Medical school administrators have known for years that initially healthy clinician trainees go on to experience depression, burnout, and suicide at higher rates than the general population. Early efforts to remedy the problem have focused on improving trainees’ recognition of warning signs and building their resilience with wellness programs.

But putting the onus on clinicians to strengthen their character has allowed administrators to mostly ignore the taxing training environments and policies that, starting in medical school, contribute to mental illness and suicidality, writes Dr. Elisabeth Poorman, a general internist and clinical instructor with the University of Washington School of Medicine.

Her commentary will be published Aug. 5 in the Journal of Patient Safety and Risk Management.

“To understand the risk of mental illness and suicide as occupational hazards” of the practice of medicine, Poorman writes, “would shift our conversation from individual strategies to systemic ones.”

“There’s been a lot of speculation about individuals’ risk factors that may predispose them to depression. I would argue that individuals’ risk factors continue to be raised as a red-herring excuse to avoid making the big, systemic changes needed to tackle this problem,” she said.

As an intern, Poorman experienced an episode of depression and had difficulty finding support through recommended channels. “Colleagues told me that what I was experiencing was normal, and I felt strongly that it was not. With treatment, I got better very quickly, but it took almost a year to make that happen. Why does such a delay exist?”

Poorman wrote the commentary for medical students, residents, and practicing physicians—and their mentors, she said. “I want to call attention to the gap between what educators think and say is available, in terms of mental-health support, and what trainees experience.”

She also voiced concerns about programs in which a faculty member is identified as a point of contact for a trainee seeking support for depression or burnout—and that same faculty member is evaluating residents’ skills and readiness. This conflict is exacerbated by the lack of clear guidelines about what mental-health information may be appropriately shared, in a professional context, and what should remain confidential.