Dear Charles Irwin, MD; Vice Dean John Davis, PhD, MD; Dean Talmadge E. King, Jr., MD,

We are writing out of ongoing concern about UCSF's mistreatment of residents and fellows who experience mental health challenges during their training. These challenges are well documented. One in four physicians experience a major depressive episode during their training. Suicide is the leading cause of death among male residents, and the second leading cause of death among female residents (only behind cancer).[1,2] Moreover, residents face significant challenges accessing mental healthcare due to long & inflexible working hours (often up to 80 hours per week), and a dearth of providers covered by our insurance at UCSF, among other factors.

Rather than supporting housestaff who struggle with mental health challenges and creating an environment that encourages us to seek help when we need it most, UCSF has repeatedly punished those who ask for help. Since 2020, we are aware of at least two cases where UCSF demanded residents with mental health challenges sign agreements which made additional conditions on their employment. This pattern of punitive responses to the disclosure of health conditions is dangerous for housestaff and patients alike, because it discourages residents and fellows from seeking support. Dr. Justin Bullock shed light on this problem when he published an article in the Journal of Hospital Medicine about his experience during his UCSF residency. [3]

Most recently, UCSF dismissed Dr. Carlos Damas, a third-year pediatric resident who experienced increased adversity after disclosing his mental health and disordered substance use history to his program director. At no point did his substance use affect his clinical performance, but his program's response to his disclosure created a work environment that contributed to a suicide attempt last fall. While hospitalized, he was placed on an “investigatory leave” period, offered no resources during that time and was subsequently terminated from residency a few months later. Dr. Damas is currently appealing the termination, with the support of most of the residents in his cohort, who have signed a letter to their program leadership attesting to his competency as a physician and calling for his reinstatement. 

We know there are other housestaff who have experienced similar treatment, but who have been afraid to share their stories publicly. We, the undersigned, demand UCSF stop treating house staff with health conditions as disciplinary cases to be managed. We all deserve to be supported during our time here. 

We demand that:

• UCSF cease requiring residents who voluntarily disclose pre-existing health concerns from signing a “return to work agreement” that imposes contingencies on their employment; 
• UCSF's program leaders follow all applicable privacy laws, including but not limited to the Health Insurance Portability and Accountability Act (HIPAA) and California's Confidentiality of Medical Information Act (CMIA), and that they be prohibited from gaining any information about a UCSF patient without house staff consent, even if that patient is also a resident or fellow. This requires relevant training to those in leadership so that they may advocate for residents' health and well-being in an appropriate manner; 
• UCSF take a collaborative approach to any support plans as needed, including involving CIR representatives if requested by house staff; 
• UCSF implement known best practices to support trainees with mental health conditions, including reforms to the Physician Well Being Committee. To this end, UCSF will convene a committee of labor and leadership to determine those best practices; and 
• UCSF immediately reinstate Dr. Damas and any resident unduly severed from their program due to prior punitive practices. 

Signed,

[1] Low, Zhi Xuan, et al. "Prevalence of burnout in medical and surgical residents: a meta-analysis." International journal of environmental research and public health 16.9 (2019): 1479.

[2] Yaghmour, Nicholas A., et al. "Causes of death of residents in ACGME-accredited programs 2000 through 2014: implications for the learning environment." Academic medicine 92.7 (2017): 976.

[3] ​​Bullock JL, Kimberg LS, Meeks LM. Trauma-Informed Transformation of Evaluation and Licensure for Physicians With Mental Illness. J Hosp Med. 2021 Jul;16(7):434-437. doi: 10.12788/jhm.3648. PMID: 34197310.