, 2025-05-09 11:11:00
Be sure to scroll down after this story to find links to extensive Medscape coverage addressing mental health and medical professionals.
Any physician-in-training learns to ask patients a question at the top of their appointment: How are you doing? Mental health is as much of a vital sign as a pulse. But recent research suggests that it’s future healers themselves who are not always doing okay.
Medscape’s latest Medical Student Lifestyle Report found that 30% of current medical school students report feeling “very depressed,” 15% have had thoughts of suicide, and 43% said they cope with issues like burnout by isolating themselves.
As much is evident in the literature — systematic reviews of research over the past few decades continually describe high rates of depression, anxiety, and suicidal ideation in medical student populations. Being a med student can be an independent risk factor for developing a mental health condition, especially in “a pressure cooker environment for distress,” explained Samia Hasan, MD, director of Mental Health Services at Indiana University (IU) School of Medicine, Indianapolis, a facility dedicated to the mental health of medical school students.
“[Medical students] tend to be very high-achieving people who come into school with good mental health. Once they’re in medical school, the change [in mental health] compared to nonmedical school peers is dramatic,” said Mental Health Clinician Stacie Pozdol, MS, LMH, who works alongside Hasan.
Recent tragic deaths by suicide among trainees, including Will West, a resident at George Washington University, Jing Mai in 2022, and, in 2017, third-year medical student Kathryn Stascavage, have elevated the conversation of mental health in medical school, but much is left unsaid: Because of institutional barriers and stigma, students often struggle in silence.
Many medical school students Medscape Medical News contacted for this piece expressed reticence in sharing their stories around mental health because of the risks associated with doing so, including looming questions about mental health on licensing boards and credentialing applications and feelings of fear or shame.
The next generation of healers is hurting — and amid a physician shortage in this country, that could be one of the most significant issues facing this generation. To uncover what it will take to serve them better, Medscape Medical News spoke to medical students and physicians leading the effort to help doctors-in-training thrive.
What’s Driving Med Students’ Mental Health Struggles?
The unique drivers to mental health distress in medical school are many: A competitive, high-demand academic environment with a massive amount of material to learn; clinical practice that requires trainees to bear witness to pain, disease, and death with little time to process what you experience; the personality traits of doctors in training themselves, which puts them at an increased risk for mental health conditions; and, of course, the culture of medicine, which includes an expectation to work at the expense of one’s self.
Medical school also carries high levels of financial debt, increasing the stakes if things start to spiral.
Physicians in training are also entering medicine after the unprecedented stressors of the COVID-19 pandemic and are studying during a time of high sociopolitical stress and ever-changing laws and policies (such as women’s reproductive healthcare post-Dobbs). This creates stress, and these topics and stressors are not always discussed in medical school curriculums, said Annelise Silva, National President of The American Medical Student Association (AMSA).
Students Medscape Medical News spoke to readily discussed the pressures of medical school success, the unbelievable stress of training itself, and competition.
Jake Vogel, a fourth-year student at Lake Erie College of Osteopathic Medicine, attended school hours away from home and was already anxious as he had only gotten into one medical school. Then, he failed his first practice quiz and was consumed with the thought that medical school was too rough. “Medical school is like nothing else I have ever been through,” he said. “It may be hard for people to relate. The sheer amount of information students have to learn is tremendous.” In failing one exam, Vogel started to feel like his years of undergrad and studying for the medical college admission test were being thrown away — and that he wasn’t cut out to be a doctor.
“By the point people get to medical school, if students are struggling, they can feel like they’re losing their life — and their life’s work,” said Rachel Davis, MD, chief of Psychiatry Practices at the University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, a facility that exclusively provides counseling to students, residents, and fellows.
A review of research on deaths by suicide among medical students found academic stress and failures to be the most common motives.
