burnout, psychological

The Library of the Royal College of Surgeons of England is home to a meticulously kept archive of the lives of medical students who attended Sir James Paget's anatomy lectures at St Bartholomew's Hospital in London, UK, between 1839 and 1859. Published in 1869, “What Becomes of Medical Students” is Paget's personal appraisal of his apprentices' achievements, ranging from “distinguished success” to “scandalous misconduct”. Although many went on to differentiate themselves, of the 1226 students under his tutelage, five died by suicide—a rate roughly 25 times higher than the male suicide mortality rate during that period.

Although the knowledge of medicine's heavy toll on its workforce is not new, scant attention has been devoted to this issue historically. But was medicine ignoring an internal crisis? That was the question posed by S Dana Hubbard—the Director of the Bureau of Public Health Education for New York City—in a 1922 letter published in the American Journal of Public Health. Hubbard chronicled the suicide rates of various professions, noting that physicians took their own lives more than twice as often as the next highest field (lawyers). Pointing out that “the occupational strain is greater in medicine than in any of the other professions”, Hubbard insisted that “our scheme of medical practice, as it relates to hours and relief, be revised”. Despite the wide circulation of the letter, few changes materialised.