Medical Student Suicides Prompt Schools to Finally Take Action

Sean Petro, at age 24, one year before his suicide while attending the USC Keck School of Medicine. (Photo courtesy of Cheryl Petro Collier.)

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.

‘Slow Going’

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.

However, a recent ACGME decision raised the number of continuous hours first-year residents can work, from 16 to 24.

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.”

Medical Student Suicides Prompt Schools to Finally Take Action 22 May,2017David Gorn

  • Keith Frederick

    St Louis University School of Medicine has lead the way in medical education by creating a culture and learning environment that maintained academic achievement while reducing the prevalence of depression to Pre admission levels. Recently however SLU SOM was placed on probation. I serve in the Missouri Legislature and am an orthopedic surgeon. I and Dr Bon Onder, a colleague in the Missouri Senate, wrote the following op ed about the need for reform of LCME, the outfit that accredits med schools:

    SLU School of Medicine on Probation?? Really?? Time to Throw The Red Flag!

    One of us remembers attending his son’s White Coat Ceremony when he was beginning his first year at SLU School of Medicine some nine years ago. The guest speaker, a female physician addressing a group of fledgling medical students who were facing medical education long known for grinding students down, described the behavior of a flock of migrating geese. She described how members of the flock take the lead position for a while, and then, when fatigued, drop back to draft off the others. She also noted that when a single goose was not able to continue, it was common that another member of the flock would drop out to stay with the one who just couldn’t go on. All these years later we wish that more of those who manage and regulate medical education had the good sense of a flock of geese, and the moral compass and compassion that has, we believe, guided SLU to place a very high value on the mental health and well being of the medical students in attendance at their University.

    Over 50 % of doctors suffer from burnout and we lose more than 400 doctors a year to suicide caused by a toxic work environment. About 1/3 of resident physicians suffer from burnout. It starts in medical school.

    Three years ago the Journal of the American Medical Association- Psychiatry published an article titled: Med Student Depression, Suicide: National Response Required. SLU has been one of the most active and undeniably the most successful medical school to address this ongoing tragedy, basing medical education on the Jesuit underpinnings of educating and nurturing the whole person; mind, body, spirit, and heart. The innovations that have been put in place at SLU School of Medicine, while beyond the scope of this article, have resulted in a reduction of the prevalence of depression from approximately 30% of students to 6% which is about the rate in the general population, all without any reduction in academic achievement. These accomplishments are unmatched by any other medical school on earth.

    The Wall Street Journal article titled “Medical School Seeks to Make Medical Training More Compassionate” published March 22, describes how the Icahn School of Medicine at Mount Sinai has embarked on a soul searching campaign of culture change after a 27 year old student there jumped to her death last summer from her eighth floor dorm residence. We applaud the school’s efforts. SLU School of Medicine wrote the book on such culture changes, and it wasn’t a recent suicide that drove them to change. They realized it was the right thing to do years ago.

    On the very day the above article was published, we and Michele Dietl, who lost her son Kevin to suicide when he was 10 days from graduation from the Kirksville College of Osteopathic Medicine met with new SLU School of Medicine Dean Kevin Berhns. Dean Behrns came to SLU from Florida about three months ago. We met with him in part to make sure he is aware of the magnitude of the accomplishments of SLU SOM and that his new University has lead the nation in medical education innovation over the last decade. We felt we needed to do this because when SLU School of Medicine was astonishingly put on probation last week by the Liaison Committee on Medical Education(LCME), claiming deficiencies in “Academic and Learning Environments”, and “Curricular Management, Evaluation and Enhancement”, areas where SLU has robust outcomes data to convincingly refute these assertions, Dean Behrns chose not to ask for reconsideration, a built in option, which quite possibly could have avoided probation.
    In football when a head coach sees a blown call that hurts his team he throws a red flag on the field to call for a careful review of the video replay.
    It may be that Dean Behrns feels you just can’t fight City Hall or LCME, but we wonder if others would have recognized LCME probation as a blown call and thrown the red flag in a heartbeat. We hope the new Dean will take that step, but if not, someone should. The Accreditation Council for Graduate Medical Education, (ACGME) which oversees training programs for resident physicians will be implementing significant changes in the requirements for training programs regarding the mental health and well being of these doctors beginning in July, and that’s a very positive step. LCME should follow their lead.

