Physicians Commit Suicide at Almost Twice the Rate of the General Population
PRESIDENT'S MESSAGE
It has been a little over four years since my cousin died by suicide, but it is still very hard to believe that he’s really gone. A few months prior to his death, he came over to my house to hang out with all of our cousins, and we had a great time exchanging laughter and hugs. He had just resigned from the military and shared so much excitement in the possibility of traveling, exploring the world, and spending more time with family and friends while figuring out his next steps. I was so happy for him. I’ve replayed our last moments together over and over in my head and I can’t remember ever asking him, “Isaiah, are you really okay?”
The Question: How are you doing?
With years of mastering the art of building rapport and obtaining a great history, many physicians have become experts in asking patients the simple question, “How are you doing today?” We have the clinical skills to recognize when something is not quite right when a patient answers, and can press our patients for more information. But as simple as the initial question may be, most physicians don’t actually know how — or if — they would answer their own question truthfully. We find it much easier to perform a surgical procedure or manage an asthma exacerbation. Some of us have learned to simply give a reflexive, automated response to the question that erroneously indicates we are well. And just like my cousin, many of us have never been asked.
The Answer: We are not okay today.
The 2022 Medscape Physician Suicide Report found that one in 10 physicians reported they had thoughts about or had attempted suicide in the previous year. Also, the rate of suicidal thoughts among physicians is almost twice as high as the general population (7.2% vs. 4%). With more than 300-400 physician suicides annually, suicide continues to be the only cause of mortality that is higher in physicians compared to non-physicians.
There is no doubt that the ever changing practice of medicine has taken its toll on physicians. Our job has become harder over the years. We are taking care of more complex patients, spending more time in the electronic medical records, experiencing an increase in our workloads, and spending more time fighting with insurance companies while advocating for the care our patients need. Burnout is more common than ever. Also, physicians experience trauma from distressing patient events in our daily work. Several studies suggest that physicians may experience undiagnosed PTSD at rates that are three times higher than the rates of the general population.
The 2022 Medscape Physician Suicide Report found that one in 10 physicians reported they had thoughts about or had attempted suicide in the previous year.
We are great at recognizing when behavioral health interventions are necessary for our patients, but we are poor prognosticators when it comes to our own mental health. We understand how taking SSRIs, participating in therapy and cognitive behavioral therapy, and avoiding substances such as alcohol can improve outcomes in depression with suicidal ideation — yet, we somehow feel a physician must figure out how to manage clinical depression by just working a little harder. We are afraid that we will lose the respect or confidence of our colleagues if somehow we are not perceived as strong and resilient. We are afraid we will lose our licenses if we get help. The stigma that plagues our minds and halts any attempts to seek help must be obliterated with the strongest broad spectrum therapies. The risk of negligence from failure to treat is too high.
The Solution: Advocacy, resources, and treatment
Last year, the Dr. Lorna Breen Health Care Provider Protection Act was signed into law after Dr. Lorna Breen, an ER physician, died by suicide in the peak of the COVID-19 pandemic. This bill was designed to improve mental health support for physicians and other health professionals by establishing:
Grants for health professionals to help create evidence-based strategies to reduce burnout and the associated secondary mental health conditions related to job stress.
A national campaign to encourage health professionals to prioritize their mental health and to use available mental and behavioral health services.
Grants for employee education and peer-support programming.
In addition to the advocacy work done by the AMA for the Dr. Lorna Breen Act, the AMA continues to advocate for medical licensing boards to only require applicants to disclose mental health conditions that impair the physicians ability to care for patients safely.
Locally, SSVMS has organized mental health and suicide prevention efforts through our Joy of Medicine program. On the Joy of Medicine tab of the SSVMS website, you can find the following resources:
Counseling Resources:SSVMS will sponsor up to six wellness sessions with vetted psychologists and/or life coaches for physicians and medical students that practice or attend medical school in Sacramento, El Dorado, Yolo, and Placer Counties.
Psychiatric Assistance:Joy of Medicine has partnered with UC Davis Health’s Department of Psychiatry to provide direct access for physicians in need of a psychiatric evaluation, referral, or medication management. Through this partnership, any physician practicing in the Sacramento region may self-refer to the UC Davis Department of Psychiatry to be seen immediately by an attending psychiatrist experienced in working with the unique needs of physicians.
To access psychiatric services, call Angel Hanson, UC Davis Department of Psychiatry practice manager, at (916) 734-3917. Identify yourself as a physician accessing the Joy of Medicine Program.
Regionally, CMA also has a confidential line for physicians searching for help with substance abuse or other emotional concerns. If you are in need of urgent assistance, call CMA’s 24-hour Physicians’ and Dentists’ Confidential Assistance Line at (650) 756-7787.
Nationally, there is also a free and confidential line that is managed by volunteer psychiatrists. We are encouraged to call for any issue, not just a crisis:
Physician Support Line1 (888) 409-0141Open Monday to Friday (except federal holidays)8:00 AM - 12:00 AM ET
And most importantly, for anyone having suicidal thoughts, you can call or text 988 to reach the Suicide and Crisis Lifeline.
What can we do now?
The time has come to break the silence and toss the grips of mental health stigma to the side. Reach out to your hospital and medical group leadership and advocate for mental health programs for physicians. Request that your local wellness task force seeks out the federal funds that have been approved by the Dr. Lorna Breen Act. Post the SSVMS and physician treatment hotlines in physician break rooms and bathrooms. Share the resources at department meetings and all staff meetings. And above all, ask at least nine colleagues how they are really doing. Find the one who is having those thoughts. And if that one is you, please tell someone and reach out to one of the resources above.
