This month, more than 25,000 medical school graduates will begin working at hospitals and medical centers across the United States. By the end of September, nearly one-third of these new doctors could become depressed and 24 percent could have thoughts of suicide.
First-year interns often move away from family and friends to start the next chapter of intensive training. It is an exciting time, but also a difficult time. A recent study in Academic Medicine confirms that their suicide risk is highest in the early months of training.
The tragic deaths of two interns in New York in August 2014 was a sentinel event, leading to an urgent re-examination of the learning and work environment in academic health centers. Medical educators partnered with other stakeholders, including leaders of the Accreditation Council for Graduate Medical Education, to develop a national response to this crisis in medicine.
As a result of these efforts, physician training programs that begin on or after July 1, 2017, must now follow new, dramatically improved “core” requirements that provide access to confidential, affordable health care, including counseling and urgent care, 24 hours a day and seven days a week.
The new guidelines also urge improving connections between residents and faculty, reducing the social isolation that is common in young physicians who work 80 hours a week. Senior residents, attending physicians, and others are also asked to watch out for signs of burnout, depression, or significant changes in performance that might indicate a new intern physician at risk for depression or suicide.
We applaud the ACGME’s commitment to preventing depression and suicide in medical trainees and understand this will require sustained commitment and effective interventions at the local level. Oregon Health and Science University, where we work, played a significant role in developing the new guidelines, and we welcome the positive changes that will affect all U.S. interns and resident physicians.
With these guidelines in place, building a comprehensive physician wellness program is now feasible for every academic health center, and we’ve seen progress as hospitals across the country are opening centers focused on physician well-being. Yet significant barriers remain, and many of our physician colleagues continue to avoid seeking professional treatment during their medical careers. The impact can be life-threatening.
Every year, an estimated 400 physicians die by suicide. Most did not receive a mental health evaluation or treatment of depression before their deaths. The most common and powerful barrier to getting treatment is fear — fear that receiving treatment for depression could have a negative impact on a doctor’s medical practice. That needs to change. We have seen hundreds of physicians receive professional care for depression, continue to practice, and thrive in their profession.
OHSU built a Resident and Faculty Wellness Program in 2004. Over the past 10 years, use of this resource has increased from 5 to 25 percent of trainees. This nationally recognized model demonstrates that physicians will access a treatment program when it is safe and effective.
Recognizing the urgency of this public health crisis in medicine, the American Medical Association recently recommended that all state medical licensing boards “refrain from asking applicants about treatment and only focus on screening for current impairment.” We join the AMA in urging the Federation of State Medical Boards to “accept safe haven non-reporting which would allow physicians receiving treatment to apply for licensure without having to disclose it.”
The Oregon Medical Board is at the forefront of a national effort to reduce physicians’ fear of reporting treatment on licensing or hospital credentialing applications. It prioritizes the identification of impaired physicians and encourages licensees struggling with burnout, depression, or substance abuse to seek professional treatment.
The new requirements for all U.S. residency programs signal an important change in medical culture. However, progress will be blocked if physicians’ worries about reporting depression or being treated for it continue to be a barrier. We urge all state licensing boards to follow Oregon’s model and the AMA’s recent recommendations to accept “safe haven.” Only then will the medical community see a paradigm shift that saves lives.
George Keepers, M.D., is professor and chair of the Department of Psychiatry at Oregon Health and Science University and chair of the Accreditation Council for Graduate Medical Education’s review committee for psychiatry. Mary Moffit, Ph.D., is associate professor of psychiatry at OHSU School of Medicine and director of the OHSU Resident and Faculty Wellness Program.