Austin Snider, a student at IU School of Medicine, had a similar experience in his first year. After failing a pharmacology exam, he spent 9-10 hours a day in bed for a week, feeling hopeless and overflowing with imposter syndrome. “I felt like I couldn’t do school at all. It was debilitating for me to have that failing experience and feel like I wasn’t good enough to be there,” he said. “I was thinking, ‘I’m not smart enough to be here’ and ‘I don’t deserve to be in medical school.’ I thought everybody else was doing great, and I couldn’t even pass a simple exam.”
The experience led him to self-isolate and second-guess medicine. It took his wife telling him that he’d changed and was no longer himself for him to reach out for the support he needed on campus.
While medical school is full of objective grading, more subjective challenges also contribute to distress, said Silva, “There are times when you have to try to outperform your fellow medical students to get somebody to like you more or to show that you’re more competent.”
Davis said that imposter syndrome in particular is a top issue among medical school students. An ongoing 10-year study by Davis and her team has found that 29% of medical students meet the criteria for “maladaptive perfectionism,” and 76% identify as having at least “moderate imposter phenomenon.”
Working through imposter syndrome involves distress tolerance, recognizing a common humanity (knowing that everyone struggles), and resetting expectations or beliefs around what success means (even good physicians fail exams occasionally), Hasan and Davis said.
Davis noted that it also involves disclosure among both students and providers. “It’s important to let people know that they’re not the only ones with depression,” said Davis, who says she struggled with severe depression in medical school and that self-disclosure from providers working with a student population can be useful.
Workload vs Expectations vs Reality
Of course, some realities of medicine are unavoidable, including the intense work required to master information and care for patients in high-stake situations and the exposure to human pain, suffering, and death.
“You almost have to become desensitized to certain things in medicine,” said Vogel. “I saw my first patient pass away recently, and within 5 minutes, the doctor was in the next room and was happy because that patient was being discharged after being in the hospital for a week. The reality is you don’t have the time during clinical rotations to process the fact that you just saw somebody’s life end.”
Then there are the damaging aspects of healthcare culture itself. “There are expectations within medical culture that you’re supposed to sacrifice yourself, you’re supposed to work hard, and you’re supposed to give things up, and those personal sacrifices start pretty early,” said Hasan. Such sacrifices include missing life events such as weddings, not seeing your family as much, or not being able to start a family, as evident in rising levels of infertility among physicians.
Before entering medical school, Donya Ahmadian, MPH, a student at St. James School of Medicine, Park Ridge, Illinois, training to be a psychiatrist, said she always knew she wanted to be a physician. However, when Ahmadian found herself struggling, the things she enjoyed from her premedicine life helped. “The adjustment made maintaining a sense of self necessary but uncertain at times. After spending a lifetime knowing that medicine was for me, this change was something that ultimately made devoting time to the activities and wellness practices that ground me even more vital.”
Silva said that she doesn’t think many medical students are adequately prepared for these stressors and that, by and large, students are recognizing that this system is the cause of a lot of distress.
While Ahmadian, Vogel, and Snider were admittedly surprised by many of the challenges they faced, they are all involved in student mental health and wellness initiatives. They represent a new generation of physicians who simply expect to be treated differently and expect to be able to better balance home and work life.
Barriers to Wellness
Arguably, more mental health support is available to medical students today than ever before, but stigma and institutional barriers continue to silence students.
Medical students often face three types of stigma around mental health — internal, stemming from personal beliefs about what it means to receive mental health care; external, from others’ expectations and judgments; and institutional, a pervasive attitude within healthcare, explained Stefanie Simmons, MD, chief medical officer at Dr. Lorna Breen Heroes’ Foundation. The group works to reduce burnout and protect the well-being of healthcare workers and was started in memory of Lorna Breen, MD, an emergency room physician who died by suicide in 2020.
“There have long been questions on medical licensing applications and hospital credentialing applications that ask about lifetime history of any diagnosis or treatment for a mental health condition or substance use disorder,” said Simmons.
Simmons said many medical students are advised by well-meaning professionals to stay quiet about their mental health — and told they are putting their careers at risk if they receive mental health care. Snider, who received treatment at IU, said he initially hesitated due to concern about discrimination.
