Two new studies paint a bleak picture of the mental-health challenges facing stressed-out and debt-ridden medical students and trainees. Articles on the studies, which appear in Wednesday’s issue of The Journal of the American Medical Association, suggest that the students’ malaise could end up hurting the patients they treat.
The first article, “U.S. Medical Students’ Health Insurance Coverage for Mental Health and Substance Abuse Treatment,” raises concerns about students’ access to such services. It says that nearly four out of five student health plans require students to kick in money for copayments—typically $20 to $25 per outpatient visit and up to $500 per inpatient stay—as well as coinsurance. The median coinsurance, or patient-billed portion, is 20 percent, which means students could rack up thousands of dollars in out-of-pocket expenses for a single course of treatment.
In addition, most plans set annual caps on the number of appointments students can have and the dollar amount of services they can receive for mental-health and substance-abuse problems.
The study’s researchers, most of whom are physicians at the Harvard-affiliated Cambridge Health Alliance, say those restrictions endanger the health of the students, as well as their patients.
“Medical students experience higher levels of psychological distress than their peers, including depression and suicidality,” said J. Wesley Boyd, an assistant clinical professor of psychiatry at Harvard Medical School and one of the article’s authors. Untreated, they tend to be less empathetic and altruistic and more prone to making medical errors, he said.
Many medical students are already reluctant to seek treatment, he said, and financial barriers make it even less likely they will seek psychiatric care.
Meanwhile, the situation is also grim for medical-school graduates who are training as internal-medicine residents, according to another article in the same issue of JAMA, “Quality of Life, Burnout, Educational Debt, and Medical Knowledge Among Internal Medicine Residents.”
Even though marathon work hours have been curtailed since 2003, 51.5 percent of the residents in a survey reported feeling burned out and 14.8 percent rated their quality of life as “bad as it could be” or “somewhat bad.”
The article’s authors, researchers at the Mayo Clinic, surveyed 16,394 medical residents in the United States in 2008-9. That’s about three-quarters of internal-medicine residents in the country.
The researchers also found that 45.8 percent of the residents were emotionally exhausted and 28.9 percent reported that their mental state had left them feeling cynical or callous.
Money worries compounded their stress. The median debt for medical students in the United States is $160,000, and not surprisingly, those who owed more than $200,000 were even more burned out, the study found.
