Below is the transcript of the following Academic Medicine Podcast episode:
Preserving Medical Student Mental Health
May 17, 2021
Read more about this episode and listen here.
Toni Gallo:
Hi everyone. I’m Toni Gallo, a staff editor with The Journal, and host of The Academic Medicine podcast. On today’s episode, to discuss medical student mental health, I’m joined by Dr. John Coverdale, one of the Journal’s associate editors. We’ll be talking to Christopher Veal, a fourth-year medical student and author of the paper, We Burn Out, We Break, We Die: Medical Schools Must Change Their Culture to Preserve Medical Student Mental Health. Chris’s paper was published in the May issue of The Journal, which is focused entirely on mental health and wellbeing.
Toni Gallo:
Today we’re also joined by Dr. Richard Page, who is the Dean of the Larner College of Medicine at the University of Vermont. Let’s start with introductions. John, could you go first?
Dr. John Coverdale:
I’m John Coverdale. I am Associate Editor of Academic Medicine and I’m also Professor of Psychiatry and Medical Ethics at Baylor College of Medicine.
Christopher Veal:
Hi. It’s an absolute privilege to be here. Thank you so much for the invitation. My name’s Christopher Veal. I’m a current fourth-year medical student at the University of Vermont Larner College of Medicine and very soon to be a first-year resident at the University of Illinois at Urbana-Champaign at the Carle Foundation Hospital as a family medicine resident. I’m incredibly grateful and excited for the opportunity. And I’m the author of this paper. Thanks for inviting me.
Toni Gallo:
Thank you. Rick?
Dr. Richard Page:
My name is Richard Page. I’m the Dean at the Larner College of Medicine at the University of Vermont. I’ve served in this role for two and a half years. My background is in cardiac electrophysiology. And, although I still practice, I don’t practice a lot anymore. And it’s a privilege to join you all today to talk about this important topic. And it’s a privilege and honor to serve as Christopher Veal’s dean.
Toni Gallo:
Well, thank you all for being here today. Before we get into our discussion, I want to alert listeners that this episode will address mental health, burnout, depression, and suicide. If you or a loved one is in distress, the National Suicide Prevention Lifeline provides free and confidential support online at SuicidePreventionLifeline.org and over the phone at 1-800-273-8255. John, could you give our listeners some background and context for our discussion today?
Dr. John Coverdale:
Yes. Well, I think this is a very important topic and I’m really impressed by how you signed your name, Chris, to the paper that you wrote for academic medicine, because it takes a lot of courage to do so when you’re talking about such personal things.
Dr. John Coverdale:
And I think that you’ll be talking about how doing so will make a big difference, maybe, to the culture of medicine when people talk so openly about their own personal struggle. So, I really admire you for what you’ve done, Rick and Chris, both being here on the podcast.
Toni Gallo:
So, Chris, maybe we can start with you describing your experience in medical school and your mental health journey for us, which you talk about in the paper we mentioned.
Christopher Veal:
Yeah, absolutely. And thank you, John, for that really lovely introduction. And thank you, Toni, for putting the number for the Suicide Prevention Lifeline on there because it’s really important and I want to make sure people are aware of that.
Christopher Veal:
So I don’t want to take too much time with my story but I think it’s really important to kind of get some context as to how I began medical school. I always kind of tell people it kind of felt like I had a dark cloud hanging over me when I first started. Before I started med school, about six months before then, my best friend had died by suicide, which was a huge blow to me.
Christopher Veal:
Five months before I started med school I had just come out of the closet to my parents which did not go well. My father disowned me at that point and virtually half my family did and so the feeling of isolation just kind of really compounded on me. And that was on top of seven years of this low grade, very much untreated depression whose gentle hum seemed to grow louder with each passing day.
Christopher Veal:
So it was tough just getting started. Oh, I forgot to mention, I was the only black man in my class of 120 students, in case that wasn’t bad enough. So just getting started was difficult. But med school is hard for everybody. I’m not going to say I’m exceptional by any means. But I will say I was really… I guess it would be disturbed and terrified after my first semester because around at least eight students had left after their first semester and, by whether this had been intentional, it was hard not to notice that the majority of those students that did leave were people of color.
Christopher Veal:
So, at that point, I felt like I had a target on my back, honestly. And for me medical school became less of a mission of trying to learn as much as I can and more of a mission of survival. The feeling of anxiety and isolation just amplified really with each passing day.
