weeks or prn due to a family issue and I precisely needed to give up 1-2 hours of gym those weeks, rearranged my studying, meetings with faculty etc to address something of a mental health issue. It was the best thing I did and now I am that much more effective.

Yes it is quite that simple.

No, not all issues are solved with medications. CBT works wonders. I met with my social worker for several sessions and we discussed mindfulness, and then took a course at the medical school for credit on mindfulness

Yes, it is that simple.

 

[Affiche]

You are taking a one size fits all approach for all mental health issues.

I saw the medical school social worker once q two weeks or prn due to a family issue and I precisely needed to give up 1-2 hours of gym those weeks, rearranged my studying, meetings with faculty etc to address something of a mental health issue. It was the best thing I did and now I am that much more effective.

Yes it is quite that simple.

No, not all issues are solved with medications. CBT works wonders. I met with my social worker for several sessions and we discussed mindfulness, and then took a course at the medical school for credit on mindfulness

Yes, it is that simple.

Erm...I think you're the one trying to apply the whole one size fits all. I'm glad that you were able to find some resolution so easily, but it's not usually that simple at all. Your experience isn't representative of others' and expecting everyone to find resolution so easily is dismissive and unrealistic. Come on, the point here is to figure out why poor mental health is such a problem in medical students, don't downplay it by pretending this is a quick fix.

 

[cellsaver]

Erm...I think you're the one trying to apply the whole one size fits all. I'm glad that you were able to find some resolution so easily, but it's not usually that simple at all. Your experience isn't representative of others' and expecting everyone to find resolution so easily is dismissive and unrealistic. Come on, the point here is to figure out why poor mental health is such a problem in medical students, don't downplay it by pretending this is a quick fix.

Thanks for the kudos on my outcomes but I think you are perpetuating the stigma by making it into a bigger deal than what it should be. With that type of talk, youre discouraging people who should see a professional therapist.

As for my resolution being so easily achieved, where did you get that?
You are making way too many snap judgements and global generalizations.

Seeing a therapist takes work just like anything else in life. If the issue is a problem, take action to resolve it. That takes commitment. The decision to admit that the mental health issue (anxiety, depression, ruminating, etc) is causing you inefficient performance is the hardest step. I think we (I) want to do it on our own. The mature, responsible decision is to ask a professional just like you would hire a personal trainer for the gym or adopt a faculty mentor. We have to be vulnerable and ask someone wiser, "how can I grow/ evolve from this situation?"

My experience was mature, direct, matter of fact, but painful, like surgery with a blunt scalpel and no anesthesia. Yet after all was done, the issue is in perspective and in the past. Plus I learned new skill sets to boot to teach patients and be compassionate

I think everyone should see a therapist for a checkup on a regular basis.

 

[mimelim]

I am curious what you make of the +50% burnout rate of physicians in today's medical profession? Are these people who "were at risk" and slipped through the cracks? Do they lack the "right stuff"? Are they not "cut out for medicine"?

my 2 cents: we've all got potential mental health problems. It is not a question of whether we have issues but rather do we have a handle of our issues; in other words: "do you manage your problems or do the problems manage you?"

As an aside, the comments posted by subscribers to the article on the NEJM website are all glowing. Unlike many here on SDN, NEJM physician subscribers/commenters concur with the Dean's above quote. The most recent one follows:

ALIYA HASAN, MD | Physician - GASTROENTEROLOGY | Disclosure: None
DENVER CO
March 23, 2017
Thank you
Thank you for sharing. My condolences to Kathryn's family, friends, and all of you. I really appreciated the point you made in the end about moving away from test scores and taking a different approach. I hope other medical schools, graduate schools, and colleges come to the same conclusion. We need to let kids be kids.​

What do I make of it?

#1 Definitions matter. What does "burnout" mean? How do physicians stack up against other professions when you use the same metrics? I have no idea what the numbers actually are. My global sense is that it is a huge problem, but people tend to be prone to exaggeration and there is always a ton of, "the grass is always greener" going on.

#2 Expectations matter. To the vast majority of the population (including physicians), work sucks. It is a means to an end. Medicine has a massive amount of delayed gratification and it builds up huge expectations. The reality is that physicians don't starve. For the most part, the do quite well for themselves, both in terms of salary and lifestyle. Compared to every profession out there, their jobs are very secure. But, it is far from perfect and unless you know that going in and that there is a lot of **** in this job, you are going to hurt at some point.

#3 We select based on academic prowess above all else. Our medical school admissions process starts with GPA/MCAT and everything else follows. The people that get into medical school by and large can survive the academic training. This isn't about being "at risk" or lacking "the right stuff" or anything like that. For the most part our medical school classes look like a cross section of high achieving pre-meds with very little selection outside of that.

#4 There are very real external pressures from the government and employers to do more and to do it more efficiently. This is a major issue with physicians becoming more hospital employees and less practice owners. When you own the practice, you can choose to simply make less money and see less patients. When you have a boss, that sometimes isn't really an option or someone else might be brought in to take your place.

 

[mimelim]

If you read the conclusion it states that the entire system works to suppress what residents would otherwise earn sans "the Match System". It also says the Match process in and of itself per say is not the primary reason (though does contribute).

Why should a nurse practitioner or a PA straight out of NP or PA school draw 2-3 times the salary of a resident? Curious what your answer is to this. I won't be arguing any counter-point most likely, just find it strange that for someone with (what 6-8 years?) of residency training thinks he is worth less than a newly graduated mid-level provider.

Several things.

#1 What people think they SHOULD be paid very rarely gets factored in when deciding how much employers pay people and this is universal, not just in healthcare. Likewise, how much you get paid rarely correlates with how much or how hard you work when comparing field to field. Nobody compares a janitor to a fireman to a doctor to a lawyer and tries to figure out a salary that way. Absent a large controlling body dictating how much each profession SHOULD get paid (ie. the government), salaries are set by the market for services.

#2 I won't write a long section on it, because you likely know most of it, or can look it up, but residents are paid by the government. While we are technically employees of the hospital, our salaries are funded directly by the government. A pay increase would have to originate from CMS. You can argue until you are blue in the face, but the reality is that this is not going to change easily. You would be asking the US legislature (and in turn the American people) to pay physicians more. Selling anything in this political climate would be hard, but this would be a complete non-starter. The only way to easily get around this is to say, well then **** it, government shouldn't be regulating it. But, that would mean a completely new system and new payment structure. I would bet dollars to donuts that training quality would drop. I would also be willing to bet that in many programs, salaries would decrease, including mine.

