In this weeks JAMA–
http://jama.jamanetwork.com/article.aspx?articleid=2474424
This is in stark contrast with the general population where ~6.7% of adults experience a depressive episode in any given year and the lifetime incidence of depression is about 20% for women and 14% for men (according to NIH data).
The results of this study are consistent with the 2013 Intern Health Study (conducted by University of MIchigan).
IMO when med students graduate they know a lot, but they don’t know anything, especially in the specialty area they’ve chosen. The powers to be get this which is why new MDs are put in years of residency/fellowship supervised training post med school. Unlike the general population, residents for example:
may work 12+ days, 80+ DUTY hours a week,
every few weeks residents may interact with a continuing different rotation of more senior residents, fellows, attendings, etc, all of whom have their own pressures, idiosyncrasies, moods, personal issues, etc which could spill out onto subordinates;
as residents move up the residency totem pole the once somewhat deer in headlights interns now in turn take on increasing responsibilities/stresses/demands as to patient care, teaching (eg interns);
residents may leave duty hours when going home at end of day but their brains may still be spinning as to whether they did the right thing for patient X, prescribed the right dosage for patient Y, etc, which means their days/week may be much longer than just 12+ hour days/80+ hour weeks and so they have less recovery time from their job;
may have to deal with death and family grieving or feel in someway responsible for a poor outcome.
I just think that the stresses, pressures, demands, responsibilities that residents face are very much unlike the general population. So as the article uses what to me is broad wording (the prevalence of depression or depressive symptoms) I’m not surprised at article’s conclusion.
as a note I only read abstract at link above
My D. is the first year resident. Her schedule is absolutely horrendous. In addition, she had to finalize her publication and take Step 3 exam, (had to spend her 2 days off for taking exam, so worked straight without days off for awhile) with very little preparation as she had no time to prepare. Every time I see her or just speak to her on a phone, she looks and sounds so much happier, upbeat and satisfied in comparison to how she was during her 4 years of Med. School. She said that having clear responsibilities and no need to be under pressure to please everybody in a world and not being screamed at by anybody who happen to pass by are all great relief. And this is despite the fact that she is not yet in her chosen specialty as her specialty requires a Prelim year. She is an Internal Medicine resident (temporarily) with lots of electives. She works hospital shifts, some floors she likes better than others and some electives she likes better than others. When she works 30 hours shift at the hospital, she is the only MD on the floor during night. She is fully responsible for about 25 patients during night. She can call chief resident, but chief is in charge of 2 floors and maybe be busy. She also has outpatient clinic with her own patients (about 25 ), and 5 of her patients speak only Spanish, so she is happy that her pursuit of Spanish at college and during Med. School paid off. Overall, despite of very stressful situations and limited time at home, she is very satisfied with what she is doing. So far the only complaint out of her mouth - not being able to go to gym as much as she wants.
When she starts in her specialty in July of 2016, she will have to study at home a lot. They do not teach her specialty at Med. School. But her schedule will be normal, no more hospital shifts, no more working during nights, holidays and weekends.
They used to say in residency, “If you’re on call every other day, then you’ll miss half of the good cases.”
There was definitely a masochistic mentality then.
One variable that I didn’t see addressed was whether the incidence of depression was higher among foreign medical school grads than among US grads. Since 25% of residents are foreign medical school grads, they are dealing with culture shock, distance from home (many lived at or near home through college and medical school and had a ready support system at hand), many are located in ‘less desirable’ locations/specialties - and the stress that if it goes poorly, they will not have other options in the US. I would therefore expect to see much higher rates of depression in foreign medical grads than in the US grad population.
Just speculation here since I have no data - but the report didn’t address this and I think it’s a weakness.
N’s Mom,
I know a great number of residents who are “foreign medical school grads”
Based on my observations, my speculation is opposite from yours. These are tough people, they have “psyched” themselves up for many obstacles completely un-known to Americans. I never actually heard about depression among them, with the exception of one televised case. I do not think though that the MD in this case was a resident, I believe that he was a world re-known pediatric surgeon and his wife even quit her practice and was staying at home wife (no children), just to support her husband. Anyway, he was a physician originally from Israel who committed a suicide. He had a show on TV which ended all of sudden and later I learned why.
Normally, “foreign medical school grads” are open to any opportunities, including non-medical, they are much more flexible and actually have a great support system, since family as a whole is also very flexible while level of understanding is simply very high, they know what each of them is going thru. Great number of them is also much older.
But again, without any data supporting my statement, it is only speculation.
The non american citizen foreign medical graduates are under 1/8th of the residents, not 1/4 (3641/26252). The number that is closer to 25% is the number of residents who graduated from foreign medical schools, but roughly half of those people are american citizens.