How the Medical Education System Contributes to Physician Burnout

January 09, 2024 - One could argue that the medical education system is the cornerstone of healthcare and patient care. Through the education and certification protocols, medical schools mold the providers that play a critical role in nearly every aspect of patient care. However, this system has been critiqued for its rigor and difficulty, with some sources tracing back high rates of physician burnout to the design of the medical school system.

Although varying thought processes exist, and there has been no foolproof conclusion on how to mitigate physician burnout, it is critical to understand the role of medical schools in forming physicians and how it can impact their mental health.

PharmaNewsIntelligence explores the relationship between the medical education system, physician burnout, and provider mental health in this article. With insight from Arti Masturzo, MD, Chief Medical Officer at CCS, this article poses potential changes to the system that may offer long-term provider benefits.

PharmaNewsIntelligence began by asking Masturzo to describe her experiences in medical school and the connection between medical school and mental health.

“The folks who struggled with mental health during medical school were the folks that weren't academically prepared for the rigor and medical school asks [of students],” she revealed. “It's like the military. They break [students], and then they rebuild [them]. And for those folks that fought the breaking, they struggled. Those who expected to be broken and were  more resilient in nature and, frankly, more academically strong struggled less.”

Despite the difficulty when she was completing her education, Masturzo reflects on the evolution of the medical school application process, noting that, over time, the system has demanded more rigorous involvement from applicants and prospective students.

“More and more is expected of medical school applicants and students every year, and it’s no wonder people in this system get more burnt out by the year. Of course, institutions say that they want “well-rounded” applicants who have healthy balances in their lives, but that balance is  nearly impossible to maintain consistently in this field,” one third-year medical student anonymously told PharmaNewsIntelligence in a survey distributed by one of our editors. 

Masturzo added that the process has evolved to weed out students who just like medicine and retain those passionate about the field.

“It is an excellent idea. [Regarding] this whole experience in the future and how the new world looks, [people] have to love medicine because the landscape, financial rewards, burdens, and mental toll are drastically different now than it was when I attended.”

While Masturzo maintains that the rigor of medical school and the difficulty of the application process are vital for producing good doctors, she also notes that rigor and mental health support are not independent.

Mental Health in Medical School

According to an article in the Baylor University Medical Center Proceedings, medical students are more likely to have depression, anxiety, and mental stress than nonmedical counterparts.

Although mental stress varies based on each student, their location, and multiple other factors — such as debt burden — 27% of medical students globally experience depression. The rate is slightly higher for anxiety, at 34%. More alarmingly, the Baylor article reveals that approximately 11% of medical students worldwide have suicidal ideations.

Masturzo shifted the conversation to explain how mental health support has evolved in medical and post-medical school education.

“We got very little mental health support, and it was not proactive,” revealed Masturzo, referencing her own experiences. “It was reactive in nature.”

When she was in school, there were mental health resources available, but students had to go out of their way to ask for help and request access to those resources.

Reactive mental health support may be helpful to an extent, but the stigma surrounding mental health makes it difficult for anyone — especially medical professionals and students — to ask for help.

“There is a stigma around mental health worldwide, and in the United States, it's a huge problem for us,” she stated. “The stigma contributing to anxiety, depression, suicide rates, all sorts of problems.”

Masturzo notes that reactive mental health help asks driven people to be vulnerable and ask for help despite their standard high achievement.

“Anytime a line of work is defined by hard work, high achieving, and high rigor, saying, ‘I need help’ is in their mind equative to ‘I can't handle it,’” she added, implying the more substantial stigma around mental health for medical students and professionals. “That's the main problem.”

So, beyond the societal stigma associated with depression, anxiety, or other mental health issues, the pressure has increased a thousandfold in those career fields.

While mental health support in medical school has evolved as the discussions around psychiatric conditions and stress have become more normalized across the healthcare sector, many medical schools do not provide adequate resources.

According to a study published in Frontiers in Health Services, only 13.3% of medical schools fully adhere to the Association of American Medical College (AAMC) guidelines for student mental health services provided by medical schools. Beyond that, less than half of schools, 46.7%, partially adhered to the guidelines.

Burnout

After such a rigorous and demanding educational process, medical professionals expect to be highly fulfilled in their chosen careers. Unfortunately, Masturzo notes that is not always the case, insinuating that the lack of fulfillment perpetuated by institutional protocols and bureaucracy contributes to higher rates of clinician burnout.

“When [people] are doing something that fulfills your heart and soul and gives [them] purpose, [they] are much less likely to burnout,” she maintained.

She notes clinicians are not strangers to hard work, revealing that burnout does not stem from an extra workload. Instead, she reframes the burnout conversation, starting with talking about fulfillment. For many clinicians, the feeling of satisfaction is working toward a mission, reward, or goal. For some clinicians, fulfillment comes from grateful patients, affirmations, or progress in their field. However, the absence of these feelings correlates with feeling less valuable.

“ The absence of the motivating soul that compels physicians to work, coupled with a myriad of factors steadily eroding their passion — all unfolding concurrently,” Masturzo noted.

"I feel undervalued, unaffirmed, and unheard. I'm assigned tasks that don't align with my education level. Individuals with less education than me are instructing, judging, and evaluating my performance — all while not being physicians themselves," she expressed, highlighting the thoughts that may arise when physicians experience dissatisfaction.

Finding Solutions in a Broken System

"Medicine should never have been entrusted to those in suits in the first place," emphasized Masturzo. "The heart of medicine should always have been in the hands of providers. We should have been the ones running the business. It's a collective failure—shame on us for not seeking the necessary education, and shame on the educational system for neglecting to teach us these essential aspects."

PharmaNewsIntelligence asked Masturzo to offer some potential solutions to the disconnect between providers and business procedures. She began by explaining that it can all start in education. All medical students engage in rotations. However, there isn’t a corporate or business medicine rotation.

Masturzo presents a scenario, stating, "Do you aspire to be in hospital administration? Excellent. You will undergo a three-month corporate experience, closely working with C-Suite executives in a health system. During this period, you'll immerse yourself in learning, attend all the meetings, and gain insights into the education and responsibilities involved in this field."

As the medical education system continues to evolve, leaders must consider the role of medical school and student mental health in burnout.