#3 I've been involved in the process of hiring PAs and sat in on enough department and committee meetings to get a pretty good feel for it. It is all about justifying their salary and return on investment. We know what PAs expect to get paid at different levels of experience. The question on the hiring side is, how will we put them to work so that they bring in more money than they cost. PAs and NPs bill. Residents do not. Mid-level providers pay for themselves. Their "value" is set by how much they can reliably bring in. It is fundamentally a different system. Again, could residency be setup in a similar fashion? Sure. But, honestly, while I can see plenty of problems with how our system is setup, I don't want to imagine the problems we would have with a far less regulated system. Residents are a vulnerable class in so many ways. Putting them at the mercy of individual hospitals that can play them off one another is a recipe for disaster.


I am far along in my training. And yes, early in my training, I too did question why I was making 4 times less than our PAs/NPs (roughly, I work double the hours for half the pay). But, the further I got, the importance of "being trained" grew. Every single one of my faculty could be making close to double what they make right now if that is what they really wanted. But, instead for many reasons (not all altruistic) they spend at least some of their time every day training me or other residents. I am being paid 65k a year with full benefits, but I am also getting a skill set that I can not get anywhere else. I can't get this training from anywhere or from anyone else. Nobody can. And that IS valuable. It allows me to command consulting and speaking fees even now (if it were allowed by my institution, but had the offers already...). It will allow me to in the future bargain with hospitals, partnerships, etc at a level that far surpasses any mid-level. That is valuable to me. Is it not to you? I will leave my program with a marketable, verifiable and credentialable (is that a word?) skill set that I didn't have when I started. That is the difference between employee (mid-level) and trainee/employee (resident).

You and I have gone back and forth about a number of things on SDN. I hear you. I am not unsympathetic to the economic plight of residents. I have had my fair share of major financial bumps in the road. I've had to depend on family or loans more than I wanted. There have been days where I have said out loud to my wife, "**** it, I'm done, I'm going to just keep my head down, graduate and open that vein/spine practice, make 2 million a year and be done with it all". Life as a resident is objectively hard. I would argue that en mass, you can't compare it to anything else. When you add in a family, it is down right brutal. There are dozens of things that I would want to change. There are dozens of things that I am actively trying to change in my own residency and will likely keep fighting for as long as I still have the energy. But, from where I sit now, salary is not the answer. Not when we are already sitting above the median household income with a track to the top 3-4% virtually guaranteed. Even if objectively we (you and I) could prove that we deserved or SHOULD be paid more, nobody is going to listen, simply because: life is not fair.

 

[LePepe]

ALIYA HASAN, MD | Physician - GASTROENTEROLOGY | Disclosure: None
DENVER CO
March 23, 2017
Thank you
Thank you for sharing. My condolences to Kathryn's family, friends, and all of you. I really appreciated the point you made in the end about moving away from test scores and taking a different approach. I hope other medical schools, graduate schools, and colleges come to the same conclusion. We need to let kids be kids.​

Since you posted this, I assume you agree with her viewpoint. What do you think of the following?

Honestly, I understand that MCAT and GPA aren't everything, but the more that these elements get minimized, it seems that more emphasis is placed on where an applicant went for undergrad, what connections they have, their luck in finding good mentors, and their race/ethnicity. Without the MCAT, I and many applicants would have never gotten the chance to prove ourselves capable.

-penissingh (reddit)

 

[Affiche]

Thanks for the kudos on my outcomes but I think you are perpetuating the stigma by making it into a bigger deal than what it should be. With that type of talk, youre discouraging people who should see a professional therapist.

As for my resolution being so easily achieved, where did you get that?
You are making way too many snap judgements and global generalizations.

Seeing a therapist takes work just like anything else in life. If the issue is a problem, take action to resolve it. That takes commitment. The decision to admit that the mental health issue (anxiety, depression, ruminating, etc) is causing you inefficient performance is the hardest step. I think we (I) want to do it on our own. The mature, responsible decision is to ask a professional just like you would hire a personal trainer for the gym or adopt a faculty mentor. We have to be vulnerable and ask someone wiser, "how can I grow/ evolve from this situation?"

My experience was mature, direct, matter of fact, but painful, like surgery with a blunt scalpel and no anesthesia. Yet after all was done, the issue is in perspective and in the past. Plus I learned new skill sets to boot to teach patients and be compassionate

I think everyone should see a therapist for a checkup on a regular basis.

No, I'm acknowledging that often seeking help for mental health isn't as simple as sacrificing a few hours of Netflix, regardless of how important it is to someone. Suggesting that it always is is incredibly dismissive to those who require more, and it doesn't exactly solve the issue here of why the hell are so many medical students depressed and untreated? Agree to disagree on this one, I suppose.

 

[neusu]

No offense dude, but you really should read the links before you post them. The first one is incredibly technical, but shows that the match INCREASES salaries. The second is a lay article that despite spending most of it's space ranting about the decreased pay admits that this is far from clear (and even reference the first article). It's evidence that wages are depressed is because someone sued, which is crap.

With all due respect, the paper linked is fundamentally flawed. The argument that residents are paying tuition for their training by accepting lower salaries is a fallacy. The midlevel providers are trained on the job, while being paid more than residents, and perform a similar role. Residents afford the attendings who train them a far easier lifestyle at a lower cost than midlevels.

 

[mimelim]

With all due respect, the paper linked is fundamentally flawed. The argument that residents are paying tuition for their training by accepting lower salaries is a fallacy. The midlevel providers are trained on the job, while being paid more than residents, and perform a similar role. Residents afford the attendings who train them a far easier lifestyle at a lower cost than midlevels.

You think that your residency training is equivalent to midlevel on the job training? I certainly can't speak to every residency in the US, but I would say that if your staff treat you as a PGY-5 the same as the NP on service, you are in a terrible training program.