Christopher Veal:
And, I kind of grew up with this mantra that my mom always told me. She said, “Failure is not an option.” And she said that with all the best intentions there but my upbringing was very, very difficult. The financial situation that my family was in really did not allow much room for failure in terms of anything. Failure meant that we were on the streets. Failure meant that we weren’t going to eat. I had this constant fear of failure and my family and my community put so much investment into me as the one that was going to make it, that I wanted to make them proud.
Christopher Veal:
But there was still this depression that kind of lingered and, again, as I said, it kind of really became more and more amplified after my first semester. I remember calling my grandmother really at one of my worst days and I told her, “Man, I’m so depressed right now I can barely get out of bed.” And the response from this 94-year-old woman who was raised by her grandmother who was a former slave, she told me, “Well, Christopher, Black people don’t have depression. Slavery is not a happy environment to be living in. Jim Crow is not a warm, fuzzy environment. Depression’s just our baseline. What are you going to do about that?”
Christopher Veal:
And while the reaction was rather blunt I, in hindsight, very much recognize where she’s coming from. For folks in marginalized communities like mine, if I didn’t make it clear before, I’m Black, we historically in this country haven’t really had the opportunity to talk about things like depression and anxiety. We were just trying to survive, right?
Christopher Veal:
And so I believe that there is this very real cultural not only stigma but just ignorance and not in a bad way because we were just not given an opportunity to discuss these things. We were just, basically, provided a life where living with these kinds of issues became our baseline. So I ignored my mental health. I basically said I’m just going to just power forward and just continue trying to run away from failure.
Christopher Veal:
But eventually something had to give. I started my second year and I did ultimately wind up failing a course for my exam by a single point and at that point I was placed in front of the Advancement Committee basically to see if I was allowed to stay at school. And I kind of envision that meeting like a Congressional Hearing meeting, honestly. I was sitting on one side of the table and there were all these deans and high figure doctors on the other side. And I was alone, representing myself, trying to plead my case as to why they should give me another chance to stay in the school.
Christopher Veal:
The meeting went as well as it could have and I remember walking out of the medical school at that point and I heard this kind of ringing in my ears, kind of tinnitus, which had been the first time it had ever happened. It was just so incredibly loud and I had this really gut wrenching pain that, at that point, when I got to my car and I was sitting there, the first thought of suicide came to me, at that point.
Christopher Veal:
I kind of shook my head and tried to get myself back together and eventually the ringing went away and the idea kind of dissipated. But, that kernel had just planted itself. And so, at that point, as the committee had given me another chance to say, hey, we’re going to allow you to continue, I just said okay, I’m going to study harder. I’m just going to hunker down and do what I can. At that point I wasn’t getting much sleep to begin with so I was maybe getting five hours sleep but now I figured I could get four and I could get maybe three hours of sleep instead. I need to spend more time working on this.
Christopher Veal:
There was a plan made so that I would do a remediation exam for the course I had failed in January, after winter break. I decided to skip the holiday. Instead of going home to see my family I spent Christmas Day and Christmas Eve in the medical library studying for course remediation and my boards, Step 1.
Christopher Veal:
There was no plan for mental health supports. There was no plan for academic support at that point. It was just do what you need to do. So, of course, I returned to school and I took the exam again and I failed it. Wouldn’t you know it. So I was called into one of the dean’s offices and as I walked in there I recalled this question that two of my former classmates had been asked prior to them leaving. And I was terrified of this question and so, in my mind, I said, okay, well I’m just praying that this question is not asked of me when I get to this office.
Christopher Veal:
So I get into the office and I’m sitting there in front of this dean and the ringing starts to come back, very gradually. And as the dean was talking, that question that I was afraid of was asked. The question was, are you sure you want to become a doctor? And, at that moment, time seemed to stop for me at that point. It was really, the ringing in my ear just became deafening. The gut-wrenching pain became suffocating. And even though the dean was talking I heard nothing. I could barely even catch my breath.
Christopher Veal:
So I remember trying to get out of the office as fast as possible and I went into one of the stairwells of the College of Medicine and I just collapsed. I couldn’t take anymore, and the pain was really unbearable. It was really just… I really haven’t been at that point in my life in terms of pain, but it was something I would have never wished on my worst enemy.
