Previous research has shown that the issue of burnout in medical training is a significant problem throughout the United States.

“Recent data show that many medical students in the U.S. meet criteria for burnout, but few studies have explored the relationship between medical student alcohol abuse or dependence and educational debt,” says Lotte N. Dyrbye, MD, MHPE, FACP. Financial debt has been previously associated with alcohol abuse and dependence in the general population. A recent national sample of college-educated adults aged 22 to 34 in the U.S. showed that nearly 16% had alcohol abuse/dependence.

For a study published in Academic Medicine, Dr. Dyrbye and colleagues surveyed medical studies about their alcohol abuse/dependence, burnout, depression, suicidality, quality of life (QOL), and fatigue. The authors note that this is the first study to explore the relationship between alcohol abuse/dependence and burnout among medical students.

Striking Results

After receiving more than 4,000 completed surveys from medical students, the research team found that about one-third met diagnostic criteria for alcohol abuse/dependence. “This rate is about double the rate that has been seen in age-matched non–medical students,” Dr. Dyrbye says, “and burnout and high educational debt were key reasons for this strikingly high rate.” The study team noted that alcohol abuse was strongly associated with depression, low mental QOL, and low emotional QOL. Emotional exhaustion and depersonalization are aspects of burnout, a syndrome characterized by high emotional exhaustion and high depersonalization among physicians and medical trainees. These aspects were strongly associated with alcohol abuse and dependence.

Several important risk factors emerged as independent risk factors for alcohol abuse and dependence among medical students. These included:

  • Reporting symptoms of burnout.
  • Having student loan debts of more than $100,000.
  • Being unmarried.
  • Being younger.

The analysis also noted that the rate of suicidal ideation (about 9%) was similar to that reported in previous research among medical students, but was higher than what has been reported in the general U.S. population (about 6%) in similarly aged individuals. Nearly 35% of medical students who reported having suicidal ideation in the survey had coexistent alcohol abuse or dependence.

Significant Implications

The Association of American Medical Colleges and other organizations provide information on debt management, but Dr. Dyrbye says the findings underscore the need for better interventions to prevent the effects of stress among physicians during their medical training. “We need to find new multifaceted strategies to address alcohol use, burnout, and the cost of medical education,” she says. “Our data are important considering that the cost of attending medical school has risen by over 200% in the past decade.” She adds that if educational debt continues to rise in the face of lower earnings, the psychological toll of these debts may become even more severe.

Boosting awareness on the problems of burnout and alcohol abuse/dependence is critical, and these are real problems that must be addressed early, according to Dr. Dyrbye. “Being mindful and using mentorship programs may help both trainees and mentors deal with these very real issues,” she says. She adds that self-care is an important practice for physicians at every stage of training.

Lotte N. Dyrbye, MD, MHPE, FACP, has indicated to Physician’s Weekly that she has a co-inventor the Physician Well-Being Index and Medical Student Well-Being Index; the copyright is owned by Mayo Clinic and licensed to MedEd Web Solutions for use outside Mayo. Royalties have been received. She also has a grant from the American Medical Association relating to undergraduate medical education (Accelerating Change in Medical Education). Neither of these aforementioned disclosures, however, is relevant to the content of the feature story. Funding for the study discussed above was provided by the American Medical Association and the Mayo Clinic Department of Medicine Program on Physician Well-Being.