The Hidden Crisis: Mental Health Challenges in Medical School
- Nate Swanson
- May 23
- 13 min read
Table of Contents:
My Story: How Depression and Suicidality Affected My First Year of Med School
I remember sitting alone at home during my first year of medical school, trying to study for an upcoming exam. I hadn’t slept the night before—something that had become all too common—and the sleep deprivation was compounding my long-standing mental health struggles. My mind felt sluggish. No matter how many hours I spent with my notes, I couldn’t retain information. The stress mounted. I began slipping in classes, and with every poor quiz grade, my self-worth plummeted further.
I hated medicine. I felt like an imposter, convinced I didn’t belong, and baffled that anyone had ever thought I was capable of becoming a doctor. Studying felt like torture, but that wasn’t the real problem: I wasn’t happy. I hadn’t been for a long time. Since I was thirteen, not a day had passed without thoughts of suicide. Medical school didn’t create that pain, but it magnified it—and I broke.
At my lowest, I decided to end my life. As a final cry for help, I emailed my advisor and told her, plainly, that I was feeling acutely suicidal. I was also facing ongoing, unresolved health issues, which only made everything feel more unbearable. Her reply was immediate: she urged me to call her. I did, though I could barely speak through the tears. We talked for an hour. She listened, reassured me, and gently convinced me to go to the ER.
Therapy hadn’t worked in the past, and my medications weren’t helping, so I was skeptical. But I went. I stayed at the hospital for a while, where I spoke extensively with a psychiatrist who made me feel heard and supported. We revised my treatment plan: new meds, a new therapist, and, most importantly, a leave of absence to get my sleep, health, and mind back in order. It was the hardest decision I’ve ever made—and the best one.
Today, I’m sleeping better than I have in years. My health has improved, I’ve undergone a life-changing surgery, and for the first time since I was a teenager, I’ve had days where I haven’t thought about suicide at all. The fog is lifting, the medications are working, and I’m on a steady path to recovery. With time on my side before returning to school, I’m stepping into a new role: sharing my story and writing full time as a blogger—because if I’ve learned anything from all of this, it’s that silence only deepens the pain.
Medical school is often described as “drinking water from a fire hose” – an immense volume of knowledge and responsibility in a short time. The intensity takes a toll: roughly one in four medical students shows signs of depression, and about one in ten has seriously contemplated suicide. In fact, medical students are three times more likely to die by suicide than their peers in the general population. This emotional erosion doesn’t happen all at once; it builds year by year, even as it remains largely hidden behind a culture of stoicism and stigma. The following narrative traces this progression through each year of medical training, interweaving students’ experiences with data that reveal a mental health crisis in our medical schools.
Why First-Year Medical Students Are Vulnerable to Mental Health Decline
Most students enter medical school bright-eyed and full of optimism. Yet for many, the first year marks the beginning of an emotional decline. X from California, a first-year student, recalls feeling scared and out-of-place almost immediately. Only a year earlier, she had been “bursting with excitement” after her acceptance, but that enthusiasm faded as classes began. Early in the term she failed her first anatomy exam and began doubting whether she belonged in medical school. She grew socially withdrawn and argued often with her partner, as nearly all her time and energy went into studying. “The sheer amount of material and the level of detail – it significantly impacted my mental health,” she admits, reflecting on how the intense competition and workload eroded her confidence. Unfortunately, X’s experience is far from unique. More than a quarter of students report symptoms of depression by the end of first year, even if they had felt mentally healthy at the start.
Indeed, research indicates that new medical trainees often begin with mental health on par with or better than their peers, but after the first year the cracks start to show. Academic pressures mount rapidly: one moment you’re congratulating yourself on getting in, and the next you’re inundated with lectures, labs, and daunting exams. As one study noted, medical school is a breeding ground for feelings of inadequacy – even top students find themselves struggling under intense academic competition and a firehose of information. By the end of Year One, the combination of heavy workload and high expectations has planted the seeds of chronic stress.
