This post was updated May 22 to include the radio version, which you can listen to by scrolling down.
Last year, all of the accumulated data pointing to the poor mental health of medical students in general suddenly became more than just numbers at USC's Keck School of Medicine.
A Keck student, 25-year-old Sean Petro, had failed to show up for a clinical rotation. Eventually, campus police found his body in a closet of his apartment, where he had hung himself. In addition to attending medical school, Petro had just become an officer in the Navy Reserve, and had hopes of becoming a flight surgeon.
At Keck, he was just one year shy of graduating.
His suicide shocked Ranjita Raghavan, now in her third year at the medical school, a year behind Petro.
"It’s really scary," she says, speaking about medical school suicides in general. "It’s one of those things that’s really alarming."
Her own schedule illustrates how daunting a medical student's life can be. Six days a week, she rises at 4:30 a.m. and doesn't return home till 7 p.m. Whatever free time she has is used to study and eat.
"No one said medical school’s going to be easy," she says. "But you just don’t know from the outside. I come off as a happy person, but it was really tough for me the first two years."
She says although she is generally upbeat about her medical school experience, she still can't quite get her mind around all the data that shows so many students are exhibiting signs of burnout, not to mention thinking about suicide.
A Known Risk
After aspiring doctors receive a prized acceptance letter to medical school, they face a daunting reality.
Get ready for 80-hour work weeks for the next seven years of med school and residency. Get ready for trying to commit a crush of information to sleep-deprived brain cells. Get ready for little time spent with family and friends. Oh, and by the way, get ready for making decisions resulting in life and death.
And get ready for, potentially, thoughts about ending your own life.
No one knows the exact number of medical students or residents who have killed themselves in the U.S.; there is no requirement to report suicide rates in medical school or residency programs. But multiple studies have shown these doctors-in-training are at risk for suicide, and the reality of poor mental health among the population is well-known.
Last year, a meta-study published in the Journal of the American Medical Association looked at 117,000 medical students around the world. The findings: 11 percent had considered ending their lives.
A 2008 study of over 4,000 students at seven U.S. medical schools found as high as 13 percent having suicidal thoughts. For comparison, in the U.S., the rate of suicidal ideation among the general population is just 7 percent for 18 to-25 -year-olds, according to 2013 numbers from the U.S. Centers for Disease Control and Prevention. For 26- to 49-year-olds, it is 4 percent.
And while a 2014 study found a slightly lower rate of suicidal ideation among medical students, residents and young doctors compared to others in their age group, it found significantly higher rates of depression and burnout.
Schools, Programs React
The data, combined with a number of actual suicides by medical students and residents, have prompted schools and residency programs across California and the country to initiate programs to reduce stress, require mental-health screenings and offer counseling.
The programs have been instituted over just the last several years; traditionally, stress and mental health problems are not issues the institutions have specifically addressed, mental health experts say.
That's changing because Petro's death is only one of several recent suicides by medical students and residents around the country, says Andres Sciolla, a psychiatrist at the UC Davis School of Medicine.
Sciolla says the suicides of two doctors-in-training in New York City in 2014 galvanized the idea among the medical community that something needed to be done.
"It’s a very big topic that the general public just doesn’t know about,” Sciolla says. “There is so much buzz in our circle right now, in the academic and physician circle, and now it’s reaching a level that can no longer be pushed under the rug. It’s becoming scandalous.”
Sciolla helped institute a mental health program at UC Davis to catch problems before they can turn into crises. Residents fill out an online confidential survey to help identify those who are dealing with high levels of stress. Those individuals are contacted and offered counseling and other resources so they don't have to suffer in silence.
At the Keck School of Medicine, administrators started to address student mental health even before Petro's death. That's partly because in 2014, the same year national attention focused on the resident suicides in New York, another medical student who was enrolled at USC disappeared and was never found. That same year, a faculty physician took his own life.
Donna Elliott, the senior associate dean of student affairs at USC, says those local and national incidents were a loud wake-up call.
“There's a strong need in medical schools now in supporting students’ mental health," Elliott says. A big first step in that direction, she says, is the need to change the culture of shame and stigma around burnout, depression and suicide.
USC has hired a director of medical student wellness, instituted mandatory "Keck Check" mental health evaluation sessions and now requires students to take several mental-health days off every year.
In the past, Elliott says, "I don’t know that we recognized the need. I think medicine traditionally has been a profession that says, ‘You just do it.’ ”
Indeed the stigma and shame of suicide is more pronounced in the medical community, says Christine Moutier, chief medical officer at the American Foundation for Suicide Prevention.
Moutier, while working at UC San Diego, was the driving force behind the first med school suicide prevention program in California, back in 2009.
"At the time, it felt like few were doing that work, and it felt like swimming upstream to get it done," Moutier says. "And it became even more difficult when I would take ideas to the regional or national level. It was slow going."
Moutier points to the irony that those attending to people’s health are facing their own health crisis. “It’s such a disconnect that health professionals don’t take this seriously,” she says.
She calls the problem a public health crisis–not just for the medical providers, but for their patients as well.
“This is a major problem,” Moutier says. “I mean, if you’re looking at the fact that almost a quarter of interns are thinking of suicide, what kind of care are they giving patients?”
A national movement is now afoot to address the issue. The Accreditation Council for Graduate Medical Education last year launched an initiative to prevent medical school and residency suicides, and it hopes to require residency training programs to have wellness initiatives in place starting in July.
Among other medical schools across the state, UCSF now requires third-year medical students, who typically spend up to 80 hours a week on hospital rotations, to attend check-in mental-health sessions. Stanford School of Medicine has a similar program to identify and help those who might be struggling with stress and burnout. One residency program at Stanford also offers stress-reduction perks like free delivery of groceries to residents' homes and time to exercise.
All of these efforts are a good start, but just a start, says Sidney Zisook, director of the psychiatry residency program at UC San Diego.
“There’s been a code of silence throughout the years. Places have tried to cover this up and hush it up, no question," Zisook says. “I do think things are moving in a positive direction now. But certainly institutions need to take a much more serious look at this.”
Raghavan, the third-year medical student from USC, says she recognizes the support she is getting from the school.
"On your own, you never have enough time to sit and think about what you need. I mean, when do I have time to do that?" she says with a laugh. "So I appreciate the school thinking about that for you, and trying to do something about it."