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Many doctors in training may skip routine health care

By Lisa Rapaport

(Reuters Health) – Trainee doctors often miss out on routine medical care and preventive health services even when they take daily prescriptions, a small study suggests.

Researchers surveyed 299 residents at 20 teaching hospitals in New England about their physical and mental health. Participants were 31 years old, on average, and 35% reported having no routine place for medical care, the study found.

Among these young doctors who lacked a place for regular checkups, 38% were taking daily prescriptions for chronic health problems.

“This is a much higher proportion than that of the general population, in which 22% of individuals aged 25 to 44 lack a routine place for medical care, leading to concern for reduced resident health and untreated medical or mental disease,” lead study author Dr. Erika Rangel, of Brigham and Women’s Hospital and Harvard Medical School in Boston, and her colleagues write in the Journal of the American College of Surgeons.

“Despite efforts to establish resident wellness programs, the proportion of trainees in this study who do not have a routine place for medical care has not improved over the past 20 years, suggesting further work must be done to reduce barriers to care,” Rangel and colleagues write.

While the study wasn’t designed to examine whether or how training to become a doctor might deter people from seeking care, it’s possible that erratic working hours, time constraints, easy access to informal health consultations, and a culture of self-reliance may contribute to this problem, the study team writes.

Most of the study participants were in their first or second year of residency programs and 78% of them reported being in a relationship – often with other doctors or residents.

Residents without a routine place for medical care were less likely to get preventive health services like skin exams, blood pressure screenings, or cholesterol checks than their counterparts who did have a regular medical home.

More than half of residents said they had not seen a primary care provider in the past year and one in four of them had not seen a mental health provider.

Residents who reported they had not seen a mental health provider within the past year were more likely than those who had to describe depression symptoms: 81% compared with 62%. Half of residents who didn’t see a mental health provider reported burnout, compared with 36% of people who did get mental health care.

People with children were more than twice as likely to report burnout as residents without kids, the study also found.

Residents who were in romantic relationships with other residents were 49% less likely to report symptoms of depression.

Residents who took prescribed medications, however, were more than twice as likely to report depression or burnout than their peers who didn’t have daily prescriptions.

Compared with survey participants in family medicine, those in surgery, internal medicine, radiology, anesthesia, obstetrics and gynecology, and pediatrics were roughly four to eight times more likely to lack a routine place for medical care.

The likelihood of depression or burnout didn’t appear to vary based on medical specialty.

Beyond its small size, another limitation of the study is that researchers relied on participant recall. Because the main focus of the study was self-care habits specific to depression, people without symptoms of depression may have been less likely to participate, skewing the results, the study team also notes.

Even so, the results highlight a potential need to improve access to care and utilization of health services among residents, they write.

“Resident health is vital to the mission of physician well-being and mitigating the escalating problem of burnout,” the researchers point out.

“Barriers to self-care and help-seeking behavior should be evaluated to promote sustainable behavior that will encourage a long professional career,” the study team concludes.

SOURCE: https://bit.ly/2Lsp41j Journal of the American College of Surgeons, online November 22, 2019.

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