Second Year of Medical School: When Stress Becomes Dangerous
In second year, the academic demands crescendo, and a single exam can feel like a make-or-break moment for one’s future. For many U.S. medical students, that exam is Step 1 of the United States Medical Licensing Exam – historically a high-stakes test taken at the end of second year. M from Arizona, a second-year student, describes how preparation for Step 1 pushed him to a breaking point. He spent upwards of 12 hours a day drilling practice questions and reviewing material. “I was doing everything right on paper,” he says, “but I started slipping into this dark place without realizing it.” When M scored lower than expected on a full-length practice exam, he spiraled. He isolated himself from friends and skipped meals, filled with a growing sense of failure. In his lowest moments, he later admitted, he felt that life would be easier if it just ended. What should have been a mere exam became, in his mind, a verdict on his worth as a future doctor.
M’s story is painfully common. The pressure of Step 1 (which, until recently, was numerically scored and a major factor in residency selection) has long been cited as a major stressor for second-year students. A 2022 study of second-year med students during their dedicated Step 1 study period found that 72% experienced a decline in overall quality of life, 77% felt burnt out, and 81% reported heightened anxiety while cramming for the exam. By the end of the preclinical phase (the first two years of training), many students are emotionally frayed. Studies show that after about two years of medical school, students tend to suffer significant burnout, stress, and anxiety – putting them at significant risk for developing depression. In other words, by the time they don their short white coats and enter the clinical wards, a substantial number of medical students are already running on empty internally, even if outwardly they appear to be coping.
Clinical Rotations and the Breaking Point: Mental Health in the Third Year
Third year is a turning point. Students leave the classroom for the hospital and clinics, where long hours and emotional upheavals become part of daily life. The transition from textbooks to patient bedsides is profound. Entering clinical settings brings students face to face with sick and dying patients – often for the first time – and immersing oneself in human suffering each day can leave its mark. J from New York, now a third-year student, remembers the first time she watched a patient die during her internal medicine rotation. “I knew intellectually that death is part of medicine,” she says, “but watching my patient slip away – I went to my car afterward and just broke down sobbing.” J found herself having nightmares about patients and dreading each new shift. The emotional toll of seeing trauma and loss on a regular basis compounded the fatigue of working 12- to 14-hour days. She started to feel numb and detached, classic signs of burnout.
Research confirms that third-year clinical rotations are rife with stressors that can trigger or worsen mental health issues. One longitudinal study noted that third-year medical students are frequently exposed to potentially traumatic events, including witnessing patient suffering and death, mistreatment by superiors, and even instances of bullying or harassment. Not surprisingly, these experiences correlate with spikes in anxiety and depression during the clinical years. “Last year, a friend called me and said that for the first time in his life he thought he was depressed and wasn’t sure he wanted to continue with medical school,” recalls one student, now a fourth-year, about the start of his third year. “He was embarrassed and didn’t know who to talk to about it.” Such stories underscore a sobering reality: by third year, many medical students are nearing a breaking point, struggling with depression or severe anxiety, yet they often suffer in silence out of shame or fear of jeopardizing their careers.
The culture of medicine can exacerbate these issues. Third-year students work within a strict hierarchy – at the bottom rung – and reports of mistreatment are distressingly common, from public scolding to belittling nicknames, further chipping away at self-worth. The result is a perfect storm: long hours, high responsibility, exposure to life-and-death situations, and at times a lack of support or even outright abuse. It’s little wonder that by this stage, burnout risk has skyrocketed – one review found that the risk of burnout doubles from the third year to the final year of medical training. In human terms, that means a student who was mentally healthy in college can, by their clinical years, become a young adult on the verge of emotional collapse.
The Emotional Weight of Fourth Year and the Transition to Residency
By fourth year, one might hope the worst is over. In many programs, the final year of medical school allows more flexibility – students apply for residency positions, go on interviews, and might have lighter course loads for a semester. For some, mental health does improve with this relative respite. But for others, fourth year can bring its own stresses: uncertainty about the future, mounting debt, the pressure to impress during rotations or sub-internships, and fear of not matching to a residency. And for those who have been suffering quietly in earlier years, the cumulative burden can become unbearable by the end.
