Making the case for self-care among physicians

If you’re a doctor, your job is to take care of others. But too often, that comes at the expense of taking care of yourself.

Mark Schuster, MD, PhD
_{Kaiser Permanente Bernard J. Tyson School of Medicine}

Just look in nearly any emergency room in America, and you’ll see physicians who are exhausted from long hours, grueling schedules, and a global pandemic that is still very much ongoing. It’s called burnout, and it’s led to a mental health crisis among much of the medical profession (and, of course, these same issues apply to other health care professionals as well.)

Research shows that physicians report higher levels of depression and suicidal ideation than the general population – and end their own lives twice as frequently. In fact, a doctor in America dies by suicide every single day.

And even when burnout isn’t life-threatening, it can be devastating. Across the board, physicians display higher rates of emotional exhaustion, and some studies have shown that a disproportionate number of them struggle with reliance on alcohol, opioids, and stimulants as well.

To make matters worse, many physicians say that they would hesitate to get care for a mental health condition because they fear professional consequences like losing their medical licenses, which means many doctors end up suffering in the shadows.

And all this anguish – which plagued our profession long before the pandemic – has only been supercharged in recent years.

According to a Kaiser Family Foundation study, about two in three frontline workers said COVID-19-related stress had a negative impact on their mental health. And, the Mayo Clinic found that emotional exhaustion, depression, and depersonalization, three key indicators of burnout, went up as well.

It was a crisis whose pain was felt in the corridors of hospitals across the country, where heroic first responders risked their own lives to save the lives of others. For some, like Lorna Breen, an emergency department doctor who worked 15-hour shifts at the peak of New York’s initial COVID-19 wave before dying by suicide, the pain proved too much to bear.

And it’s not only physicians who pay the price of the mental health crisis in our profession. It’s patients, too.

Studies have shown that the more burned out a physician feels, the less satisfied a patient will be with the care they experience. Some have also suggested that burnout is associated with more medical errors.

Due to burnout, many doctors end up choosing to spend less time serving patients over the course of their careers. Another study measured this attrition and discovered that burnout’s impact on the medical labor force is the equivalent of losing the graduates of seven medical schools every four years.

As the dean of a medical school, I know all too well what that means in practice. Losing those students is unacceptable. But I also know that burnout isn’t inevitable, and with the right interventions at the very beginning of a future physician’s medical education journey, we believe we can mitigate it. If medical schools commit to mental wellness initiatives that prepare future doctors for the work ahead, we may be able to reduce burnout in the medical profession.

When we opened our school, the Kaiser Permanente Bernard J. Tyson School of Medicine, we sought to make sure every student would have the mental health support they need. That started with establishing onsite psychological services and allowing students to seek services as often as they want – and encouraging all of our students to meet with them at least once. This way, entering or exiting their office wouldn’t be stigmatized but rather normalized.

We also wanted to include self-care in our curriculum. One way we do this is by providing students with a physician-coach for all four years of their education. Students work with their coach to reflect on progress, set personal and professional goals, and gain insights into how to best attend to well-being and gain resilience skills that will apply not only through medical school, but into residency and beyond.

And it’s not just coaching. Our pedagogy is based on small group learning, which we believe has mental health benefits of its own. At our school, if a student isn’t participating, or if something is clearly off with them, they won’t slip through the cracks in the back of big lecture halls. This small-group approach gives faculty a greater ability to get to know their students and notice when they don’t appear to be themselves – and thus a greater opportunity to offer help.

We’ve also incorporated self-care into our learning space, equipping our school with facilities like an on-site gym, yoga garden, and meditation area. While all these activities might not resonate with each of our students, we’ve found that, in general, something works for everyone.

Of course, we don’t have all the answers. No one medical school or employer does. When it comes to the mental health of our students, there is always more to learn and more we can do. The good news is our students are the best guides. They told us they didn’t have enough unstructured time, and we reorganized the schedule. We continue to look for ways to make the school an inclusive environment that ameliorates rather than exacerbates the stress of training for this profession. That may be a tall order, one that’s hard to achieve, but we’re working on it. And the truth is, in this profession, there are going to be days when everyone feels underwater and overwhelmed. I know I have.

But the first step to overcoming this crisis is talking about it – so no one has to suffer in the shadows. The second step is to actually do something about it. That’s the culture we and other schools are trying to build in our school communities. Because you shouldn’t have to sacrifice your own health to work in health care.

Mark Schuster, MD, PhD, is founding dean and CEO of the Kaiser Permanente Bernard J. Tyson School of Medicine, an innovative new medical school in Pasadena, California, that opened in July 2020. Previously, he was the Berenberg Professor of Pediatrics at Harvard Medical School and Chief of General Pediatrics and Vice Chair for Health Policy in the Department of Medicine at Boston Children’s Hospital.