Christopher Veal:
And so that was when I decided we are going to do this. We are going to make a plan to die by suicide. So, as I left the College of Medicine, I walked out and there was a huge blizzard out there. It was like one of the worst blizzards I’ve seen. If you’ve ever been in Vermont in winter, you know how bad they can get. As I was kind of walking, I told myself, well, if I ran my car into a pole my family wouldn’t think it was intentional. They would think it was an accident because the weather was so bad. And so that would be something my mother would be able to live with and I wouldn’t be an undue burden unto her, because at that point in my mind my life was a burden because I had failed.
Christopher Veal:
So I got into my car and I remember sitting in the driver’s seat, looking out the window as the snow built up on the windshield and I just sat there. And something told me, deep down, to call the mother of my best friend who had died by suicide just a year or so ago. And the reason why that was the person I thought about calling was because we had kind of gotten in this relationship in our shared loss, her son’s death, my best friend’s death. And she really was the only person that I was very close to who knew me personally but also understood the rigors of medical school because she was also a doctor.
Christopher Veal:
So I called her and I was really just calling more or less to say goodbye. But she immediately heard something in my voice that she knew wasn’t right. Her name is Carla. I said, “Carla, I’m doing fine. I just wanted to call and check in.” She was like, “No, no, no. Something’s going on. I’m not going to let you off this phone until you tell me what’s going on.”
Christopher Veal:
So I tell her everything that I just basically told you guys. And she refused to get off that phone until I drove home safely. So I made it home that night and we made an action plan and the plan would be for me to finish the course that I was in at that moment, which I only had a few more weeks left of. And then come live with her and her husband, both doctors in San Diego, for the remainder, however much time I needed, just to get back to where I needed to be mentally, physically, emotionally, academically.
Christopher Veal:
So that’s what I wound up doing. I went to California. At the end of the course I just drove west. I didn’t set my GPS, I just wanted to get as far away from Vermont as possible. Eventually I had to put my GPS on because I got lost in Colorado. But I made it to San Diego and I really had this plan on just not coming back to Vermont. I was terrified of coming back because I didn’t want to… it was that notion of failure, right? That fear of returning to it and seeing the failure that I had done. The failure to my community, the failure to myself, the failure to my family.
Christopher Veal:
But my godparents were very fervent on getting me into therapy which, again, I had not done before. And so I was introduced to Cognitive Behavioral Therapy in San Diego and this, by far, marked a turning point in my life. I mean, Cognitive Behavior Therapy changed my life. It got me over that fear of failure which, as I mentioned before, was really debilitating. But it taught me something that I really have relied on to this day and it’s this notion of being comfortable being uncomfortable.
Christopher Veal:
And, for me, that meant returning back to Vermont, even though it was incredibly uncomfortable returning back and I had to kind of see the shame that I had to really get over. But it was really, it was a moment in my life where that kind of cognitive therapy made sense and carried me through really one of the worst moments of my life.
Christopher Veal:
So eventually I got to the point where I felt comfortable studying for my boards again and I did study for them while I was in California, when I was with them. But I still was very, very hesitant and fearful of asking for help because I felt like Vermont, that place did not really… I felt I had gotten to this point because of my experience at UVM. So I didn’t want them to know that I needed even more of their help.
Christopher Veal:
So I didn’t ask for help which was a mistake because it wasn’t like help wasn’t offered. It was really me being ashamed of asking for help. But as I said, I regretted it because when I eventually took Step 1 I failed it.
Christopher Veal:
Now, the failure would have really crippled me prior to me going through CBT and being into therapy and having that rebirth out in California. But, because of all that, it didn’t hurt as much. I felt like the failure was not necessarily the end all be all but just a lesson. It was the failure that taught me how to succeed.
Christopher Veal:
So, I came back to school and when I came back, I knew, okay, this has to be different. You cannot just not get help when there’s plenty of help here for you. There are people here that know what they’re doing, who are great at what they’re doing, who can help you, who know more than you. And you need to be humble enough to admit that you don’t know everything. You need to get help and you need to continue going to therapy and you need to continue taking care of yourself, you need to continue loving yourself, which is something I had just started doing since I had moved from California.
