When the Healer Needs Healing: Addressing the Mental Health Concerns of Physicians in Training

Abstract: Background/Significance: The unique acute and chronic stressors that physicians face throughout their training and early career experience places them at risk for mental health concerns. Medical students matriculate with better well-being than their age-group peers but this reverses in early medical school with 41-90% of medical students and residents reporting burnout (1). Sadly, this persists into practice, and rates of suicide and depression in physicians both exceed the general public (2). As psychiatrists who bridge the gap between medicine and mental health, consultation-liaison (CL) psychiatrists work closely with non-psychiatric colleagues, understand the complexities of the general medical hospital, and are ideally situated to help aid physician trainees in need.



Methods: At our institution’s school of medicine (SOM), we deliver confidential behavioral health care for trainees led by board-certified CL psychiatrists. We first describe a program for medical students, followed by a program for residents and fellows, both free of charge. Medical student visits with the programs psychiatrist(s) were tracked from January 2022 to present. Resident and fellow visits with the employee assistance program (EAP) were tracked from January 2022-present. Psychiatric consults via EAP were tracked from July 2023-present. Data collection included demographics, academic year/post graduate year, diagnoses, appointment counts and medication(s) prescribed. Data will be gathered via retrospective chart review and utilization reports.



Results: Data collection is in process. Preliminary data indicates that 170 and 152 SOM students were seen by psychiatry in 2022 and 2023, respectively, for a total of 1489 visits across the two years. Of medications prescribed at the time of this writing, SSRIs were the most prescribed class of medications (53.4%), followed by non-SSRI antidepressants (24.1%) and then propranolol (10.7%). 259 and 228 residents and fellows accessed mental health and wellness services via EAP in 2022 and 2023 respectively. There have been 14 unique psychiatric consultation visits from July through December 2023.



Discussion: At our institution’s SOM, we provide comprehensive behavioral health consultation for medical students, residents, and fellows. Based on our preliminary data, commonly seen diagnoses and issues include fatigue, burnout, insomnia, adjustment disorder, trauma disorders, depression and anxiety spectrum disorders, and ADHD. We show through utilization rates and prescribing practices that mental health care is needed throughout the stages of medical training.



Conclusion: Physician and trainee mental health needs to be prioritized given increased rates of burnout, depression, and suicide. At our SOM, we intervene in early medical training stages with the aim to alleviate suffering and prevent tragic outcomes. We are led by board-certified CL psychiatrists who understand the complex dynamics between physicians and health care systems.



References:

Dyrbye LN, West CP, Satele D, Boone S, et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014 Mar;89(3):443-51.



Kalmoe MC, Chapman MB, Gold JA, Giedinghagen AM. Physician Suicide: A Call to Action. Mo Med. 2019 May-Jun;116(3):211-216.



Presentation Eligibility: Not previously published or presented

Diversity, Equity, and Inclusion: This presentation advances diversity, equity, and inclusion by describing a program that is accessible to all medical students, residents, and fellows. We will describe unique mental health challenges experienced in historically marginalized groups in medicine including racial and ethnic minorities, and women.