In 2015, K from Missouri – a talented fourth-year student just weeks away from graduation – died by suicide. He was 26 years old and had seemed, on the surface, to be thriving. In reality, K had recognized he was becoming depressed during medical school, but he was so fearful of the stigma and potential career repercussions that he sought counseling under a fake name, paying in cash to avoid any record of treatment. His parents later learned that K was not alone in his struggles: one of his close friends revealed that “20 to 30 percent of kids in our class were doing the same thing” – silently battling mental health issues and hiding their pain. The tragedy of K’s death is sadly not an isolated incident. In recent years, suicides of medical students have been reported from coast to coast – from a third-year student in California who took his life during clerkships, to a student in New York who died just months before starting her residency.
Even those who make it through medical school continue to face elevated risks. In one study, 9.4% of fourth-year medical students and new physicians (residents) reported having suicidal thoughts in just a two-week period. And once they graduate, doctors-in-training enter a system where suicide sadly remains a leading cause of death. An estimated 300 to 400 U.S. physicians die by suicide each year – roughly the size of an entire medical school class lost annually – and that figure does not even account for suicides among medical students, which often go untracked by institutions. These numbers drive home a chilling point: the culmination of medical school is not the end of the mental health crisis, and for some it is tragically too late.
How to Cope with Mental Health Challenges in Medical School
Confronted with this epidemic of depression and burnout, medical students and institutions are beginning to seek solutions. What can be done to help our future doctors cope – and to prevent more senseless loss of life? The good news is that a variety of strategies have shown promise, from personal coping techniques to systemic reforms. Below are some approaches that students and schools are adopting to support mental health:
Reaching Out Early and Often: The most crucial step for any student in distress is to seek help – whether through campus counseling services, student mental health programs, or an external therapist. Tragically, only about one-third of medical students who experience burnout or depression actually seek professional help, largely because of fear that admitting struggles will jeopardize their career. This culture of silence can be deadly. Students are now working to change it by normalizing conversations about mental health. Many medical schools offer confidential counseling, and student-led mental health clubs or peer support networks can provide a safe space to talk. “You are not the only one feeling this way, and getting help is a sign of strength, not weakness,” says a counselor who works exclusively with medical trainees. Breaking through the isolation and shame by talking to someone – a therapist, a dean, a friend – is often the first step toward recovery.
Peer Support and Community: Building connections with classmates and mentors can act as a powerful buffer against stress. Recognizing this, some medical schools have restructured aspects of training to foster closer communities. Several institutions (including major programs like Johns Hopkins and Weill Cornell) have woven resilience training and peer-support groups into the curriculum. For example, after a fourth-year student’s suicide in 2016, the Icahn School of Medicine at Mount Sinai created a program called “PEERS” where students meet in small groups with faculty facilitators throughout all four years to discuss stressors specific to each stage of training. In smaller learning communities, faculty are more likely to notice when a student stops showing up or appears distressed – and can quickly connect them with help. Classmates, too, look out for each other: an informal check-in from a peer (“Hey, you’ve seemed down, want to talk?”) can sometimes make all the difference. The bottom line is that no student should have to suffer alone. Medical culture is slowly shifting to emphasize teamwork and mutual support, not just competition.
Self-Care and Healthy Habits: While it may sound cliché, basic self-care is vital in an environment as stressful as medical school. Regular exercise, adequate sleep, and time for hobbies or family can be literal life-savers. There is research to back this up: one systematic review found that physical activity is strongly associated with reduced burnout and improved quality of life among medical students. For many students, working out or even a simple walk provides a needed mental break from studies. Mindfulness practices, such as meditation or yoga, have also gained popularity as tools to reduce anxiety. Another student, who went through severe depression in school and later recovered, recalls that once he started treatment, he gradually returned to routines that kept him grounded – going to the gym, attending family gatherings, and getting full nights of sleep – and his intrusive suicidal thoughts finally began to subside. In short, maintaining some semblance of a normal life outside of medicine – eating well, staying connected to loved ones, doing activities that spark joy – is not indulgent, but rather essential for mental health.