I am not going to argue the merits of that econ paper because frankly I don't have time to learn the necessary background to appreciate half of what he is trying to say. But, anecdotally, I would accept lower pay to train at the program that I am training at. For the 'more desirable' programs across the country I'm sure that the same is true to varying degrees.

 

[zeppelinpage4]

I hope you don't legitimately believe it's this simple.

Addressing mental health issues isn't quite like "oh, I'll have to give up 2 hours of netflix today to fix my depression, *sigh*". To actually address it, it usually takes consistent meetings with a therapist, actually practicing healthy behaviors/coping mechanisms addressed in those sessions, possibly experimenting with different medications that can induce debilitating side effects, and in some cases, removing self from stress-inducing environments completely until the response to triggers is under control. It can be really, really hard to manage something like this while balancing the unforgiving pace of medical school.

I say this from my own experience, so N=1 but I completely agree with Affiche.
I went through multiple trials of different medications, and the side effects from the first few made it really hard to function. I'd wake up in the middle of the night and not be able to sleep, or I'd be drowsy and exhausted during the day...and those were the milder effects. It took months for me to settle into a good regimen. I couldn't imagine being an active student while getting used to those. But everyone has a different level of resilience and tolerance for such things. I had a classmate who completed MS2 while getting cancer therapy, the dude was a trooper and went through more than I can imagine. I couldn't do that.

Also commuting an hour for treatment can be difficult when you're on heavier rotations like ob/gyn, doing 12 hour shifts, studying for a shelf exam, and trying to find some time to sleep and relaxing in for yourself on top of that.

 

[zeppelinpage4]

You are taking a one size fits all approach for all mental health issues. Youre also making it into a bigger deal than it really is. Consistent meetings with a therapist is a no brainer. You do what you gotta do. Its not like having a craniotomy. Practicing coping mechanisms isnt all that debilitating or paralyzingly. If anything they are liberating. You make it sound like such a burden when it fact practicing the injurious behaviors are far more burdensome! The therapist can be a guide / coach and you practice privately developing new skill sets. Its not like going cold turkey from breaking heroin or fentanyl addiction (analogy here, I dont have addiction disorder).

Our school had a faculty medical school psychiatrist who saw herself more as coach than prescriber. She would not prescribe anything and she was really popular with the MD students. She was awesome and we hated to see her leave for retirement.

I saw the medical school social worker once q two weeks or prn due to a family issue and I precisely needed to give up 1-2 hours of gym those weeks, rearranged my studying, meetings with faculty etc to address something of a mental health issue. It was the best thing I did and now I am that much more effective.

Yes it is quite that simple.

No, not all issues are solved with medications. CBT works wonders. I met with my social worker for several sessions and we discussed mindfulness, and then took a course at the medical school for credit on mindfulness

Yes, it is that simple.

Wish that was my experience. I really wanna get off these meds and do CBT, but I need to actively search for someone that is covered under my insurance and there is no CBT offered by my school as far as I know. Thanks for reminding me of it though, I might use the free time I have now to find a good CBT provider before residency.

Everyone pushed meds on me from the start, though I didn't want them. I gave in because it felt like I had to take the meds and get functional quick, or risk failing stuff again. Those meds raised my LFTs briefly and gave a bunch of us a scare, leading to more doctors appointments and anxiety. They caused a full blown seizure. Those meds kept me from being able to get a good nights sleep every night and made it difficult to productive study during the day. On top of that, the free psych care offered by my school was not very helpful (went MS1 and got a grad student that just poked me about my childhood for some reason) and the clinic was an hour away from where I did my 3rd Year rotations. Almost no private psychiatrists took my insurance at the time either. Fortunately, My school deans were amazing when they found out my situation, they stepped in to make special arrangements to help me, and it's because of them I was able to comeback, but the resources def didn't seem to be in place, or if they were, I wasn't made aware of them.

Not to say woe is me, the purpose of this post isn't for sympathy, but just to give another perspective on the process of dealing with mental illness in med school. What I went through wasn't fun or easy, but it wasn't horrible either and I'm in a much better place now. I def had and continue to have a great support network as well as resources to help me get better. I've had friends go through much much worse in terms of health and family issues, so I'm still grateful for the way things went, and I'm really glad your experience was better too. We're both survivors of this process.

But I just wanted to show that experiences like mine happen too. Maybe my experience was uncommon but it def was not a straightforward one and done process. As Affiche said, each individual experience is different, and people should be aware of that, so they don't get their expectations to high or too low, and then get disillusioned when going into treatment. As we both know, getting better takes a lot of conscious effort, and time, but it's definitely worth the effort.

 

[Bickly Darlington]

ALIYA HASAN, MD | Physician - GASTROENTEROLOGY | Disclosure: None
DENVER CO
March 23, 2017
Thank you
Thank you for sharing. My condolences to Kathryn's family, friends, and all of you. I really appreciated the point you made in the end about moving away from test scores and taking a different approach. I hope other medical schools, graduate schools, and colleges come to the same conclusion. We need to let kids be kids.​

Sorry Aliya, 24-year-olds sitting for the MCAT are grown adults, not "kids".

And if someone is unable to handle the stress of a 6-hour standardized test, perhaps they shouldn't pursue a 40-year career in an extremely stressful profession?

 

[caramelbear]

Since you posted this, I assume you agree with her viewpoint. What do you think of the following?

Honestly, I understand that MCAT and GPA aren't everything, but the more that these elements get minimized, it seems that more emphasis is placed on where an applicant went for undergrad, what connections they have, their luck in finding good mentors, and their race/ethnicity. Without the MCAT, I and many applicants would have never gotten the chance to prove ourselves capable.

-penissingh (reddit)

This. I can honestly say that without my grades and MCAT, I don't think I would have gotten into my school. My application would have been too boring. "Holistic approach" can mean so many things. Is actively seeking people who have crazy awesome experiences in volunteering, etc abroad during undergrad with the most unique hobbies really that much better? Not to throw out the privilege buzzword which I've grown to hate, but the ability to volunteer on 3 continents during undergrad without having to worry about the finances/logistics of daily living is privilege. Some people have to work to make it through undergrad and can't just up and leave randomly. A full-time job as a CNA, scribe, etc may not be glamorous, but it provides a ton of exposure to patients and medicine. Med school admissions are always going to be really competitive. If grades and MCAT aren't the big competitive factors, the something is going to take their place. ECs? Race/ethnicity? Research in a basic science field that the applicant has no interest in?