    Sadly over the last decade med students have died by suicide in medical schools all over this country at an alarming rate, yet not one of these med schools is currently on probation. Over the same time period, no med student at SLU School of medicine has died by suicide, and SLU has essentially eliminated depression in its first and second year med students and yet it ends up on probation. We believe it is time that LCME take depression and suicide more seriously, and require med schools to periodically measure the prevalence of depression among their students. We believe if the LCME accreditation process can lead to probation for SLU School of Medicine, then the process that LCME is using is broken and should be redesigned. SLU School of Medicine is a beacon of hope and light to medical education but due to an outdated process, the LCME failed to appreciate the fact that what they observed at SLU SOM is the proper future of medical education.

    State Representative Dr. Keith Frederick
    State Senator Dr. Bob Onder

    March 27, 2017

  • Spencer Binsfeld

    this artical is talking about how students are going through a lot of mental health issues as the are trying to pursue medical careers. your whole life you are taught you can be whoever you want to be and that it isn’t a difficult challenge to reach high expectation goals. the thing is that students in medical school are dealing with high amounts of studying and doing research to pass their classes. they talk about how they have 80 work weeks of school and time studyi g that they dont get to have time to spend with their family and friends. that being your life for seven years has caused these students to have depression and want to committee suicide. in my opinion there this should they should implement programs that promote student positivity and make them more motivated to do their work and talk about issues they have. @laczkoword #mycmstargs

    • maria monk

      i am seriously considering suicide bc students have destroyed my will to live

      • MikeCassady

        Maria, please go talk to someone, and get away from the situation making you think negatively about yourself. Turn whatever made you decide to be a teacher into something creative. I care. Flirting with the idea of taking our own life, or imagining it, is not banal. I think most of us have had suicidal thoughts, and in too many cases those thoughts lead to actual circumstances when we play with the idea of death and die by accident, or not because we really tried to do it. In my story of flirting with “ending it all”, I have it framed as an end-of-adolsescence-moment, a sudden gear-shift from passive to active.

        I think it helps to have a first person story which we use to explain ourselves to ourselves; its truth only matters to me, or, in your case, to you. I’ll spare you the twists and turns of my struggle with adolescent passivity from tribalism in high school, to my first years of college as the Vietnam draft law came into force, my deciision to volonteer for Army service (non-combatant) since I didn’t think student deferments were right, my return to my last year and a half of university studies after three years in the Army and the torment of a short marriage and divorce while in the military, the choice against continuing graduate studies, my rash decision to train as a deep sea diver in order to go out and see the postwar world (or some such), then my first job after diving school out in Saudi Arabia. Looking back, I think I was searching for some way to see in the world that I mattered in a way I wanted to matter, however vague that may sound, and is. That brings us to the “night to remember”, where my story is one of getting into the driver’s seat.

        I was working for the first time on a construction barge off the coast of Bahrain. We were conneting a big gas pipe to a platform anchored to the seabed. It was night but still hot and humid, and the wind was up and the seas were rough. We were working in about 100 feet of water. Lights had been lowered over the job, supposedly to allow visibility. Several divers had been down to attach lifting cables around the end of the line to be attached to the pipe running up the platform. The seas were getting more agitated by the minute. The diving boss told me to suit-up for a dive.

        I liked the diving work. Working underwater, often without visibility, it was a good kind of work if you like problem solving. I was raised on a ranch in rural California, and had lots of experience doing practical work, so problem solving was second nature for me. How I got the idea to take diving training while in my last weeks at the university is too complicated to go into, but I know one thought I had at several points as I fought with myself about abandoning graduate school was that if I were killed doing the work, no one would take it for anything but an accident while doing fairly dangerous work. I was very conflicted in my ideas of wanting to leave the earth that doing so by choice, as an overt vote against life, would be terrible for my parents, siblings and all the people I knew, but a diving accident would allow me to hide my wishes to escape the pain of living.

        I was suited up to go down to the job. I had my helmet on, and had tested the communications. I slipped into the cool, but not cold water, and started down the down-line fixed to the job. When I reached the bottom, I became aware that the pipe lifted slightly on the lifting cables was moving quite a bit. I left the down line and moved along the pipe toward the pipe-end I was supposed to work on. But, as I went, I was aware the pipe was moving up and down, on and off the seabed, quite a lot (if just inches), and it was kicking up silt from the seabed, which made clouds of mud billowing in the lights over the job. If I had to imagine what Hell might look like, I was looking at it that night, and I didn’t like it. But, I was a new diver, and the people up on the barge might criticize me for expressing fear about what I was seeing. So, I went on a bit further.