Christopher Veal:
So, I got a new therapist. I got a dynamite tutor who is one of my closest friends now, Dr. Eileen Jossey-Kelly, who changed everything for me. And just a few months later I retook the Step 1, I passed it, and I was good to go. I had really gotten my life back together. I was really riding this high and I felt like I was finally at a place I was supposed to be.
Christopher Veal:
But all that really kind of came crashing down in 2020, in the summer of 2020, after five people in my family had died from COVID, after a cousin of mine had been killed by police in a very public way, and at this point I really thought there wasn’t really much more I could take but I learned in the summer that one of my classmates had died by suicide. And it really just rocked me to the core because I knew how close I was to that just a year or so prior. The demographics of me being a Black male in medicine, there’s not that many of us to begin with. My friend was also a Black male.
Christopher Veal:
It just destroyed me knowing that I knew how bad things could get. But I kept it to myself. I didn’t talk about it. I was ashamed. But I realized that moment that had I talked about this, had I told my friends in my medical school, and at medical schools in other places, that this can happen and if it does happen there is help and that you are not a failure and you should not be ashamed of just being human, that may have saved him.
Christopher Veal:
And so, that was when I started writing and really I had written a journal entry which was an entry that was about race as being a Black man in 2020 as a fourth-year medical student, because after all that stuff had to do with my family. And also, dealing with this emotional mental health. And I did something honestly pretty bold and I’m still kind of impressed that I did this to this day. I actually sent this essay to Dean Page via email like at 10:00 p.m. on a Friday. And I think it was because I was still very raw from the death of my friend and I wanted the dean of my school to understand why these things happen. Just what is going through the heads of students here.
Christopher Veal:
But it’s very easy for leadership of the university not to know about these things because we’re afraid of talking about them because we fear it’s going to negatively impact us on some kind of dean’s letter or getting into residency, right? By the end of the day these issues, these factors, play a role into whether we survive medical school or survive life.
Christopher Veal:
So Dean Page responded to me, honestly, within an hour which was surprising because again late night on a Friday and he was so taken and he was so surprised. Dean Page will probably talk about this when he comes up, but he responded to me basically saying, “I had no idea this was going on.” And he made a promise to me that he was going to do everything he could to make sure this doesn’t happen, or at least what he could do to mitigate it from happening.
Christopher Veal:
That’s really when I thought more about the power of writing and the power of storytelling. And I created a video series called, The Larner Stories Project, in reflection of that, understanding that by sharing one’s story one helps people feel less alone anymore. But it also opens the door to change. And really, my writing, when I wrote this article, that’s really where it came from. That’s basically my medical education in a nutshell and I hope I didn’t take too much time. But that’s it.
Dr. John Coverdale:
Gosh, thank you, Chris. Wow. Do you want to talk first about how easy or difficult it was to sign your name to the paper that you wrote, because it must have taken some courage and also what was your response to getting the letter? Was it 10:00 p.m. at night or whatever the time was.
Christopher Veal:
I’ll answer your second question first because, one I was surprised that Dean Page was awake that late on a Friday night. But also, as I said, I don’t know what motivated me to send that journal entry to him. I will say half that journal entry was the paper that we wound up publishing in Academic Medicine but in a much more raw form.
Christopher Veal:
And I think that after I had written that I was so wrought with emotion and I think that I was so fed up with this continuing to happen. I had learned, around that time, of several other suicides that happened at other medical schools. Another was a Black man in our medical school on the other side of the country. And, as I mentioned, there are not that many of us to begin with, right? I mean, I’m Black and gay so I’m like a unicorn here, right?
Christopher Veal:
And I could not bear the thought of knowing that what did happen to my friend, what almost happened to me, what was surely going to happen to somebody else was going to happen again. And so that answers really kind of both why I sent that message and why I was so happy that Dean Page took it seriously. But also why I wrote about my journey in such a public way.
Christopher Veal:
I was told by a friend a long time ago that when you share your story you grant permission for others to do the same. That is important because not only does it help people not feel alone but it destigmatizes this issue that is a very human issue that many, many people go through. And I don’t think people should be ashamed of feeling inadequate. They should not be ashamed of feeling like they have the weight of an entire community and entire history.
Christopher Veal:
I am a Black African American. Both sides of my family are derived from slaves. I have a history that I know I’m very proud of my history, but I also recognize the responsibility I have, not only to give back and to look back, but to move forward.
