COMMENTARY

MDs Rebut Claims of Toxic Culture After Resident Suicides

Vihren Dimitrov, MD; Nehad Shabarek, MD

Disclosures

July 28, 2021

Vihren Dimitrov, MD

The tragic loss of three medical residents in our beloved South Bronx hospital shook us to the core. They were our colleagues and friends — promising young physicians whose lives and contributions to our hospital family will never be forgotten. We miss them and we grieve them.

We have been keenly aware of the growing trend of physician suicides across the country. That's one of the reasons why, years ago, we established the nationally recognized Helping Healers Heal program across our health system, and more recently expanded other mental health counseling and support to our frontline clinicians.

Our focus is wellness and prevention, as well as helping address the sadness, anxiety, and depression that so many of us experience after a traumatic event. During the surge of the COVID pandemic, these programs proved to be essential, as we expanded these services to all staff, not just those on the frontlines of patient care.

Nehad Shabarek, MD

We share concerns about the physician suicide crisis in this country. However, there have been some misrepresentations about our residency program; numerous statements have been made that are false and simply hurtful.

Out of respect for our colleagues and their families, we cannot share everything that we know about this tragic and irreparable loss. But we must set the record straight:

1. We lost two residents to suicide. Though no less horrific, the third death was investigated and declared an accident by the police department.

2. Resident work hours and workload are closely monitored to follow guidance set by the New York State Department of Health and by ACGME. In fact, at the peak of the COVID pandemic, when we were caring for nearly 130 intubated patients at a time, we adopted a strict residency program schedule with built-in breaks and reduced shifts and hours. Even at that tasking time, no one worked more than 80 hours. Although the maximum number of patients assigned to an intern allowed by ACGME is 10, we rarely have more than five or six patients assigned to each of our interns.

3. Bullying is never tolerated in our workplace. We have a zero-tolerance policy. We swiftly investigate any allegation and do not hesitate to take the appropriate action against anyone who does not honor our values of professionalism and respect.

4. Our ACGME survey results are close to the mean of all internal medicine residency programs in the country. The fact that the results range from 75% to 95% clearly indicates that residents respond independently and there is no coaching.

5. No resident has ever been threatened to have their visa canceled or withdrawn. Never. And the implication that we were intolerant because of their nationality is reprehensible. At NYC Health + Hospitals, we celebrate diversity. We are deeply committed to serving everyone, regardless of where they come from, what language they speak, what religion they practice. If you spend one day, or one hour, in our facility, you will see and feel our pride and commitment to this mission. We take pride in the fact that our staff and residents reflect the diversity of the community we serve.

6. As for the allegations of "toxic culture at Lincoln" — many of our graduates chose to stay on as attendings, serve the local community, and train new residents. Out of the 67 attendings in our department, 24 are former graduates. They are being joined by another five graduates from this year's graduating class. There is no better testament to how our graduates feel about our residency program, Department of Medicine, and Lincoln Hospital.

It is a legitimate question: how to prevent another suicide. No one has the exact answer. But it is a question we will keep asking ourselves as we continue to do all we can to meet our residents' needs, extend the social and mental health support they need to thrive, and provide the learning and training they need to offer the best care to our patients.

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