Questions around mental health on applications have also historically been placed alongside “moral character questions,” such as whether or not someone has been convicted of a felony, said Simmons. “Mental health is positioned as a moral issue, as opposed to a health issue.”
“I think the mental health crisis in physicians is the biggest issue facing physicians today, and it’s not talked about enough,” said Aditya Nellore, MD, a current occupational medicine resident at the Harvard T.H. Chan School of Public Health, Boston. “Yet, the baked-in culture in medicine is counter to vulnerability. It’s like struggling with your mental health is seen as a weakness, so it’s easy to feel like you’re not going to be as good of a doctor as someone else if you’re struggling.”
When Nellore was a college undergrad, he struggled with severe untreated mental health issues, including depression, anxiety, and suicidal ideation. “I couldn’t sleep, and everything was going wrong. I just wasn’t myself.” His struggles negatively impacted his performance. Eventually, he was kicked out of school for poor grades.
Years later, after getting help, Nellore returned to school and pursued medicine. “It was a big uphill battle because of how competitive medical school is, and I already knew there was a stigma around mental health,” Nellore said.
Eventually, when interviewers for residency programs asked Nellore what his proudest accomplishment was, he told them the story of how he persevered in the face of mental health struggles. In March of 2022, he found out he hadn’t matched to a single position.
“I was shell-shocked,” he said. After reaching out for feedback, he was told that people found it “unprofessional” and “inappropriate” to discuss mental health during an interview. “I was devastated. It felt like I couldn’t be open about what I’ve been through and who I am.”
Nellore was forced to restart the match process. “That was really, really difficult for me to handle,” he said. Nellore wound up switching specialties. While he was more guarded the second time around, he still disclosed his mental health struggles — and he matched.
“Being open is important for my personal growth and who I am as a human being. If sharing my story is going to blacklist me from somewhere, then that’s not a place that I want to be,” he said. “Thankfully, I found a place that embraces that and loves that fact about me.” Nellore has continued to be vocal about mental health, including on his social media platform @the.singing.doctor.
To reduce barriers to care and stigma on the institutional level, Dr. Lorna Breen Heroes’ Foundation is working to eliminate stigmatizing language around mental health. So far, they have removed stigmatizing language from 30 state licensing organizations’ licensing boards and over 400 hospitals’ credentialing applications.
While being licensed or credentialed may seem far off for medical students, Simmons said: “It’s very important to remove these barriers to mental health care. Because until they’re eliminated, you can tell people to seek mental health care, but the lack of surety around how that information will be used in future for employment decisions, licensing, and credential still exists.”
Med School Mental Health: Today and Tomorrow
Improving mental health in medical school involves big-picture cultural changes, institutional programs, student-run support groups, and even students being more open among themselves.
For one, teaching doctors to prioritize their mental health early, before they become doctors, could go a long way toward improving the situation in the entire field. “You’ve got physicians leaving the field due to burnout,” explained Davis. “If you can create a better balance at the outset, you would hopefully impact attrition from the field and make a big difference in the trajectory of somebody’s well-being.” She noted that substance use disorders, for example, can take 15-20 years to develop.
A 2023 JAMA Internal Medicine study found that most medical schools provide some mental health services for their students; 124 of 157 US schools offered free therapy sessions, too.
Many medical schools have also developed dedicated mental health programs like the ones at IU and CU, which provide counseling exclusively to learners. About half of the medical school students at IU and CU utilize the services of their school’s dedicated facilities. These facilities prioritize reducing barriers to care, such as time, ease, and confidentiality. They might exist separately from the medical school or utilize an entirely different electronic medical records system.
These centers have also been developed to meet students’ unique needs. “[Students] don’t have to explain to us what a Step 1 exam is. Typically they can find an appointment within a week, and they can just jump in and say, ‘this is the issue I’m having, and I’d like to address it,’” Hasan explained of the services at IU.
Snider said that, for many, university mental health services can be lifesaving: “I want everybody to know you don’t have to go through this alone.”