Christopher Veal:
And that’s something that I really do take seriously and I do not want people in my community, people in our marginalized communities to feel like because they are not fitting in this square peg, this round hole and square peg kind of scenario, in this very much White male dominated profession that was really developed in that way. Just because they don’t fit into that mold doesn’t mean that they’re inadequate. It doesn’t mean that they don’t belong here. It just means that the system needs to change, the culture needs to change with the people that constitute it. So that’s really kind of why I shared my story, mainly so other people felt like they could share their stories as well.
Dr. Richard Page:
So when I received that email, Chris, it was so personal. And as I’ve written actually that your paper that came out in Academic Medicine was both important and courageous to be able to take that on, express yourself in that way, in the setting of having lost a student, in the setting of a pandemic, and everything else going on. The personal story and the sharing of how hard it can be and how there needs to be academic and mental health support, that this is an equity issue. But even if there is that support is it getting to people? Is it reaching people? Are we able to address issues of stigma attached to reaching out, to accepting help?
Dr. Richard Page:
And as you mentioned, as you were retelling your own experience, the willingness to acknowledge that there is help there and to accept it, takes courage. So I have actually had the opportunity to read the first draft, if you will, which was really two stories. It included your personal story in terms of being, what I would characterize, as a near miss for a suicide, as well as your story of driving across country and your experience as a Black man driving across country and going to a Quick Stop at night.
Dr. Richard Page:
And your experience there really touched me in terms of how you were put in a circumstance where, as a Black man, at a rest stop in the middle of the night in the Midwest is taking a risk where it’s not taking a risk for everyone who walks into that same establishment.
Dr. Richard Page:
So I should mention that you published twice in your senior year. You published that experience driving across country at about the time when Black Lives Matter was coming more in the public discourse where we had our White Coats For Black Lives protest and acknowledgment at the college. That was an incredibly important message as well.
Dr. Richard Page:
The second time I got to read this personal story of yours was a couple weeks before it was published in Academic Medicine. We had been doing a fair amount in terms of mental health, and wellness, and resiliency, and suicide prevention at the same time we were not doing anywhere near enough. To see it as you’ve so clearly written, as a problem not for just our medical school but for every medical school.
Dr. Richard Page:
But also the fact that you reminded me, actually, of the impact that a dean can have. I saw it as a gift that you had provided me this in advance and I met with my senior leadership team, I think, the next day. And I said, “We’re going to address this and we’re going to work with Chris Veal to get this word out.”
Dr. Richard Page:
We timed it so we had a statement to our community acknowledging this very important paper that was put online with a call to action that was personal from me to the college as to what we needed to do. And the bullet points that I provided was, our community shall embrace the fact that we are all vulnerable and must give a priority to self-care and wellness.
Dr. Richard Page:
Number two, we shall work to eliminate any stigma associated with mental health or the need for psychological assistance. Next, we aspire to provide equitable, academic, and personal support for each student. Next, we shall offer tools for members of our community, not just students but staff and faculty who are suffering to help recognize and assist in a setting of psychological crisis, including the risk of suicide.
Dr. Richard Page:
And finally, we shall assure that each student is provided information regarding the confidential mental health services that are available. And in following up this statement, we developed a mental health task force that’s looking at the spectrum of wellness, resiliency, but also focusing on mental health, depression, and suicide prevention.
Dr. Richard Page:
And this group has met, I think, three times so far since. We have great leadership to identify what we have in place, what we need in place, and how to get that to the community so people who are in need of help know it’s there and everyone else can be looking out for how they can help.
Dr. Richard Page:
The normalization of mental health issues, depression, and the risk for suicide has to be there. The destigmatization has to start with us. And what I feel fortunate for is that even with COVID and everything else going on, you called the question. And I was delighted actually, subsequently from hearing from other deans for whom this has resonated. I’ll confess I got a call from a dean who had a suicide within the last two weeks, because I have spoken to this issue with other deans.
Dr. Richard Page:
You commented on the guilt you felt. The guilt is shared by so many. When there is a death by suicide, there is terrible grief but there is also guilt and you have to wonder what could be done more or better, or what could I have done. And the fact of the matter is, we need to do everything we can to keep this from happening going forward.
