Physician Suicide and Mental Health — Medicine Is Our Calling, but It’s Not Supposed to Kill Us!

By Lynette D. Charity, MD

Physicians are dying by suicide at an estimated rate of 300 to 400 every year, and while there are no statistics on medical students and residents, they also are dying by suicide. In May 2018, a fourth-year medical student and a first-year psychiatry resident, both females, died by suicide within five days of each other. What is happening here?

Imposing Numbers
Medscape, a website that provides access to medical information and continuing medical education to physicians and health professionals, annually publishes a national physician burnout and suicide report. Earlier this year, Medscape surveyed more than 15,000 physicians in more than 29 specialties about their degree of burnout, depression, and suicidal ideations. The numbers were concerning, with 42% of physicians reporting symptoms of burnout. And regarding depression, 35% said that their depression made them more easily exasperated with their patients. This number increased to 47% in response to being more easily exasperated by their staff/peers. In response to the question “Have you ever felt suicidal?” 23% of male and 22% of female physicians said “yes” but had not attempted suicide. Shockingly, 1% of male physicians and 2% of female physicians disclosed that they had attempted suicide.1

Clearly, physician suicide is a serious public health concern. Physicians strive to improve the health of their patients, yet they sacrifice their own well-being to do so. As healers, they perform life-saving surgeries, treat myriad diseases, and are at the forefront of medical discoveries and technology. However, these accomplishments don’t protect them from the stress of the new health care environment. Forgetting about themselves, physicians work through illness, physical and mental, for the betterment of their patients.

Stress in the workplace can cause burnout, which is defined as a state of emotional, physical, and mental exhaustion. Burnout can lead to major depression, a persistent feeling of sadness or loss of interest.2 Of note in the survey, only approximately 14% disclosed that they were under treatment for their depression, while 64% had not sought treatment. Major depression can be associated with thoughts of suicide. Symptoms of major depression may include changes in sleep, appetite, energy level, concentration, daily behavior, or self-esteem.1

Physicians are stressed by having too many responsibilities—too many bureaucratic tasks (eg, meetings, paperwork, and charting), too many hours on the job, and too many patients with too little time to connect and listen to their concerns. And these lead to burnout. In 2017, a study in the Annals of Family Medicine reported increasing evidence that suggested that the use of EHRs can take up a significant amount of a physician’s workday, making it more difficult for them to do their jobs. “Off the clock,” they spend an additional two hours or longer at home playing catch-up. Being transformed from an expert clinician into a data entry clerk has added to their stress.3 Approximately 30% of physicians surveyed also felt that their loss of autonomy, insufficient compensation and reimbursement, and lack of respect from administrators, employers, colleagues, and staff contributed to their burnout.1

Despite having all this knowledge learned through medical school training and postgraduate experience, physicians-to-be and physicians rarely seek treatment. In the Medscape report, physicians’ coping mechanisms for burnout included sleep (56%), exercise (46%), and talking with family and close friends (53%). However, the use of self-isolation (47%) and alcohol (24%) were also seen as options, though not healthful strategies.1

A Way Forward
What are the barriers to mental health care for physicians? We know that many people with mental illness are untreated or undertreated. This is especially true for physicians. Why? Fear of being found out. The stigma of mental illness in physicians arises from the erroneous premise that physicians with mental illness are impaired. Many state medical boards ask applicants who are obtaining medical licenses about their mental health histories. Their certification applications ask physicians to disclose whether they’ve ever been diagnosed with a mental illness. Physicians who check a box within this question must send documentation to the board about their mental illness. Who wants to do that? Does not HIPAA apply here?

Mental illness is a disease, and for many syndromes there is treatment. And with proper treatment, there’s no impairment. But untreated or undertreated depression can lead to suicide. Yet physicians worry that by disclosing their mental illnesses, they may face increased costs for professional liability insurance, disability insurance, and health insurance, so they forego treatment and may choose to self-medicate with alcohol or unprescribed psychiatric medications with potentially devastating results. Many physicians who need help seek it anonymously. They pay out of pocket, avoid seeing a colleague because of the stigma and the perceived shame, and avoid filling out an insurance claim. Payment for their illness becomes an additional financial burden for those who already carry heavy debt loads, adding to their angst.4

Is there a solution to this problem of physician suicide? The first order of business is to eradicate stigma and allow physicians to receive mental health care without repercussions. The “mental illness box” should be removed from all credentialing applications immediately. And physicians with mental health issues must realize that any justification for declining treatment is moot if they die by suicide. In a 2019 article published by the Association of American Medical Colleges, new findings revealed that there will be a shortage of nearly 122,000 physicians by 2032 as demand continues to grow faster than supply.5 This number may increase in the wake of the COVID-19 pandemic. We need everyone. And even if you choose to quit your “calling,” please get the help you need so that you don’t quit your life!

— Lynette D. Charity, MD, is a board-certified anesthesiologist with more than 40 years of expertise. She’s also a CME accredited keynote speaker, author, and humorist. Her focus is on physician mental health care. Contact her at lynette@drcharityspeaks.com. https://drcharityspeaks.com

References
1. Kane L. Medscape national physician burnout and suicide report 2020: the generational divide. Medscape website. https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460. Published January 15, 2020.

2. Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry.2016;15(2):103-111.

3. Arndt BG, Beasley JW, Watkinson MD, et al. Tethered to the EHR: primary care physician workload assessment using EHR event log data and time-motion observations. Ann Fam Med. 2017;15(5):419-426.

4. Kalmoe MC, Chapman MB, Gold JA, Giedinghagen AM. Physician suicide: a call to action. Mo Med. 2019;116(3):211-216.

5. New findings confirm predictions on physician shortage. Association of American Medical Colleges website. https://www.aamc.org/news-insights/press-releases/new-findings-confirm-predictions-physician-shortage. Published April 23, 2019.