“My parents want me to go to med school, but I've been looking at other options. I don't think they'll be happy. I'm so confused. I don't even know if I want to be a doctor.” —Anjana, 20.
South Asian families often pressure their children to choose medicine as a career as it is seen as economically stable and high-status. It is no secret that South Asian parents proudly speak of their children making it into medical school. There is almost a “halo effect” attached to these young people as they are not only lauded as exemplary figures but also bring “good name” to their parents. However, the road to medicine can be paved with unforeseen challenges that are often obscured by the benefits of such a valued status.
As someone who pursued medical school before switching to psychology, I understand Anjana's uncertainty about whether medicine is her calling. I remember my parents encouraging me to go to medical school, especially since a close friend was already in an accelerated program. Balancing personal passion with parental approval can be a challenge for first-generation South Asians. Some may choose medicine out of a sense of obligation to please their parents or to prove themselves in a community where comparison breeds competition.
For others, they may be drawn to medicine out of a deep interest in patient care or a tradition passed down through generations. “Having been exposed to an uncle who was a cardiologist and a father who was a pharmacist, I knew I would become a physician,” recalls Jay Bhatt, a family physician in Chicago. “I was fortunate to have family and SA friends in the field, and I was able to see the impact and opportunities firsthand.”
Whatever the reason, the general consensus is that no one is fully prepared for the rigorous process of the medical field. For SAs who are relentless in their pursuit of success, the demands of long shifts, night shifts on call, endless paperwork, inefficient systems and lack of support can be a shocking wake-up call that saps their energy and enthusiasm. To make matters even more difficult, many SAs have to balance the responsibilities and expectations of their families. “My parents don't understand the pressures of medical school. They always put me down that I have to study and not get to do things with my family. It's a tough balance!” said a frustrated student, Raeshma.
Despite the growing number of South Asian physicians in the U.S., they still face minority feelings and a need to self-validate in a majority non-South Asian environment. This can lead to additional pressures and feelings of isolation. “As a South Asian woman, I think there's a lot of pressure to be perfect in every aspect of life, so the personal pressure we put on ourselves to succeed also contributes to the negative impact,” says Vineet Arora, dean of medical education at the University of Chicago Pritzker School of Medicine. Given the need to self-validate, South Asian physicians may take on extra shifts and work longer hours, ultimately leading to burnout.
Burnout is a serious issue that affects many professionals, but it can be particularly difficult for SAs in healthcare. Bhatt argues that “culturally, as South Asians we are taught not to ask for help, we are expected to be strong and overcome mental issues and accumulating cognitive load.”
Burnout
“I was just going through the motions at work. I looked normal, but there was something cold about it. Seeing patients as cases felt like watching a video game instead of reality.” —Tina Shah, MD, national expert on workforce health and public policy.
Burnout is caused by chronic, excessive stress. It causes emotional, physical and mental fatigue and occurs when you feel overwhelmed, drained and unable to meet the constant demands. Over time, burnout reduces productivity and leaves you feeling increasingly helpless, hopeless and resentful. Symptoms of burnout include chronic fatigue, insomnia, poor memory and concentration, chest pains, gastrointestinal problems, increasing feelings of cynicism and apathy towards work, lack of motivation, and feelings of helplessness and lack of accomplishment.
Shah, an expert in the field, said burnout wasn't well-studied during her early medical training, but while her residency classes emphasized community-building and psychological counseling, no such programs were available when she went on to fellowship, where she faced challenges.
“Burnout is very personal. I got through my internship and residency without any issues, then pursued my love of clinical practice and training in pulmonology and as a clinical fellow, but somewhere in the first year of my fellowship, I knew it was time to leave,” Shah recalls. Not only did she feel disconnected from her patients, she explains, but she also felt like “a part of my soul was gone” while dealing with the depression that often accompanies burnout.
“During my training, my 'shift' ended when there was 'nothing to do' and the handover, so my work didn't end until it was done,” Arora says. She agrees with Shah about her own experience of not being able to have empathy for patients and others. In Bhatt's case, spending a lot of time with seriously ill patients who died early in his training contributed to his issues, along with depression.
In my own training and career, I have seen how burnout affects South Asian physicians’ interactions with patients, subordinates, and colleagues. Professionally, I have experienced disrespect from burnt-out South Asian psychiatrists who have clearly lost basic empathy for their patients and patience for therapeutic interventions.
Overall, it seemed like no one really cared about these doctors, and given cultural factors, they didn't necessarily ask for help. “As SAs, we're taught not to ask for help and to just push through our mental health issues and the cognitive load that builds up,” says Bhatt.
Luckily, Shah was able to switch to a research year for her fellowship, freeing her from her late-night ICU on-call schedule and giving her time to recover. Arora says the positive aspects of the South Asian community were extremely helpful: “Socializing, eating, dancing – things I really enjoyed and that really sparked my recovery.” For Bhatt, requesting time off, getting support from work and going to therapy all helped her cope. “I also reached out to my family for help in a different way than I had before. I was scared to tell them how much I was struggling with depression.”
Advocacy
In 2022, Shah was selected by the U.S. Surgeon General as a Senior Advisor to develop the nation's first strategy to address health care burnout and “mass resignations.” As the first Clinical Director of Wellbeing at the Department of Veterans Affairs, she reduced burnout by streamlining in-basket messaging, enabling physicians to prioritize patient care and see up to 18,000 patients. Her own experience with burnout led Shah to strive to have a broader impact, which became critical in post-pandemic healthcare. She continues to advocate for the issue nationally.
As dean of medical education, Arora strives to ensure the infrastructure, leaders and support are in place to address burnout and works with her team to prevent it, she says, by having leaders at the student and resident level and a chief wellness officer at the faculty level. She also strengthened mental health support for learners and eliminated the stigma around seeking medical care.
As executive vice president and chief medical officer for the American Hospital Association, Dr. Bhatt has worked extensively on this issue for America's hospitals and healthcare workers. He has co-authored multiple research papers on the topic and has participated in national collaborative efforts such as the National Academies of Medicine Clinician Health Collaborative.
It's clear that the work of these dedicated physicians and many others is making a difference in physician burnout rates: According to a recent AMA report, “After surging to a record high of 62.8% in 2021, AMA's own survey data shows that physician burnout has fallen below 50% for the first time since 2020. This change marks a milestone in the ongoing fight against physician burnout, but the fight is far from over.”
South Asian immigrant support
“Society may praise you on the outside, but deep inside you can feel very lonely. As a physician, it's very difficult to go against public opinion.” — Tina Shah
It is inspiring to see how these doctors have been inspired to support the next generation of healthcare workers. However, given South Africa’s expectations for achievement, conflicting work and cultural expectations remain an issue. However, it could be empowering if South African families can support healthcare workers in productive ways. Here are some ways to help reduce burnout and support the healthcare community:
Recognize the role of pressure on career choices and understand exactly what medicine entails. Ask about ways to show support. Eliminate the stigma of mental health care and take feelings seriously. Encourage strengths and avoid harmful conversations based on comparison. Acknowledge that there are many ways to leverage a medical degree. Be a source of support, not another stressor.
To find a therapist, check out Psychology Today's Therapy Directory .