Dr. John Coverdale:
Again, I admire you both really. Chris, what a wonderful effort you put into trying to normalize adversities in medical school and hoping to mitigate the shame and stigma associated with the struggles that you have and other people might, and very likely will have and in trying to break a cultural silence.
Dr. John Coverdale:
And, Rick, what a wonderful effort you have put into trying to change factors in your school that might assist people to speak up and get the help that they need and in helping other schools too. I just might point out that there’s a paper published in the New England Journal of Medicine, I think last week, entitled My Intern, which was also about a suicide of an intern in that case and the senior intern or resident’s response to that death by suicide and his struggles associated with that. And there’s a comment there about how residency too leaves little time for self-reflection and even less time for personal grief.
Dr. John Coverdale:
And it’s very important that, under those circumstances, that people take an opportunity to get assistance for their mental issues. What was the response by the school, Rick? And did you have any pushback from anybody regarding the wonderful initiatives you were trying to put into place?
Dr. Richard Page:
There was absolutely no pushback. To the contrary, people recognized how important this issue is, recognized that while we had already had efforts underway, and I will share that I’ve received two significant gifts from alumni of our college. One to assist in developing resiliency of medical students and the other to educate about wellness and substance use disorder, which we haven’t talked about but can be a very important issue for medical students, residents, and physicians in practice.
Dr. Richard Page:
So there was really a groundswell to acknowledge and identify what we’re already doing. Is there 24-hour support? Are we teaching each other how to address these issues? Recognizing we had done some work, we still have so much work to do. And this is going to be an ongoing priority that wellness, resiliency are very important. But also looking for those who have mental health issues, depression, and potentially being at risk of death by suicide, to be looking out for that and to provide support, because this is an equity issue. It’s both academic and mental health support but we never want another near miss, much less another person who might take their life.
Christopher Veal:
And if I can just add to that. I think that the response that Dean Page talks about, and that I have gotten feedback about personally, has greatly been positive. But there has also been some negative feedback, to me personally, which I was not expecting, as well.
Christopher Veal:
Twitter can be really a cesspool of people. But because this article has gotten so much attention and there was a very big article written about it in MedPage Today, I’ve found that some, I would say, perhaps old school physicians or people in academic medicine, they think that addressing these kind of issues is more a sign of weakness than anything else. And I have been very disturbed to get these kind of messages. But I do think it’s really important to kind of underscore that this is not a sign of weakness. It’s a sign of humanism.
Christopher Veal:
Change cannot be made in silence. It’s made through policy awareness and action. And even though there are some critics out there who think that doing this lovey dovey stuff is not as important, I will very strongly and vehemently disagree as much as I can.
Dr. Richard Page:
And if I may add to that, Chris. I still mourn the loss of two colleagues who, well past medical school and were in practice, took their own lives. I have pictures of them, group photos, in my office to remind me of the importance of this.
Dr. Richard Page:
So for someone, I don’t know what old school is, but there has been an issue with mental health and suicide among clinical caregivers, physicians in particular, that has gone on for years and we should not accept it. We should do everything we can, starting from education on. And frankly it happens in other health care professions. It happens in graduate schools as well. We need to prepare people for what they have in store for them, give them support while they’re in school, and give them the tools and support throughout their careers.
Toni Gallo:
I want to give you both a chance if you have any final thoughts to share with listeners before we end our discussion.
Christopher Veal:
Thank you. And I appreciate this time because there is one thing I do want to talk about which we hadn’t really had a chance to talk about and it’s something I have actually learned recently myself. So the week after Match Day I woke up to find a notification on my phone that my article had been trending on Twitter. I, honestly, was kind of surprised because the article had been available for some time now and I really wasn’t expecting it to get any increased recognition.
Christopher Veal:
When I opened up Twitter and I saw why my article was trending my heart just sank. People were tweeting my article in response to increasing accounts of suicide among medical students that did not match on Match Day. One user noted that two students in her class had died by suicide in the past week, marking a total of three students in her class, over the course of her medical education, had died by suicide. This hit me particularly hard because I recognized that I too hadn’t matched on that Monday of Match Week either.
Christopher Veal:
Now, thankfully, UVM did everything they could do to ensure that I was supported and that I had a match and a SOAP, which I did and trust me, I am immensely, incredibly grateful and the words cannot describe how grateful I am for the support I got from my university.