De-emphasizing grades and MCAT works TO A POINT. A pass/fail philosophy is probably ideal, but there have to be some minimum standards. If students are not academically up to the challenge of med school, the stress of constantly underperforming will only make our current wellness problem worse.

 

[intubesteak]

My wife was applying to med school and had a really hard time with all of the competition, stress, etc. She thought long and hard about everything, talked to mentors, and ultimately decided it was not for her and stopped going on interviews. Part of this was the realization that the stress continues to ramp up and does not go away after getting accepted. She was pretty worried about regretting this decision in the long run because she has always wanted to be a doctor. Now she is in PA school and feels like she absolutely made the right decision, which was incredibly difficult to make in the first place.

Point being that becoming a physician does not have to be for everyone. There are other, awesome jobs out there that will not try to break your soul in the process of getting there. I do think we need to work on things in medical education for the sake of student wellness, but this journey is a choice that nobody is forcing you to make.

What really sucks is once you are in med school, there is basically no turning back from a financial standpoint (at least in perception). It was mentioned above but there really needs to be a way to get out if you need to, and right now there really is no way to get a clean break. That has got to be a major factor in this whole mess.

 

[WingedOx]

I am curious what you make of the +50% burnout rate of physicians in today's medical profession? Are these people who "were at risk" and slipped through the cracks? Do they lack the "right stuff"? Are they not "cut out for medicine"?

my 2 cents: we've all got potential mental health problems. It is not a question of whether we have issues but rather do we have a handle of our issues; in other words: "do you manage your problems or do the problems manage you?"

As an aside, the comments posted by subscribers to the article on the NEJM website are all glowing. Unlike many here on SDN, NEJM physician subscribers/commenters concur with the Dean's above quote. The most recent one follows:

ALIYA HASAN, MD | Physician - GASTROENTEROLOGY | Disclosure: None
DENVER CO
March 23, 2017
Thank you
Thank you for sharing. My condolences to Kathryn's family, friends, and all of you. I really appreciated the point you made in the end about moving away from test scores and taking a different approach. I hope other medical schools, graduate schools, and colleges come to the same conclusion. We need to let kids be kids.​

De-emphasizing test scores sounds great, but like any other complaint, you'd need to come up with an alternative for how you handle competition for finite spots.

 

[Bickly Darlington]

De-emphasizing test scores sounds great, but like any other complaint, you'd need to come up with an alternative for how you handle competition for finite spots.

Amen. Dr. Hasan is naively wishing for a system that is simultaneously meritocratic and non-competitive. If there is a better way to objectively evaluate future physicians, by all means utilize that instead. But don't expect the stress inherent in any fair competition for membership in a highly paid, highly prestigious profession to dissipate.

 

[W19]

Med students should be allowed to challenge the PA board after MS3 and bail out of med school if they want to. We were allowed to challenge the LPN or LVN board in nursing school after year 1, which many of us did. For instance, I made 25k+/year working on weekend (2x12hrs sat/sun) in year 2 of nursing school with that LPN license.

 

[cellsaver]

What do I make of it?

#1 Definitions matter. What does "burnout" mean? How do physicians stack up against other professions when you use the same metrics? I have no idea what the numbers actually are.

Thanks for your input.

Let me share some data to close this argument:

"It has been known for more than 150 years that physicians have an increased propensity to die by suicide.....Because of their greater knowledge of and better access to lethal means, physicians have a far higher suicide completion rate than the general public."
Medscape, 2016​

more data:

"Burnout and satisfaction with work-life balance in US physicians worsened from 2011 to 2014. More than half of US physicians are now experiencing professional burnout."
Mayo Clinic Proceedings, 2015
​

more data:

Medical specialties with the highest burnout rates
"General surgery subspecialties (42.4 percent in 2011 versus 52.7 percent in 2014)"
AMA Wire, 2016
​

more data:

"Sadly, although physicians globally have a lower mortality risk from cancer and heart disease relative to the general population (presumably related to knowledge of self care and acess to early diagnosis), they have a significantly higher risk of dying from suicide, the end stage of an eminently treatable disease process. Perhaps even more alarming is that, after accidents, suicide is the most common cause of death among medical students"
​

Some helpful data to support Dean Muller:

Association Between Physician Burnout and Identification With Medicine as a Calling
"Physicians who experience more burnout are less likely to identify with medicine as a calling. Erosion of the sense that medicine is a calling may have adverse consequences for physicians as well as those for whom they care."
Mayo Clinic Proceedings, 2017

####
​

My thoughts:

Several SDNers objected to the Dean's recommendation. Let's review what he actually wrote:

“…..we have also committed ourselves to a genuine paradigm shift in the way we define performance and achievement. We must minimize the importance of MCAT scores and grade point averages in admissions, pull out of school ranking systems that are neither valid nor holistic, stop pretending that high scores on standardized exams can be equated with clinical or scientific excellence, and take other bold steps to relieve the pressure that we know is contributing at least to distress, if not to mental illness, among our students."

He recommended a paradigm shift and to minimize the importance (not abolish, not negate, not diminish) of the usual suspects that, by the way, drive the majority of the threads on SDN (e.g. "What are my chances?")

Considering the data on the misery index physicians have today (here's one more

How Being a Doctor Became the Most Miserable Profession
Nine of 10 doctors discourage others from joining the profession, and 300 physicians commit suicide every year. When did it get this bad?​

we can safely conclude our current medical educational system is failing. Screening for "at risk" physicians is like screening for Prostate Cancer by using the PSA. Physicians who comprise the above data have proven they have the right stuff to be physicians. They're not lightweights nor slackers. I can only imagine how high their Step scores were and yet....their misery indices are even higher. So we can't say they are slipping through the cracks. On the contrary: they have shown us they have what it takes.

MCAT, GPA, USMLE Step 1/2 /3 Scores, AOA, published research, yada yada yada aren't providing what Americans deserve: healthy physicians to serve as healers.

I am not sure Dean Muller is correct that our medical education is "causing" the mental illness, however.

Dean Muller overall is right. Perhaps the metric that is missing from selecting/training physicians is vocation.
Do they have a calling to medicine? I sense most people in general do not even consider "their calling".