Institutional Reforms: The medical education system itself bears responsibility, and change is underway. In recent years, a majority of U.S. medical schools have shifted to pass/fail grading in preclinical courses, reducing the cutthroat competition that once pitted students against each other. Many schools have also added wellness programs, resiliency curricula, and improved access to mental health resources. Some are experimenting with adjustments to workload and scheduling – for instance, limiting overnight call for students or ensuring regular mental health check-ins. National organizations are also stepping up: the Accreditation Council for Graduate Medical Education (ACGME) implemented work-hour restrictions in residency to combat fatigue, and several professional bodies now host annual wellness conferences. The American Medical Association has urged academic centers to provide “free, confidential, and stigma-free mental health services” for medical students and trainees. These efforts acknowledge that systemic problems require systemic solutions. By creating a training environment that values well-being as much as academic achievement, the hope is to prevent burnout and depression before they begin.
A Call to Action: It's Time to Prioritize Mental Health in Medical Education
Ultimately, turning the tide on medical student suicide and depression will require a cultural shift within medicine. The courage and compassion that medical students show their patients must be extended to themselves and each other. This means erasing the stigma that still clings to mental illness in the profession. As one student who battled depression observed, “I have seen and experienced the destruction that staying silent can cause.” He decided to speak openly about his struggles to assure others that they are not alone, saying, “I encourage everyone to share their stories and help erase the stigma”. His message is a clarion call: the vulnerability of asking for help should be met with support, not judgment, in our medical schools.
Faculty and administrators, too, must actively foster an environment where wellness is prioritized. There should be no penalty – explicit or implied – for a student who takes time for mental health care. Every medical school should educate students from day one that seeking help is not a sign of unfitness, but a mark of maturity and insight. Mentorship programs can pair students with physicians who have navigated their own challenges, demonstrating that one can struggle and still become an excellent doctor. And when warning signs emerge (a student withdrawing socially, falling behind academically, or vocalizing hopelessness), schools must intervene with compassion and resources, not silence.
The stakes could not be higher. We invest so much in training new doctors; we cannot continue to lose them to an illness that is very often treatable. Depression in medical school is a quiet epidemic, but it is one we have the knowledge and tools to address. It’s time for the culture of medicine to catch up with that reality and make mental health a priority at every level of training. This means taking concrete steps – from expanding counseling services to rethinking punitive grading and licensing questions that deter students from getting therapy. It means leaders publicly affirming that physician wellness is inseparable from patient care quality.
For those currently struggling in the halls of academia: you are valued, and help is available. For their colleagues and teachers: we must notice, and we must care. And for the broader medical community: we must continue to push for change. The lives of our healers-in-training depend on it. If we can instill in the next generation of doctors that seeking help is not weakness but wisdom, we will not only save lives – we will shape a more compassionate, resilient profession for years to come. No one who dreams of healing others should have to destroy themselves to do it.
If you like this one, check out this one next: Why Medical Students Suffer From Imposter Syndrome And What To Do About It
References
Rotenstein L.S. et al. (2016). Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA, 316(21), 2214-2236 pubmed.ncbi.nlm.nih.gov.
Murphy B. (2019). How often do physicians and medical students die of suicide? American Medical Association (AMA) News ama-assn.orgama-assn.org.
Morris N. (2016). Medical school can be brutal, and it’s making many of us suicidal. The Washington Post, Oct 9, 2016 washingtonpost.com.
Anonymous. (2021). Depression: A Medical Student’s Perspective. Academic Medicine, 96(5), 765-766 journals.lww.com.
Paturel A. (2020). Healing the Very Youngest Healers. AAMC News, Jan 21, 2020 aamc.orgaamc.org
Green S. (2022). Depression and Burnout During the Clinical Years. Geisel School of Medicine News, March 3, 2022 geiselmed.dartmouth.edu
Buscaren D. (2016). After student suicides, medical schools look for changes. WHYY (NPR), Sep 8, 2016 whyy.org
Tackett S. et al. (2022). Student well-being during dedicated preparation for USMLE Step 1 exams. BMC Medical Education, 22, Article 16 bmcmededuc.biomedcentral.com.
Haglund M. et al. (2009). Resilience in the third year of medical school: a prospective study of stress and well-being. Academic Medicine, 84(2), 258-268 pubmed.ncbi.nlm.nih.gov.
Taylor C.E. et al. (2022). Physical activity, burnout and quality of life in medical students: a systematic review.The Clinical Teacher, 20(2), e13548 pmc.ncbi.nlm.nih.gov.
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