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Depression and burnout aren’t easy things to talk about period, but if you’re a medical student or resident, being honest about these feelings may be even harder.

Why? Medical school and residency breed a culture of perfection. Ancient wisdom tells us that “nobody’s perfect” and that “to err is human,” but when it comes down to it, most people in the medical field are obsessed with perfection in both their professional and personal lives.

So, if you’re a medical student, resident or physician dealing with mild or serious depression, you may not want to admit it or talk about it. You’ve got an image and a professional reputation to maintain, and showing signs of “weakness” is the last thing you want to do. Best just to keep on truckin’ and giving it your all, right?

Wrong. Among all professionals, physicians have one of the highest rates of depression and suicide. Male physicians are three times more likely to commit suicide than other professionals, and female physicians are 400% more likely to commit suicide than women in other fields. Those are scary numbers.

Many feelings of depression stem from the desire to be perfect. But the expectation of perfection can lead to a lifetime of disappointment. Learning effective ways to cope with letdowns, disappointments and feelings of “not being good enough” early on will help you throughout your entire life. These emotional skills may even save your life.

Today, we’ll look at a few of the leading causes of depression and burnout among medical students and residents. It’s not an exhaustive list, but it covers the biggies. Next week, we’ll look at things you can do to combat these feelings and readjust your attitude for a healthier perspective.

The Burden of Debt

Debt is stressful for everyone, but it can be particularly stressful for those in med school and residency. You’ll likely end up with a lot of it ($150,000 or more, if you’re like others), but hey — you’ll be making the big bucks once you graduate, right?

Well, yes, and that’s a huge motivator for many. There are countless students who make it through a few years of med school and want out, though. Whether it’s temporary doubt or a blinding realization that they simply don’t want to practice medicine, these folks are faced with a terrifying question: How on earth will I pay off all that debt?

As a result, they feel trapped and hopeless. They push through every day because of fear. This creates tremendous imbalance in their entire lives.

Competition and Coat Envy

As you move forward with your education, you want nothing more than to feel respected, competent and valued. It’s natural and healthy to want to feel these things, as they boost self-esteem and self-worth.

However, the hierarchical structure of medical education often leads to feelings of inadequacy. If you’re like others, you’re sick of being asked what year you are. You feel like you constantly have to prove yourself, and you feel it’s unfair that people who are just a couple years ahead of you get much more respect. At times, your education might feel like a game of rank.

Everyone dreams of the long white coat. “Paying your dues” is a reality, and in medicine, it’s a very necessary one. That doesn’t make it any easier emotionally, though, and bottling up your resentment will only lead to more problems down the road.

You’re Always Working and Sleep is Scarce

Med students and residents put in grueling hours — 80-120 is normal, and even with laws in place putting caps on hours, exhaustion is the standard.

The hectic schedules of med students, residents and physicians can be physically and mentally draining, yes, but the effects are much more far-reaching. You spend less time with your family and friends. You spend less time with yourself, and may at times feel like your identity is dissolving into your education. On top of this, you’re always being evaluated, and you’re expected to perform your best no matter what. And it’s downright hard.

Awareness and honesty about the things that get you down is the first step towards change, though. And no matter how stuck you feel, there are things that you can do. Stay tuned for next week’s post for some tried-and-true tactics.

Have you ever felt depressed, burnt out or “stuck” as a med student or resident?

What did you do to get through it?   

Doctor Career: Sponsors

Though the views expressed above are solely the writer’s, Beloit Health supports “The Dose with Dr. Goodhook” and is partnering with Adventures in Medicine to create an open, inspiring and insightful community for residents and physicians. Click here to learn more about ways that Beloit Health is making practice purposeful.