I do. I'm a non-traditional MD student with X years in the clinical setting (Clinical Perfusion hence my profile name). I wince every time I see/read/hear MD students seeking short cuts (e.g. First Aid for the USMLE, BRS, Kaplan, Sketchy Micro, etc) to be really great healers for a vocation/calling. I am really not fond of studying/reading/working as much as I do, and my husband often provides a shoulder for me to rest my pounding head. However I see my journey as a vocation and am thrilled to be doing it. I couldn't imagine doing anything else.

"If the practice of medicine is not seen as work that is personally rewarding and serving a greater good, physician performance may suffer and, more importantly, so too may the quality of care that patients receive. Therefore, fostering a health care workplace that supports physician well-being and medicine as a vocation merits greater attention."​

Association Between Physician Burnout and Identification With Medicine as a Calling
Jager, Andrew J. et al. Mayo Clinic Proceedings , Volume 92 , Issue 3 , 415 - 422

​

have a great weekend everyone!

 

[WingedOx]

Dean Muller overall is right. Perhaps the metric that is missing from selecting/training physicians is vocation.
Do they have a calling to medicine? I sense most people in general do not even consider "their calling".

uhh, sure. You wanna be idealistic that's cool, but I kind of like the fact that I can turn it off and go home at the end of the day. I've put a ton of time and energy into what I'm doing, but I could have been just as happy doing plenty of other things. Sometimes medicine is great. Sometimes it really really sucks.

I do. I'm a non-traditional MD student with X years in the clinical setting (Clinical Perfusion hence my profile name). I wince every time I see/read/hear MD students seeking short cuts (e.g. First Aid for the USMLE, BRS, Kaplan, Sketchy Micro, etc) to be really great healers for a vocation/calling.

What the hell does this even mean?

I am really not fond of studying/reading/working as much as I do, and my husband often provides a shoulder for me to rest my pounding head. However I see my journey as a vocation and am thrilled to be doing it. I couldn't imagine doing anything else.

Cool, just don't find yourself flat-footed when medicine doesn't give back what you put in. Medicine/psychiatry is a job. My happiness and life satisfaction comes from elsewhere.

 

[GUH]

Dean Muller overall is right. Perhaps the metric that is missing from selecting/training physicians is vocation.
Do they have a calling to medicine? I sense most people in general do not even consider "their calling"...

Your placing the blame for burnout on the students and doctors themselves does not take into account the fact that abusive training and work environments are a major cause.

I do. I'm a non-traditional MD student with X years in the clinical setting (Clinical Perfusion hence my profile name). I wince every time I see/read/hear MD students seeking short cuts (e.g. First Aid for the USMLE, BRS, Kaplan, Sketchy Micro, etc) to be really great healers for a vocation/calling. I am really not fond of studying/reading/working as much as I do, and my husband often provides a shoulder for me to rest my pounding head. However I see my journey as a vocation and am thrilled to be doing it. I couldn't imagine doing anything else.

Those study aids you mentioned are not "shortcuts"; they are tools used by students to not only survive the board exams, which we are all required to take, but also to help them memorize medical information, some of which might save a future patient's life. Feeling like medicine is your "calling" is not sufficient to be a competent physician.

 

[751866]

With all due respect, the paper linked is fundamentally flawed. The argument that residents are paying tuition for their training by accepting lower salaries is a fallacy. The midlevel providers are trained on the job, while being paid more than residents, and perform a similar role. Residents afford the attendings who train them a far easier lifestyle at a lower cost than midlevels.

I think you should familiarize yourself with the idea of implicit costs. If someone came right out of medical school and tried to practice without training they'd probably be paid far less than someone with appropriate training, assuming some basic market forces are in play. If patients like their physician they'll stick with them. If a physician is good, presumably the physician will be sued less... the reasons go on and on... The idea would then be that taking a lower salary now for better training and better long term pay with less risk is a tradeoff. I could go make more money, but not as much, right now, but I'm going to accept less for some time to build some valuable skills. The difference between what you could be making and what you are making, in a really simplistic way, is your opportunity cost. For physicians, there's an additional step on the ladder after residency in terms of income and responsibility. That extra rung isn't really on the ladder for non-physicians. It also seems to me like physicians learn a ton of knowledge in medical school so that they can learn to be a physician in residency, more or less. Non-physicians learn a smaller knowledge base in school while learning more about their job post graduation.

The sad thing about that MIT paper is it's too far over the heads of most of the target audience. As a result, they can't critique and understand it in a meaningful manner, so it's making sense primarily to the people who can't do much about it.

 

[neusu]

But, anecdotally, I would accept lower pay to train at the program that I am training at.

I'll gladly take 30% of your gross salary so you can achieve your dreams.

What "similar role"? Note writing? Billing for consults or minor procedures? Floor scut?

Unless your program is having mid levels do thousands of cases a year and learn how to operate, the training isn't similar at all.

Our NPs learn how to be great NPs. They learn it pretty quickly actually, at least the good ones. They don't learn how to be doctors, much less surgeons.

I'm not implying that NPs become surgeons, quite the contrary. What I am implying, however, is we train them to be subspecialty practicioners (e.g. ICU, anesthesia, surgical), while paying them for it. I had all of 5-days of orientation and was thrown on the wards to fend for myself. Our new midlevels have 6-weeks of it. Suffice it to say, if they perform less work in the lower level of complexity and number of hours per week, how is it in any way reasonable to pay them more? Frankly, the argument of "you'll make a lot more in a couple of years," is wearing thin. No one knows what will happen in the future, and the curent training and compensation system is entirely unfair.

I think you should familiarize yourself with the idea of implicit costs.

I am fully aware of implicit costs. Indeed, the argument that we are paying a tuition for our training, and thus accepting a lessor salary is an example therein. Even so, if we are paying a tuition, what degree are we earning? One could argue the de facto board eligibility is the degree. To keep with our economic bent, this is more-over rent-seeking on the part of the board.

