When Saviours Suffer: Why So Many Doctors-to-Be Are Taking Extreme Steps
New Delhi: The medical profession is often described as one of the noblest professions, built around saving lives and caring for others. But behind the white coat, stethoscope and years of rigorous training, a growing number of medical students and postgraduate residents are struggling with an increasingly difficult reality.Data revealed by the National Medical Commission (NMC) in response to an RTI application has brought this crisis into sharp focus. According to the reported data, 64 MBBS students and 8 postgraduate medical students died by suicide between 2018 and 2022. During the same period, 153 MBBS students dropped out of medical colleges, while 1,117 postgraduate students dropped out across India.The figures are not merely statistics. Each number represents a student, a family, a career and a life that was lost or disrupted.The Pressure Begins Long Before ResidencyMedical education demands years of intense academic preparation. Students spend years preparing for competitive examinations, followed by demanding undergraduate training and, for those pursuing specialisation, another round of highly competitive entrance examinations.But academic pressure is only one part of the problem.According to doctors and resident representatives quoted in the report, medical students and residents frequently face long working hours, inadequate rest, hostile working environments, academic pressure, difficult relationships with seniors and a lack of effective institutional support.Postgraduate residents may be required to work extremely long shifts, sometimes stretching to 36 hours or more, while simultaneously managing clinical responsibilities, academic requirements, examinations and expectations from multiple levels of the hierarchy.The result can be a dangerous combination of physical exhaustion, emotional burnout and psychological distress.When Training Becomes SurvivalThe postgraduate years are supposed to be a period of learning, professional development and clinical growth.Instead, for some residents, the experience can become one of simply trying to survive the next duty, the next examination, the next night shift or the next interaction with a senior.A stressful environment becomes even more difficult when students feel that they have nowhere to turn.The report highlights concerns regarding inadequate counselling and support mechanisms for students who may already be struggling. Without accessible and confidential support systems, students at risk may continue suffering silently.There is also the issue of language and cultural barriers. Students come from different states, regions and linguistic backgrounds. Adjusting to a new institution, a new city, a new language and an unfamiliar academic environment can add another layer of stress.The Problem Is Bigger Than Academic PressureIt is easy to blame medical students' distress entirely on examinations or workload. But the problem is far more complex.The environment in which medical education takes place matters enormously.A system characterised by excessive working hours, inadequate rest, humiliation, bullying, toxic hierarchy, poor infrastructure, academic pressure and limited avenues for grievance redressal can gradually affect a student's mental well-being.The Federation of Resident Doctors' Association (FORDA) has also pointed towards the complex issues affecting residents beyond academic pressures alone.Medical education inevitably demands hard work. Long hours and stressful situations are sometimes unavoidable in clinical training. But hard work should not mean sacrificing basic human dignity, sleep, safety and psychological well-being.Recent Incidents Make the Concern Even More UrgentThe concern is not limited to historical data.The report also referred to recent incidents involving young medical professionals.In February 2024, a 23-year-old final-year MBBS student allegedly died by suicide in a hostel room at Maulana Azad Medical College.In December 2023, a third-year postgraduate resident doctor at Safdarjung Hospital allegedly died by suicide at his home in South Delhi.Such incidents force an uncomfortable question upon the medical community:How can a system designed to train people to save lives fail to protect the lives of those being trained?The Bond and the Fear of LeavingAnother concern highlighted in the report relates to the bonds imposed on medical students and residents in some institutions and states.Students who discontinue their courses may face substantial financial penalties or restrictions on appearing for examinations for a certain period.While bonds may have been introduced for legitimate policy reasons, the question is whether a student who is already struggling should be effectively trapped in an environment that they feel unable to continue in.There must be a distinction between encouraging students to complete their education and forcing vulnerable students to remain in an unbearable situation.As one doctor quoted in the report pointed out, students should have a reasonable exit mechanism if they genuinely cannot continue.Where Is the Institutional Responsibility?The responsibility cannot be placed entirely on the individual student.If dozens of students are dying by suicide and more than a thousand postgraduate students are dropping out, the response cannot simply be to tell students to "be stronger."The medical education system must examine itself.Institutions need mechanisms through which students can confidentially report bullying, harassment, excessive workload and other concerns without fear of retaliation.There should also be meaningful access to professional psychological support, confidential counselling, adequate rest, reasonable working conditions and effective grievance redressal mechanisms.Most importantly, these mechanisms must be accessible in reality, rather than existing only on paper.We Need to Stop Normalising ToxicityOne of the most dangerous phrases in medical education is:"We went through it, so you should go through it too."Previous generations may have tolerated excessive working hours, humiliation or toxic environments. That does not make those practices necessary or acceptable.Medicine should teach resilience, but resilience should not be confused with the ability to tolerate abuse.A demanding profession can still be humane.A resident can be expected to work hard without being degraded.A student can be held accountable without being humiliated.A doctor can be trained rigorously without being broken in the process.Doctors Are Saviours TooWe often teach doctors to recognise warning signs in patients.We tell them to identify symptoms early, intervene quickly and prevent tragedy whenever possible.Perhaps it is time to apply the same principle to our own profession.A struggling medical student is not a weak student.A burnt-out resident is not an incompetent doctor.Asking for help is not a failure.Leaving a toxic environment is not a failure.The medical education system must create an environment where seeking help is seen as a sign of awareness rather than weakness.The numbers revealed by the NMC should not simply become another statistic quoted in newspaper articles. They should become a reason for serious institutional introspection.Because behind every suicide statistic is a person who once entered medical college with dreams of becoming a doctor.The people who are training to save lives deserve a system that cares about saving theirs too.
