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Mental health program looks to address ‘tough it out’ culture among medical residents

Launched in 2019, the Resident Integrated Support Environment (RISE) offers support to physicians in training.

healthcare worker
REUTERS/Brendan McDermid

Dr. Katie Thorsness has seen too many struggling medical residents avoid seeking help.

The “tough it out” culture surrounding physician training leads some medical residents to suffer their mental health woes in silence, letting issues fester until they find themselves in a dangerous spot, said Thorsness, a psychiatrist for Resident Integrated Support Environment, or RISE, a program created by the Hennepin Healthcare Foundation to help residents with mental, financial, and physical health needs.

Before RISE was launched in 2019, Thorsness said, “I saw a lot of physicians, oftentimes too late. For various reasons they were worried about seeking treatment. As a psychiatrist I could hear how much they were suffering in silence.” 

Physicians are at significantly increased risk of depression and suicide, Thorsness said. “We know that 28% of residents will experience a major depressive event while in training, which is much higher than the 7% to 8% of similarly aged adults in the U.S.” 

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And with a higher rate of depression comes a higher risk of suicide, she added: “Male physicians are 1.4 times more likely to die by suicide and female physicians are 2.3 times more likely to die by suicide than gender- and age-matched individuals in the U.S.” 

Dr. Katie Thorsness
Dr. Katie Thorsness
The goal of RISE is to encourage conversations around resident mental health, something that has traditionally been discouraged by residency programs, she said.  Residents think “pulling yourself up by your bootstraps” is the only choice, she said. “You have to complete training. You have to get through. You have to manage this rotation.” 

Female residents — especially those with children — often bear the brunt of this antiquated practice, Thorsness said. “I think a lot of that has to do with some of the traditional emotional load that a lot of women carry in their families or relationships. Medical training has not evolved to support residents with children.”  

She’s noticed that younger residents are more comfortable talking about their mental health — and asking for help when they are in crisis. She wants to make the RISE program, and organizations like the Dr. Mom Foundation, more visible in residency programs, making it clear that doctors are human and that being open about mental health struggles is not a sign of weakness. 

“What RISE is hoping to do is reframe that belief for residents and start a conversation that says that asking for help and being vulnerable is a brave thing to do as a physician,” Thorsness said. Whenever she is contacted by a resident who said they were referred by a colleague, it shows that conversations are happening, and the silence is being broken. 

“The highest honor of being a support in RISE is having the residents recommend it to each other,” Thorsness said.