        Suddenly it came to me I could be sucked under the pipeline by the lifting motion and crushed under it. It was a pipeline that was 36 inches in diameter (gas lines are bigger than liquid petrol pipes). And, it came to me at the same moment that here was an accident looking for a place to happen, and I could be written off as a statistic; my parents and friends would be sorry, but because I had been taken away by an accident. It was then that my passivity looked me straight in the face and said to just continue and avoid getting laughed at for my inexperiece by those up on the deck. And, then the boss up on deck asked me how I was doing, and I can still hear myself saying words I can’t exactly say were mine, “This is too dangerous down here, I’m coming up.” The boss didn’t even pause. He said, if you think it’s too dangerous get yourself out of there. No one was laughing at me, or criticizing me, and it didn’t even matter to me if they did, though I wasn’t even thinking about that. I worked my way back to the downline as the pipe almost threw me off as I went along. I ascended the line, and was aware that every hand-hold on the line was me, aware that each move was me authoring my story one handhold at a time. When I reached the ladder on the side of the barge and climbed out, I was no longer the same person, even if I looked the same to those around me.

        Even if all was not smooth sailing after that night, I became conscious of myself as an autonomous person (I hesitate to use “second birth” since I see taking charge as I’ve written it for me as an earthly enough second birth—blood, tears and all—kick-start, driver’s seat take-over, whathaveyou. Since your voyage through time is unique and all in the details, it’s your story in the same way my story is mine and all stories belong uniquely to someone. If our stories are similar in any way, they are probably similar in being a struggle with autonomy. Many people may never achieve autonomy in any clear way, and are happy as clams seeing a world that makes perfect sense of them. By good luck, or bad, we have not been spared the struggle with autonomy, not fitting in, finding no blessing in passive conformity, living the life of shopping discount holiday. But, you may find as I did that I was a story looking for an author. If it makes no sense to anyone else, why should it?, as long as you write it in a way that meets your standards of making sense.

        I care—that is the hallmark of moral autonomy. Let life just keep getting in the way.

      • lie2menomo

        Please do not let anyone destroy your will to live, think or breath. Please be pissed that anyone thinks you or anyone eles wants or deserves to be treated or feel this way, Please do not give up and in to feeling this way, Please do not let them get away with this and let some one eles feel the way you do. PLEASE trust you are not alone and will not be questioned or felt you are just emotionally weak or uninportanant. Please feel free to call PM and i will get mad and even with you…..

  • Darlene E. Pfister

    The elephant in the room is once again being ignored. Yes, there needs to be mental health access and removal of the stigma and extra support for these students. What is IDIOTIC though are 80 hour weeks for these young, essentially students. Okay, get freaking real. We need healthy functionable health care providers because that schedule is DANGEROUS not only to the health of the physician in training, but the patients, get it? There is also no mention of the hazing/abuse that occurs in many medical schools, residencies, which are often reported by physicians, nonsupportive and detrimental to mental health and ultimately patient care. CHANGE the medical school/residency system to support better physical and mental health for the sake of all of us.

    • Ford Prefect

      How much of it is the alpha types who can easily function on no sleep hazing the ones who can’t? Seems quite Darwinian and we are left with poorer medical care.

      • Darlene E. Pfister

        Would not surprise me, yet even the alphas, though they may think they can function, if they were tested and compared, would likely fall short. We are not only losing students and residents to suicide but seasoned physicians who finally crack. It make zero sense!

    • lie2menomo

      I am not a student or a doctor, I have been following this topic for years, I am very angry nothing is being done. I think i get what is going on and the azing and abuse along with the rules that you have to follow like not being in debt with loans. And how if you are not doing what is expected of you tou are shuned and not given referals and recomendations. This is what makes me very upset and i can see how it would make a person feel hopeless and helpless. I am worried even death that is not accident or suside. Mabey speaking up and out. Please share more about the elephant. PM me if you like.

      • Darlene E. Pfister

        The elephant in the room is the unspoken abusive and/or causal conditions. and addressing changing and cessation of those, rather than just continuing to focus on providing the victim with “coping skills.” Dr. Pamela Wible is a crusader on this topic:

  • maria monk

    as a teacher i feel suicidal after having to read the bullying mean comments student make about me..


David Gorn

David Gorn is the former Deputy News Director of KQED Radio. His public radio pieces have appeared on NPR, the World, Marketplace and the California Report.

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