Just three days into her fourth year of medical school, Kathryn Stascavage jumped to her death leaving fellow students and teachers at the Icahn School of Medicine at Mount Sinai stunned. In the days that followed, school officials held open meetings for students to share their feelings. There was grief and surprise at the loss of a promising young life –- and, unfortunately, the feelings and stressors that could lead a medical student to end their life were familiar. "Immediately, the students could relate to it," Dr. David Muller, the dean of students at the Icahn School of Medicine at Mount Sinai, told ABC News. He described the tragedy in a recent editorial in The New England Journal of Medicine titled "Kathryn," which has been viewed more than 243,000 times. Physicians remain at a greater risk for dying by suicide compared to the general public, according to a 2004 study in the American Journal of Psychology. The suicide rate among men who are physicians is 1.41 times higher than the general population of men. For women who are physicians, the relative risk is even higher —- 2.27 times greater than the general population of women. Since Stascavage’s death, Muller has made it his mission to attack the issue to help his students, both when they are in school and after they graduate and enter hospitals as fully-trained physicians. "People can be grumpy and burnt out –- we accept it with a job as challenging as ours," Muller said. "But for someone to die made it impossible to pretend anymore that this wasn’t the biggest crisis facing medical training." Stress at the start As a group, doctor and medical students face clear stressors that can impact mental health. Every year, an estimated 300 to 400 physicians die by suicide, according to the American Foundation for Suicide Prevention (AFSP). It is not clear how many of those are medical students. According to a 2005 Mayo Clinic study, about 45 percent of medical students say they feel burned out during intense training, before even starting their careers. "You finish residency and become a [supervising doctor] in this grinding machine," Muller said. "You get paid more and the hours are a little more predictable, but the pressure is still quite high –- perhaps even higher." Christine Moutier, a psychiatrist and chief medical officer at the American Foundation for Suicide Prevention, emphasized that the interplay between depression, suicide and burnout is complex and not well understood. "It’s a complex interaction," Moutier told ABC News. "Multiple factors may add up in a given point of time,” she said, emphasizing that it’s never just a single event or factor that leads to suicide. Doctors suffering from depression may not seek treatment and may attempt to self-medicate, according to the AFSP. Physicians have reported several barriers to seeking mental health treatment, including fear it could have negative professional consequences. "The stigma is absolutely horrific for some doctors," said Michael Myers, a psychiatrist at SUNY-Downstate Medical Center in Brooklyn, New York, and author of “The Physician as Patient: A Clinical Handbook for Mental Health Professionals." Physicians may be concerned that colleagues or employers will find out about their depression, or that a diagnosis may affect job security, academic standing or the ability to get insurance. Many state medical licensing boards –- the entities that give doctors approval to practice medicine -- have historically asked applicants if they have problems with alcohol, drugs or mental illness. Other factors can contribute to a doctors’ hesitation to seek care including a demanding schedule or a reluctance to swap the role of caregiver for that of the patient. "Doctors are trained to look after other people," Myers said. "We prefer that role, and it’s one that it’s easier for us." Schools respond to suicide risks Mount Sinai is one of multiple schools that have stated an intent to decrease stigma around mental illness, to help students now and in the future. Many hospitals and training programs are embracing an emphasis on well-being, which will soon be mandatory. The group that regulates medical residencies and fellowships, the Accreditation Council for Graduate Medical Education (ACGME), will require training programs to have wellness initiatives in place starting in July. Experts say this will help set young doctors up for a sustainable and fulfilling career. "Well-being has a huge impact on trainees becoming the physicians they want to be,” said Timothy Brigham, co-chair of the ACGME physician well-being task force. Muller, the dean at the Icahn School of Medicine at Mount Sinai, believes that academic pressure is one factor in medicine’s mental health crisis. He has started new initiatives to counteract the obsession both with test scores and with competition, which a doctor may have to contend with throughout their career. Mount Sinai has now changed their grading to a pass-fail grading system for the first two years to cut down on competition between peers. In addition, they will no longer limit the number of high marks given out to students during their third and fourth year. Muller also hopes to de-emphasize the importance of the licensing exams –- the Medical College Admissions Test (MCAT) and Step 1 –- that students take for admission to medical school and residency, respectively. Though the tests were intended to ensure students had enough medical knowledge to simply pass the test, trainees often compete for top scores. "We know these students are going to be great doctors if they get a chance to evolve, rather than cramming for six months for Step 1," Muller said. He called the exam "a colossal waste of time." To de-emphasize test scores, Mount Sinai is working to withdraw from U.S. News & World Report’s annual medical school rankings. Additionally, Muller wants to give students a healthy foundation to prepare them for a stressful career. He is instituting yearly mental health check-ups for students to set an example that mental health care should be as routine as any other type of medical care. "Just like how you have to get your flu shot," he said, "we’d have an expectation that everyone has the equivalent of a [primary care] visit for mental health." The school is also working to ensure access to resources for physical health, from sleep hygiene information to nutrition to exercise. Other medical schools including Duke and University of San Francisco have launched similar wellness programs. After Stascavage's death, Muller said addressing the ongoing mental health crisis in medicine is imperative. "Once you force yourself to open your eyes and stare at the whole spectrum [of mental illness among doctors], it’s stunning, in a terrifying way," he said. Source