While it is an entirely different arugment whether someone fresh out of school should be allowed to practice independently, in medicine it is not possible. Why do we accept this as the standard when our colleagues who finish with half the training (e.g. 2-years instead of 4) can practice independently immediately? Historically, someone with an MD could practice after school, and internship and residency were for more specialized training. Should NPs and PAs be required to do further training? Should we allow people who have completed a PGY-1 training period to bill independently? The former may well resolve itself with the push on the NP front to grant doctorate level degrees and have residency training programs. The latter currently exists in that many states grant full licensure after completion of a PGY-1 training program and USMLE Step 3. Billing insurance, though, may be prohibitive as most require board eligibility to bill.

The fact remains, however, that many students, residents, and attendings are beside themselves with the current state of medicine. There is an ever increasing rift between specialty training decreasing the lateral movement during training. Further, as mentioned earlier in the thread, students and residents who are having issues have few places to turn, and few options aside from keeping their head down and trying not to, rhetorically, lose it. Finally, no amount of burnout surveys, screening tests for depression, or mandatory debriefing meetings will change this given the underlying tone of the issue.

 

[751866]

I am fully aware of implicit costs. Indeed, the argument that we are paying a tuition for our training, and thus accepting a lessor salary is an example therein. Even so, if we are paying a tuition, what degree are we earning? One could argue the de facto board eligibility is the degree. To keep with our economic bent, this is more-over rent-seeking on the part of the board.

I do agree with some of your other points after this bit. I also agree with your stance on the "you'll make more in a few years" argument. It's not much of an argument in itself and it's kind of like people rationalizing stealing from those who have more simply because "they can afford the loss." I only seemed to defend the "more in a few years" argument as a point for where the implicit trade off comes in from and economist's perspective.

I don't think it's really a good point to ask what degree is earned for the tuition. The knowledge and skills acquired are the benefit conferred from the interaction. No formal recognition would change that. In the absence of someone being able to say "I'm board certified in XYZ," a track record would presumably command benefits in the market. People would probably learn to stay away from the doctor who seems to suck at everything or who is always involved in litigation. Hospitals and groups would hire physicians based on these things, too, ideally. Anyone without similar training would be looked at as a less favorable candidate. So, asking what degree we get would be like asking for a receipt for "the peace of mind" I purchased with a home security system or the happiness someone has from staying at a lesser paying but more gratifying job. I would agree with Southern Surgeon, though, that residents are paid and get on-the-job training the same as most other jobs. You don't start making the big bucks in most jobs, but you're paid to do grunt work at first. The difference with medicine seems to be an artificial ceiling on non-attending pay. Sure, you might argue that after residency there is a huge increase in knowledge and skills. I would make that statement, although I would prefer to say it's more of a continual rather than discrete accumulation. However, for pay to uniformly increase by such a large amount from the last year of residency to a first year attending doesn't seem to make sense. Surely, not everyone is that good to command that increase.

 

[neusu]

The argument isn't that "you'll make more soon"

The argument is that you are getting on the job training. You are trading service for education. Mid level providesr aren't doing that. The dollar figure of that training has never been quantified.

My personal experience is that my residency training has been exponentially more valuable than my medical school education. But I got paid for one and had to pay for the other.

Like I've said before I think on the whole we come out on top. The PA/NP comparisons are tiresome and don't really apply.

If this is truly your argument, then surely you would agree the compensation should be performance and merit based, rather than on annum. Say for example you are an analyst for a Wall Street firm, or a programmer in Silicon Valley. Indeed, you are paid less (albeit more than a resident) as you learn, and increase your skill set. Even so, when you make incremental increases in your abilities, and/or perform you are compensated accordingly. Residency, on the other hand, pays a comparatively low start, keeps you there, not even adjusting for inflation as you progress through the program, and dumps you off at the other end with a massive increase in salary, however no real metrics as to whether you have earned it or not aside from providing a pulse and accumulating evaluations for the duration of your program. Let's look at other apprenticed fields such as the trades. A short stint at technical college and then you are an apprentice plumber/electrician/carpenter. You are paid the same hourly rate (or more) than a resident, plus overtime should you work it. After accumulating the skill set and hours needed, you are granted permit to become an independent plumber/electrician/carpenter. How is that we allow ourselves to be exploited to the degree where an 80-hours-a-week, 28-hour continuous maximum seems "reasonable." Tell me what plumber/electrician/carpenter think it is reasonable to work 28-hours in a row, let alone 80-hours-a-week for years on end?

Finally, your tiredness of the PA/NP comparison is tired. They play a valuable role in the health care system as midlevel providers. Their leadership, however, intends to create an alternative pathway to the same end, without the same level of rigor. You say they aren't doing the same job you are, and currently it is true. The fact of the matter remains, for now, that a resident is paid less, does more, and enables the attending to carry a larger load. You suggest the cost the resident should pay has not been quantified. I'd argue the benefit the resident accrues has not been quantified either, outweighs that cost, especially if you take in to consideration the federal government reimbursement for graduate medical education.

 

[TheFutureFatMan]

I'm not going to blow sunshine up your ass and tell you that those seminars are helpful. They aren't. They are poorly taught, poorly run and frankly, the people that need the help aren't going to be paying attention anyways. But, frankly, medicine is a team sport and a huge problem with physicians is that we assume that we have all the answers and that nobody else can possibly figure out how to do things. Then when asked to play an active role, we are too busy with our practices to actually take ownership of it. Try sitting on a hospital committee or two, notice the interest level of physicians. Complaining? Sure. But, actually spending time, energy and resources, pretty hard to come by. The lion's share want to graduate residency, open or join a practice and make their hard earned money, the hell with everything else.




No offense dude, but you really should read the links before you post them. The first one is incredibly technical, but shows that the match INCREASES salaries. The second is a lay article that despite spending most of it's space ranting about the decreased pay admits that this is far from clear (and even reference the first article). It's evidence that wages are depressed is because someone sued, which is crap.

Lols...anyone smell something burning?

 

[dadaddadaBATMAN]

Thanks for your input.

​

have a great weekend everyone!

My general criticisms:
1.) Write less if you want people to read it. While you are welcome to write a 5 page thesis, it's going to get ignored.

2.) Presuming to know other people's motivation is dubious at best, and can make you look like a twit. I would quit wasting your energy on this.

3.) Your comments on first aid, pathoma, etc are bizarre. Is it a shortcut to use a hammer on a nail instead of your forehead?

