“Say her name,” “She didn’t deserve this,” and “The system failed you” were the sentiments expressed on social media by resident physicians and trainees in medicine on the death of Dr. Nakita Mortimer, an advocate, mentor, physician trainee union organizer, and Black woman resident physician who tragically ended her life on May 26, 2023.
This narrative is all too common within medicine’s ivory tower, as suicide is the 2nd leading cause of death among physicians in training, only conceding the crown to cancer.
Cancer may be the most prevalent malignancy that plagues these professional degree trainees, but the insidious toxic exposure to the hazing mindset within academia makes Dr. Mortimer’s story all the more relevant to anyone whether they are in medicine or not.
Academic hazing refers to practices that encourage maintaining a culture of overworking and acceptance of burnout from unreasonable and exploitive expectations. Trainees experience a decline in their physical, mental, spiritual, and emotional well-being.
This culture emphasizes you will not be a clinically competent physician without the experience of working 24-hour shifts, depression, and social isolation. In short, wellness in this culture is a rite of passage that must be earned.
In 2020, Dr. Uche Blackstock described how academia reinforces toxic internal beliefs such as imposter syndrome, as trainees experience isolation, sense of failure, discrimination, and lack of belonging if they are unable to meet unrealistic expectations.
Individuals from non-white, wealthy backgrounds such as immigrants, first generation, underrepresented racial and/or sexual minorities are harmed the most in this culture — a category Dr. Mortimer fit into well as a descendent of Haitian immigrants.
As a trainee, I faced some attendings or supervising physicians who wholeheartedly believe this generation of trainees have it “better” with implemented work guidelines than they did, thereby, invalidating the current experience of trainees with the justification of continual toxic exposure to academic hazing. They subscribe to the “I had it harder, so be grateful” mentality.
In 2003, the Accreditation Council for Graduate Medical Education (ACGME) issued groundbreaking guidelines to mitigate one aspect of maltreatment within physician training: restrictive sleep. Working between 90 to 100 hours per week and up to 36 hours consecutively without sleep, was once normal practice in American physician training. In comparison, European physician trainees work no more than 48 hours per week, including overtime.
The now 80-hour workweek cap is seen as a victory, yet lessens only one aspect of academic hazing. Now, almost 20 years into this implementation by the ACGME, still 66 suicides have occurred between 2000 to 2014, and it’s time to ask why, as one life gone is still too many.
The idea that wellness through resiliency develops strong and effective functioning academics– the favored mantra of academia — is a fallacy.
Despite this, I desperately want academia to invest in more wellness-centered initiatives, such as promoting work-life balance, manageable schedules, and encouraging not working when ill.
As a Black woman trainee, I know that I (like all the other “Dr. Mortimers” in America) train in a country where only 5 percent of physicians identify as Black. Our life experiences create a rare level of resiliency few can relate to. As a first-generation, low-income physician and second-generation immigrant, I can claim 31 years of experience in resiliency — a level of experiential expertise that academic medicine will never be able to provide.
Dr. Mortimer knew this all too well, which is why she was a strong advocate for sustainable solutions for physicians in training beyond just work-hour caps, but for manageable schedules, livable wages, and overall meaningful wellness. She was aware that healthy doctors create healthy communities and understood that her own wellness was essential to better serve her patients.
In November 2022, she eloquently spoke: “One truth is the honor it is to care for the members of The Bronx community and New York at large … The other truth is that with its [medical training] current conditions, this work is often unnecessarily challenging to our wellness as individuals.”
I’m confident she craved wellness as the constant exposure to the same insidious toxic academic hazing evolved into a cancerous burden that became too much for her to bear.
Though I never knew her personally, I am mourning the loss of my sister in medicine. Her resume and life reflect much of my own, full of service to others, with the desire to change the culture of medicine and academia for the betterment of those who will come after us.
One death is too many, and I will continue to say her name because she did not deserve this. The system did fail her and still fails trainees. Yet, it can change. Wellness centered on work-life balance, livable wages, and manageable work schedules is key to ending the academic hazing culture and creating the desired clinically competent physician.
Faith Crittenden is a pediatrics resident.