The harsh culture of medical training is taking a toll on young physicians
A co-author of this piece, Dr. Ralph Greco, from Stanford School of Medicine, was interviewed in our story about the mental health of American physicians, published in the Sept 7, 2015, issue of TIME magazine. His co-author, Rhoda Feldman, is the mother of the late Dr. Greg Feldman, one of Dr. Greco’s former residents.
Every year we lose as many as 400 promising, talented doctors, whose lives our society can ill afford to lose, to suicide. Almost five years ago, Greg Feldman was one of these physicians. He was 33 years old, a graduate of Harvard College and Harvard Medical School and had completed a 5-year residency in general surgery at Stanford. Then, four and a half months after beginning advanced training in vascular surgery in Chicago, he died by suicide. We lost him needlessly, and for that matter, so did all the patients he could have saved and all the young surgeons he could have trained.
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What makes a man full of talent, full of empathy and full of love, a man with no history of depression or substance abuse, end his life? Is the culture of training programs to blame?
It is long overdue that the medical profession take a cold hard look in the mirror and acknowledge the brutal and often thankless road of medical training. It should surprise no one that a hierarchical program, where obedience and respect for those senior was mandatory, would breed abusive behavior. Stress and burnout are now deeply embedded in the medical profession.
In 2009, the American College of Surgeons surveyed its 20,000 plus members about this, and received almost 10,000 responses. Surgeons reported stress and burnout, alcohol and drug abuse, as well as suicidal ideation far higher than the general population. Moreover, a third of respondents said they would not recommend a career in medicine to their children. All of this should have been a wake up call for those of us in the profession, but again was mostly ignored.
Just as it has taken more than a decade to acknowledge that working more than 100 hours a week has deleterious consequences, it will take time and hard work to change the culture that drives young residents and those in fellowships to despair. The suicides of two more residents in major New York teaching hospitals must create a groundswell of support for the Accreditation Council for Graduate Medical Education (ACGME) to require that every training program establish a curriculum to bring the lives of its residents and fellows into balance and to enforce zero tolerance for abuse, humiliation or ridicule of trainees.
The medical profession can be extremely proud of a stellar record of teaching residents how to take care of patients. Now it is time to teach them how to take care of themselves. The repercussions of yet another young life snuffed out, while doctors stood idly by, would be disastrous.
Rhoda Feldman is the mother of the late Greg Feldman and a retired educational consultant. Ralph S. Greco, MD, is Johnson and Johnson Distinguished Professor of Surgery at Stanford University School of Medicine.