They're tools. You are welcome to ignore uworld, pathoma and first aid, however you will likely have a worse score on step 1.

And in the case of uworld and pathoma, I would argue you will also have an inferior understanding of pathophysiology. They're excellent resources.

4. Medscape is not a good source. Cite primary literature.

5. Your answer was tangential to mimelims criticism. He asked how burnout was defined in various professions and what the rate was in non-physicians, not how prevalent it was among physicians.

I guarantee the definition varies between papers, and the data is likely poor in most fields.

Best of luck with your med school career.

Edit: forgot the most important piece. If you're proposing a paradigm shift, you need to propose a viable alternative to the current model. And, like the strange comments of that dean, your model of the calling presumes that a deficiency in current physicians and students is the cause of burn out. I think that's total nonsense, but feel free to make whatever argument you want.

 

[TheFutureFatMan]

It isnt the people who have mental issues who acknowledge them that concern me but those who think eveeyone else has them except for themselves.

I think the percentage of people who believe that everyone else has a problem except for them is probably pretty small...and an incredibly subjective thing to figure out.

 

[Bickly Darlington]

How is that we allow ourselves to be exploited to the degree where an 80-hours-a-week, 28-hour continuous maximum seems "reasonable." Tell me what plumber/electrician/carpenter think it is reasonable to work 28-hours in a row, let alone 80-hours-a-week for years on end?

What plumber/electrician/carpenter would think it is reasonable to make $200,000/$250,000/$300,000 per year in his/her 30's? You want the big bucks and respect that the medical profession affords, you have to pay the price of admission to the field.

 

[cellsaver]

I think the percentage of people who believe that everyone else has a problem except for them is probably pretty small...and an incredibly subjective thing to figure out.

I wish you were right. Our country is so fragmented precisely because each side thinks the other is a threat/deplorable to our civilization.

 

[TheFutureFatMan]

I wish you were right. Our country is so fragmented precisely because each side thinks the other is a threat/deplorable to our civilization.

I can't even focus because your avatar is making me hungry.

 

[cellsaver]

I can't even focus because your avatar is making me hungry.

know what food it is?

 

[Raryn]

With all due respect, the paper linked is fundamentally flawed. The argument that residents are paying tuition for their training by accepting lower salaries is a fallacy. The midlevel providers are trained on the job, while being paid more than residents, and perform a similar role. Residents afford the attendings who train them a far easier lifestyle at a lower cost than midlevels.

So the easy answer is that NPs can bill but residents can't. You can say that NPs in an inpatient setting typically bill under the authority of an attending and residents can do the same so that's a bit of a mis-statement. Fine.

That leads to the more difficult answers:

I'm not implying that NPs become surgeons, quite the contrary. What I am implying, however, is we train them to be subspecialty practicioners (e.g. ICU, anesthesia, surgical), while paying them for it. I had all of 5-days of orientation and was thrown on the wards to fend for myself. Our new midlevels have 6-weeks of it. Suffice it to say, if they perform less work in the lower level of complexity and number of hours per week, how is it in any way reasonable to pay them more? Frankly, the argument of "you'll make a lot more in a couple of years," is wearing thin. No one knows what will happen in the future, and the curent training and compensation system is entirely unfair.

1) There's a whole educational infrastructure that has to be built for the residents. The program director (half their time at least, >$100k/year), program coordinator, GME office, etc have to be paid. The people who recruit residents that have yearly turnover, get the programs accredited for training, and report frequently to the ACGME. Administrative staff isn't free, and while you could probably streamline it a bit, you'll never get it down to zero. Faculty are also expected to take their valuable time to make a didactic schedule, run morning reports, etc. A good proportion of money has to go to this every year.
2) Exactly as you said, the residents participate in all parts of the care. They have to, they're training to be attendings. Guess what? In a lot of fields, the parts the NPs do are straight scut most of the time. They speed up the attending. So do the residents when they do straight scut... except the residents are also trained on how to do more complex things, things that might slow down the attending. Especially when you take into account that residents have a lot more turnover than the ancillary staff. There's new interns every year that have to be taught the basics. I can do admissions at three or four times the speed I could as an intern, and do a better job at it too. But give me an intern to have to walk through it? I probably go half the speed I go on my own, because I actually give a damn and try to explain thing.
3) Residents are allowed to make more mistakes, as long as it doesn't (seriously) harm the patients. For example, there's more things ordered out of curiosity, a lot more patients who have extensive workups that might have been focused with more experience. This is done to allow them to get that experience without it being dictated from on high... except that this frequently costs hospitals money. Unlike what much of the lay public thinks, ordering extra lab tests doesn't typically get the hospital reimbursed at a higher level when they're often paid a flat fee per diagnosis, but the tests still have costs to be run. The majority of the funding hospitals receive for residents is to pay the hospitals for these inefficiencies. Only about 1/3 is actually the direct salary reimbursement that residents get.

Look, if residencies truly treated us like midlevels, just training us to do the bare minimum to make attending lives easier, didn't take extra time out to teach us, minimized the educational infrastructure, and dictated terms to us rather than allowing us to make mistakes and build our own clinical skills? Then yeah, I'd give you a point. But at least in my program, we treated much better than the typical NP/PA, and you could tell that in how clinical skills developed. I'd take an end-of-the-year intern over a midlevel for most services any day.

 

[WingedOx]

The argument isn't that "you'll make more soon"

The argument is that you are getting on the job training. You are trading service for education. Mid level providesr aren't doing that. The dollar figure of that training has never been quantified.

My personal experience is that my residency training has been exponentially more valuable than my medical school education. But I got paid for one and had to pay for the other.

.

I can't emphasize enough how true this is.

 

[ridethecliche]

So many of these posts wanting to get rid of all the test scores, grades, etc etc etc. that are required for entry seem to hark back to a time when you'd get your friends dad to call the dean and get you a spot because 'Edward James the third, has a really good character and would make a great physician'.

I completely agree with the mental health screening stuff. It needs to be talked about. It needs to be confidential. And it needs to be addressed so students have somewhere to turn when they're freaking the fark out. Medical students aren't special creatures, but the reality is that we give up a ton of stuff to dedicate a good part of a decade of our lives to learning something that at the end of the day should theoretically help society. Treating those same people as expendable cogs is bs if you want them to function well. That's where the economics are though.

