New Doctors Face Special Mental Health Risks

You are unlikely to find anyone claiming medical residencies are an easy time in someone’s life. After years of education, they’re working as doctors while trying to prove themselves and complete the necessary steps to become independent.

Many of them have spent exorbitant amounts of money on school, sacrificed time with loved ones, and dedicated incredible amounts of time to this endeavor. They’re likely already burnt out, but now it’s time to hit the ground running.

New studies have shown that first-year medical residents are facing increased mental health risks.

The Struggles of Being a First-Year Resident

“Whether the internship placement is one that is stressful and time-consuming or not, much is riding on it. Falling short here may lead to students feeling invalidated or that the entire experience was for naught. When the experience is one that is extremely stressful and time-consuming, it wears on a person,” says Matt Glowiak, PhD, LCPC, a licensed professional counselor who specializes in medical professionals’ mental health, addiction, recovery, depression, and anxiety.

“From a physiological standpoint, students may find themselves sleeping less, not exercising as much, or eating less frequently or unhealthy meals. Emotionally, students may feel hopeless, exhausted, burnt out, anxious, or depressed.”

The COVID-19 pandemic further exacerbated these mental health issues, adds Vanessa Downing, PhD, ACC, a licensed psychologist and an executive coach for physicians.

Two recent studies published in facets of the Journal of the American Medical Association (JAMA) from teams at the University of Michigan address this head-on. They looked specifically at the mental health of first-year residents, also commonly referred to as interns.  

The first study was from JAMA Surgery and looked at the prevalence and span of depression experienced by first-year residents. Researchers found surgical interns had a higher likelihood of developing depression than doctors in other disciplines.

Surgical interns weren’t the only group of first-year residents found to have higher levels of depression.

The second study was from JAMA Health Forum, and also looked at the prevalence and span of depression experienced by first-year residents but focused on how sexual orientation played into these rates.

Researchers found that not only did people who identified as a sexual minority—lesbian, gay, bisexual, or other non-heterosexual orientations—have higher depression levels at the start of their residency, but their depressive symptoms also increased more drastically throughout the year than their heterosexual colleagues. This distinction was especially prevalent in the second half of the year.

“It’s a matter of having an additional cognitive load or emotional burden thrust upon minorities for simply being different from the majority in power,” explains Juan-Carlos Zuberbuhler, MD, an assistant professor of clinical science and a coach director for REACH, a well-being and resilience program at Kaiser Permanente Bernard J. Tyson School of Medicine.

“The racial, sexual, and gender biases don’t end when you enter the healthcare field, and the disappointment stings even more so when it comes from a field that aims to help others. There are deeply rooted power structures in the medical field that perpetuate systemic prejudices and sadly exploit those who want to be of service.”

"So you have to come in understanding that the healthcare system is just as broken as other systems,” he says.

Then there is the concern some residents may have that reporting unethical and discriminatory experiences may lead to them being transferred to a new placement, thus having to start over and feel further behind, explains Glowiak.

How To Lower The Mental Health Risk Of Medical Residents 

Unfortunately, a great deal of the responsibility to better their mental health falls on residents themselves instead of their employers. With few resources and even less time, this can feel like an impossible task, adding to the stress they already have.

“Healthcare organizations need to take accountability of our human interdependence and ensure they create, in a top-down manner, systemic changes that address the structural and social determinants of health for anyone who interacts with their system,” says Zuberbuhler.

To this end, Glowiak explains how critical it is for faculty supervision geared towards students’ well-being to occur in addition to general internship supervision.

“This provides students a safe space to share, reflect, voice any concerns, and receive necessary support,” he says.

“Workloads should be realistic given the student’s developmental level, experience, and availability. Supervision should be consistent. Atop any contextual considerations regarding the work itself, it helps to provide emotional support to the extent both practical and necessary. If an intern is struggling, it should be discussed in a safe space.”

An accessible, safe space is all the more critical given that interns tend to work hours that prohibit them from seeking consistent outside help. The JAMA Surgery study found that only 26.5% of residents who experienced new on-set depression sought mental health care.

“If they need to take a leave of absence for a few weeks to receive appropriate treatment, they may need to repeat the whole year of training,” says Downing.

“Organizations need to do whatever they can to create ‘easy buttons’ that residents can hit to get help getting connected to support, and to send the message that seeking help when it’s needed is not a sign of weakness.”