Others say there’s much more work to be done. Silence is still pervasive even when services are available. Hasan said that while they see half of the medical school class during their medical school years, not everyone talks about their visits, and silence around seeking support can make it feel like no one else is struggling.
Ahmadian began seeking therapy before attending medical school and plans to continue throughout her psychiatry training. But she said that seeking out mental health services offered by a medical school doesn’t always feel like “the norm.” “We’ve come a long way, but students still feel an implicit stigma surrounding transparency around seeking those resources. My hope and dream for medical curricula at large is to begin integrating more mindfulness and behavioral health tools and practices within the day-to-day student life experience.”
Healthcare, as a field, is slow to change, but cultural shifts are happening. “While no residency program openly asked me about my mental health, from the conversations regarding mental health I have had with the programs, they all echoed the importance of mental health,” said Vogel.
“There needs to continue to be that critical look at what’s being expected as the increasing expectations of medical students grow and grow and grow,” said Silva. She pointed to 8-hour licensing exams as an example. “I’m not saying that we shouldn’t have our licensing exams. We need exams to build a benchmark, but certain pieces within the system could be re-looked at. How do we build something holistic?”
Medical schools are also changing the curriculum, making some exams pass-fail, and altering the structure of rotations and the timing of board exams.
In 2017, the Accreditation Council for Graduate Medical Education revised its Common Program Requirements to “emphasize that psychological, emotional, and physical well-being are critical in the development of the competent, caring, and resilient physician” in accredited residency and fellowship programs. “It’s a recognition that you have to do preventative wellness work and create mental health support,” said Hasan.
Student-led peer groups are more common on campuses, too, as doctors-in-training realize that anxiety, self-doubt, and imposter syndrome are shared struggles.
Vogel, for one, founded the peer support program Medtal Health, a free, anonymous support program for medical school students conducted on Zoom. “I don’t know a single person in my school that hasn’t had thoughts that they aren’t supposed to be in medical school or that they aren’t good enough,” he said, noting that many open up about their feelings on calls and feel less alone. He also noted that there are times when no one shows up to scheduled Zooms. “While that could mean that nobody is struggling for that day, it also could be that people are struggling in silence because they feel that they don’t deserve to have a voice or have their thoughts heard.”
Davis said she’s noticed that “everybody wants to be a peer support specialist,” but “no one wants to use the peer support,” adding, “I think people are used to being so high functioning, they don’t want to be seen as someone who needs to talk to a peer.”
Ahmadian is part of the Psychiatry Student Interest Group Network (PsychSIGN), a national group of medical school students interested in psychiatry that provides mentoring opportunities, wellness seminars, guidance through the match process, and more. AMSA supports and informs medical school students via community, mentorship opportunities, chapters nationwide, and offers courses around topics such as navigating reproductive health in medicine as part of a “hidden curriculum” in medical school to fill gaps in education.
Ahmadian said it is “up to us as future practitioners to address this deeply woven culture within medical school, residency, and throughout the practice of care” and the “associated stigmas which keep doors to healing and recovery more difficult to access.”
“I would encourage my colleagues to be brave and share their stories,” added Nellore. “I think the more people are vulnerable, the more tolerant others have to be about it, and the more understanding and empathetic people will become. Even sharing stories one-on-one or in small groups is powerful. There are ways to further the conversation without being super public.”
Read more about the mental health challenges and solutions for medical professionals:
VIDEO: Beat Med School Burnout
VIDEO: Medical School Expectation vs. Reality
VIDEO: You Belong in Medical School—Don’t Let Imposter Syndrome Win
How These MDs Conquered Imposter Syndrome
How a Mindset Shift Can Transform the Way You Practice
Why Postpartum Depression Hits Physician Moms at High Rates
‘I Feel Alone’: Why Loneliness is Now Common Among Doctors
Why Do MDs Have Such a High Rate of Eating Disorders?
Why ‘Resilience’ Can Be a Loaded Term for Healthcare Workers