The fact that failure basically implies that you're done financially is a pretty good way to ensure that people are way more stressed than they ought to be. I'd like to see data on stress and quality of life for students stratified by family income and further stratified by whether their parents are paying for a large amount of their education. None of that is a bad thing, but I'm interested to see if it is reflected on how students feel day to day. Walking through 4+ years of your life with an anchor strapped to your ankle is a good way to constantly feel like you're swimming against the tide.

I'm so damn thankful for where I ended up even though it's really not where I wanted to end up. I've had a few unexpected issues/hiccups along the way and there have been some incredible support systems here to catch me. Having a fantastic peer group helps too. Pass/fail helps a lot as well, especially because said peer group can actually spare the time to look out for one another instead of gunning all the damn time.

Nice suggestions. Although i'm surprised to see medical education suffering from too much red tape and bureaucratic nonsense

Can't tell if srs....
My entire class is sitting through 2 weeks of third year orientation right now wondering what the heck we're being taught and why it applies to anything at all.

Also...P/F brings it's own problems.

Most programs I know that are pass-fail do not have 70% as the break point. The "pass" grade shifts based on overall class performance. Lets say the majority of your class really rocks at renal, and you don't. sucks to suck, the passing grade isn't simply a 70% now it's an 84%.

Then don't do it that way. My program isn't like that. It's set to 70%. This is so much more helpful if you use NBME exams because you can legitimately look at how those questions have been scored in the past and build an exam that meets a certain standard. Scaling pass fail to a standard deviation of the class is not a P/F system. Anyone that claims otherwise is lying.

 

[operaman]

Every time I read stories like these I have a hard time relating because my med school and residency experience thusfar has been awesome. There are some occasional terrible days but I think that's just life. I believe people who say they're struggling but I can't really empathize. I've been told every year of school and training how next year or the next rotation was utter hell only to have a pretty damn good time in the end.

My contrarian approach would say keep the mcat and gpa and try to add MORE objective criteria. Add in psychometric testing.

Add in structured/scored interviews like every major corporation uses in hiring and has found actually works well. This one you could even do as a phone-based screener that's scored independenly and just included as part of your application. Yes it would suck to jump through another hoop, but when reviewing an application I would find this far more useful than a list of fluffy ECs.

I always remember that for every student who doesn't make it through school, there were stacks of applications that were rejected who would have done just fine in that person's stead.

As for major policy level things you could do to help this issue with students feeling trapped, I think federal legislation that would allow you to discharge medical school student loan debt in bankruptcy if you don't actually graduate would be a start. Maybe people wouldn't feel so trapped if they knew they could walk away and truly start fresh. The unmatched could defer graduation and take advantage of this provision. The bankruptcy code would actually be a good place for this and fits in with the mission of the Bk code in the first place - granting fresh starts.

While we're fantasizing here, you could actually craft additional legislation that would penalize medical schools for the tuition paid by students who take advantage of bankruptcy to discharge their med school debt. It would save taxpayer dollars and give schools a strong incentive both to recruit capable students and ensure their wellbeing through to graduation and ultimately matching.

Also agree that mandatory confidential mental health screening for admitted students is a good idea. I would extend it to add mandatory counseling visits- maybe one per semester or year. The mandate would only be to show up. Talking would be optional, though hell I think pretty much everyone would enjoy bitching about the bs of medical school for a few minutes to a captive audience - but getting people in the door would be valuable. Maybe people would feel less self conscious about being seen going there if everyone was always having required visits. Besides, given how much meaningful time wasting is already done in med school, surely they can drop some piece of fluff and use that time for something like this that might actually help a few people.

 

[MSTP18]

Add in psychometric testing.

If this were to ever happen, it would almost instantly be rendered moot because Kaplan & Co. will develop test prep programs for it.

 

[IsWhat]

The great irony of medical education is the qualities society seeks in a physician are the exact opposite medical students need to actually get through the training process.

IMO, the best thing medical schools can do is require quarterly visits to a psychologist (I would even extend this into residency). Make this mandatory for everyone.

 

[WingedOx]

Also agree that mandatory confidential mental health screening for admitted students is a good idea. I would extend it to add mandatory counseling visits- maybe one per semester or year. The mandate would only be to show up. Talking would be optional, though hell I think pretty much everyone would enjoy bitching about the bs of medical school for a few minutes to a captive audience - but getting people in the door would be valuable. Maybe people would feel less self conscious about being seen going there if everyone was always having required visits. Besides, given how much meaningful time wasting is already done in med school, surely they can drop some piece of fluff and use that time for something like this that might actually help a few people.

The great irony of medical education is the qualities society seeks in a physician are the exact opposite medical students need to actually get through the training process.

IMO, the best thing medical schools can do is require quarterly visits to a psychologist (I would even extend this into residency). Make this mandatory for everyone.

Sounds great "on paper", but from the provider's side, treating patients who don't actually want to be there isn't the best use of our resources.

 

[Bickly Darlington]

Sounds great "on paper", but from the provider's side, treating patients who don't actually want to be there isn't the best use of our resources.

A required quarterly psychology visit sounds more like mandatory screening, not mandatory treatment. Like DOT or FAA physicals, it provides a form of "fitness for duty" evaluation, albeit with an optional treatment component. As a provider, you must be aware of the high number of practicing physicians in therapy. You probably currently treat a few. Isn't it a better use of provider resources to identify those who need help early on and treat those willing to take help, rather than to let these people slip through the cracks and end up needing more intense therapy down the line?

 

[WingedOx]

A required quarterly psychology visit sounds more like mandatory screening, not mandatory treatment. Like DOT or FAA physicals, it provides a form of "fitness for duty" evaluation, albeit with an optional treatment component. As a provider, you must be aware of the high number of practicing physicians in therapy. You probably currently treat a few. Isn't it a better use of provider resources to identify those who need help early on and treat those willing to take help, rather than to let these people slip through the cracks and end up needing more intense therapy down the line?

In theory, sure. In practice though I think you overestimate our ability to get much out of a "screening mental health exam" with any good specificity/sensitivity.

Not to mention sending a crush of 200+ students through either an academic mental health department and/or an overburdened student counseling service every August would be a logical headache.