Christopher Veal:
But while I was never suicidal during that week, the emotional roller coaster and the feelings of failure and disbelief that I had during those days leading into the SOAP, I really wouldn’t wish on my worst enemy. So, with that in mind, I do want to just talk about two issues that really need to be addressed. It’s in the realm of reform for the Match system and greater support for any students going through this.
Christopher Veal:
This year, the NRMP reported that a percentage of registrants that matched into a first-year program, physicians declined from 80.8% to 78.5%. Even though the rate of residency positions per applicant have increased slightly since 2010, the figure is still way down from 2003 and well below the rates of the late 1980’s and early 1990’s.
Christopher Veal:
This really impacts the high need work for specialties like primary care and psychiatry, especially in parts of the country that need these physicians the most to address our public health issues and our population needs.
Christopher Veal:
So, in kind of a broader sense, there’s this really incredibly cruel bottleneck effect that leaves over 20% of applicants that don’t match without any path forward in completing their training. You really can’t practice medicine if you don’t go to residency. And it’s cruel because it’s just as they reach the finish line of their medical education, with all the debt that comes with it, it’s just taken away from them, like Lucy and the football, right?
Christopher Veal:
So that’s one huge issue. The second issue is, is a support system. Now I mentioned I was very, very supported by my school during the SOAP process. While matching is not stressful enough, those that go through SOAP almost instantly experience another extremely stressful situation. And I can’t guarantee that every student has the same level of support that I had. This really creates a perfect storm for suicide risk. We’re seeing this if you look at Twitter. Especially for those with preexisting vulnerabilities.
Christopher Veal:
So what we need is a targeted effort toward reform of the Match system and sustained support structures in place for those that do not match. The first steps we can take toward that, toward reform, are by garnering support for the Physician Shortage Reduction Act of 2021. This was very recently introduced by Senators Bob Menendez of New Jersey, John Bozeman of Arkansas, and Democratic Leader Chuck Schumer. It’s a bipartisan bill. It aims to expand the number of federally supported medical residents and physicians by 2,000 annually for seven years, for a total of 14,000 spots at the end of this term.
Christopher Veal:
This is something that the AAMC has endorsed and I would beg the AAMC and our listeners to continue to aggressively pressure the Senate to approve this bill because it’s more than just getting more spots. It’s about suicide prevention. It’s about creating equity.
Christopher Veal:
In terms of support for our students that did not match or did not SOAP, I recently learned of a new service that was developed in the wake of COVID called The Physician Support Line. It’s a free and confidential service reserved for medical students and doctors that’s staffed 24/7 by psychiatrists who are there to provide emotional support. All medical students and providers should have access to this support line. The number is 1-888-409-0141. You can also get to their website which is http://www.PhysicianSupportLine.com.
Christopher Veal:
Moreover, there needs to be a direct outreach from a service like this, or from a student’s academic institution to ensure that students are supported and they have the resources they need. I mentioned this in my paper but I really believe that self-advocacy in the midst of depression and crisis is almost impossible.
Christopher Veal:
So that’s really kind of what I want and I really want to make sure that people understand the larger suicide prevention effort that can come with reforming the Match process. And, by doing this, it can avert tremendous unnecessary stress for anyone who’s in the medical system and also its students. By doing this we’re really helping to reduce the racial health equities that have plagued our health care system for far too long. So thank you very much for that.
Dr. Richard Page:
And I just want to thank the two of you for focusing on this important issue. I want to thank Chris Veal for the courage to speak up. And I ask everyone who’s listening to consider this and learn what they can and provide support and advocate for academic and mental health support that’s truly equitable so that the precious lives and the precious commodity of our future doctors are preserved and we develop tools and resources so that there is support throughout a medical career and for acknowledgment.
Dr. Richard Page:
And, again, normalization, destigmatization of the need that folks need help every once in a while. And we need to be looking out for that. We need to learn to accept the help that’s out there and work together to provide for a healthy health care work force throughout the United States. So thank you for inviting us.
Toni Gallo:
Well, we really appreciate you both taking the time to talk with us today. And I want to encourage listeners to look for Chris’s paper in the May issue and to look at the other articles in that issue as well. As I said, they’re all focused on mental health and wellbeing, including this important issue of reducing the stigma of sharing your mental health journey for physicians and trainees. So thank you very much and that’s it for us today.
Toni Gallo:
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