Authored by Sophia Huynh
Art by Amber Briscoe
Shrowded in the shadows of the COVID-19 pandemic, a silent crisis brews: physician suicide. A quiet murmur since the 19th century, physician suicide remained largely unknown and overlooked until the COVID-19 pandemic. While physician burnout is widely known to the general public, the extent of this burden was exacerbated by an increased sense of powerlessness over work hours and patient deaths, which results in climbing rates of depression, anxiety, burnout, and social isolation within physicians. Due to the great efforts of healthcare professionals, the number of COVID cases ebb and flow to a manageable level, but that begs the question: what about the front-line physicians that are left in their wake?
Physicians have increased access to lethal opportunities for suicide such as drugs, which signals to another looming issue: a physician’s workplace creates an environment that is conducive to suicide. Throughout their academic and professional careers, physicians garner extensive knowledge of pharmacology and lethal doses of medications and gain access to these medications through their workplace. Additionally, medical students graduate into a work environment that is increasingly corporatized as physicians worldwide are expected to perform in unforgiving environments for extended periods of time. One study found that 23% of interns had suicidal thoughts, and 28% of residents experienced a depressive episode during their training [1], compared to 7-8% of similarly aged individuals in the general population [2]. When these statistics are further dissected, female physicians are found to have higher rates of suicide and alcohol abuse than their male counterparts [3]. While few studies explain this observation, it can be induced by the struggle of navigating a male-dominated profession riddled with gender biases. Nonetheless, the healthcare work environment is one that overworks and strips autonomy from the physician [4], while imposing impersonal measures of performance that views neither the physician nor the patient as individuals [5].
It is imperative that the healthcare work environment is improved on all fronts, for everyone involved. Despite undergoing extensive training in the various aspects of mental health and treatment plans, physicians who pass away from suicide are less likely to have received mental health treatment than non-physicians [6]. There are many explanations for this statistic, such as a mental health stigma and the fear of professional licensing repercussions that come with reaching out for support. This emphasizes a harrowing truth: physicians, despite their resources and education, continue to remain an increasingly vulnerable group for depression, anxiety, and suicide.
While the conversation regarding physician suicide steadily grows louder, it is far from loud enough. Proactive steps must be taken to create a supportive atmosphere in healthcare environments that supports patients and physicians alike. To lead the way, the Association of American Medical Colleges are implementing programs to support physicians. At the University of California, San Diego (UCSD), the Interactive Screening Program allows physicians and medical students to anonymously reach out for help, which can circumvent stigma, and has lead to at least 180 physicians at UCSD gaining a referral for mental health care, that they otherwise would not have received [7]. Following a medical student’s death by suicide, Mount Sinai, a medical college, launched a four-year wellness curriculum called PEERS (Practice Enhancement, Engagement, Resilience, and Support) that promotes small group meetings with students and faculty to tackle stressors, which aims to provide medical students with skills to manage personal and academic challenges [8]. Although these programs and support systems are all small steps in the right direction, more questions remain unanswered. Further research is required to elucidate explanations for the female physician suicide rate being so high, and to better understand how to best support intersectional individuals such as LGBT+, BIPOC, first-generation, and international physicians.
Physicians are a cornerstone of our society and have been our advocates for hundreds of years. As the crisis of physician suicide quietly festers, it signals a need for the greater society to begin advocating for our physicians as we humanize healthcare.
Works Cited
Guille, C., Zhuo, Z., Krystal, J. H., Nichols, B., Brady, K. T., & Sen, S. (2015a). Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of suicidal ideation in medical interns. JAMA Psychiatry, 72(12), 1192. https://doi.org/10.1001/jamapsychiatry.2015.1880 https://pubmed.ncbi.nlm.nih.gov/26535958/
Mata, D. A., Ramos, M. A., Bansal, N., Khan, R., Guille, C., Di Angelantonio, E., & Sen, S. (2015a). Prevalence of depression and depressive symptoms among resident physicians. JAMA, 314(22), 2373. https://doi.org/10.1001/jama.2015.15845 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866499/
Cromie, W. J. (2005, February 3). Suicide high among female doctors. Harvard Gazette. https://news.harvard.edu/gazette/story/2005/02/suicide-high-among-female-doctors/
Kakarala, S. E., & Prigerson, H. G. (2022). COVID-19 and increased risk of physician suicide: A call to detoxify the U.S. medical system. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.791752
Ofri, D. (2010). Quality measures and the individual physician. The New England Journal of Medicine, 363(7), 606–607. https://doi.org/10.1056/nejmp1006298
Moutier, C. (2022, June 29). Creating a safety net: preventing physician suicide. AAMC. https://www.aamc.org/news/creating-safety-net-preventing-physician-suicide
Paturel, A. (2022, June 29). Healing the very youngest healers. AAMC. https://www.aamc.org/news/healing-very-youngest-healers