What’s Really Keeping the Doctors Away?

History would argue that doctors are a fundamental building block of human societies. From the swnw hierarchy of Ancient Egypt (1) through the first recorded use of the term “doctor” in 14th Century Britain (2) to today’s modern medical practice, it seems as long as there have been humans, there have been those charged with looking after their health. However, just because things have always been a certain way, we shouldn’t assume it will remain the case, as Elsevier Health’s 2023 Clinician of the Future: Education Edition report shows us (3).

“Clinician of the Future” is an annual series of reports focused on “identifying and providing solutions to address the changing healthcare landscape and helping students and clinicians navigate this new world.” In the recently released 2023 Education Edition, the insights of over 2000 medical and nursing students from 91 countries were included. What did they have to say? Well, a quarter of medical students in the US (and just under a quarter in the UK) are considering quitting their studies and leaving healthcare. Additionally, the majority of students reported that they were planning on entering into roles that wouldn’t involve them directly treating patients. Does the next generation have a reduced devotion to improving the lives of patients? Well, an overwhelming majority of respondents confirmed that they have the vocational drive to make a positive impact in their patients’ lives. So what is behind these concerning numbers?

The answer lies in the responses to another question: “Are you worried about your mental health?” to which the majority responded “yes.” Several factors are at play in mental health worries, including study–life balance, financial pressure and the cost of studying, academic pressure, knowledge and misinformation, and the worry of future shortages and burnout. These concerns are not unfounded; in both the general clinician population and amongst ophthalmologists, mental health disorders are prevalent (4).

As the Clinician of the Future report notes, the results represent just one point within a wider vicious circle – students are seeing clinician shortages and the mental ill-health facing those who decide to become clinicians. As a result, many are looking for other ways to have a positive impact on patients’ lives – without risking their mental health. Understandable as this is, shortfalls in incoming clinician numbers only exacerbates future shortages and risk of burnout.

How can this cycle be broken? As expected for a multifaceted problem, the report highlights a number of potential focus points – one in particular being the provision of more guidance and support. It is well documented that, despite increased awareness of mental health conditions within the medical profession, there are still barriers to seeking treatment, including time limitations, a lack of convenient access, worries about the impact of medical licensure, and the perceived stigma of mental illness (5).

Studies highlight evidence-based interventions that reduce the stigma of mental health and endorse support for colleagues who have psychological difficulties as potential ways of improving both attitudes towards mental health and help-seeking behaviors (6). But, of course, though intervention at any point can prove important, the best time to instill such behaviors is at the beginning. As Diane Evans-Prior, an attendee at the US Clinician of the Future Education study roundtable, explained, “I see this as an opportunity, because if our students are concerned about their mental health, as educators, our way to respond to that is to imbue our programs with opportunities to thread self-care and really to utilize effective debriefing techniques in moments of crisis for our students.”

Although history shows that doctors have long been looking out for the health of others, it also shows that their own mental health has been less well addressed, to say the least. Although the statistics discussed here from the Clinician of the Future report show a decreased desire of the future generation to be on the front lines of patient care, it also highlights that this generation is more willing to take the steps to look out for their mental wellbeing. Being a clinician shouldn’t mean dealing with one’s mental ill health alone, but if this perception – and any underlying truths – are not addressed, fewer and fewer individuals will elect to enter the field. At its most vicious, this cycle may eventually lead to the point where there are no clinicians of the future.

What do you think can be done to increase the number of patient-facing clinicians in future generations? How can we work to address the clinician shortage in the short term? How can we tackle the mental health challenges facing clinicians? Please let us know in the comments below or at: edit@theophthalmologist.com.