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CURBING PHYSICIAN SUICIDE RATES BY CHANGING THE CULTURE OF MEDICINE

What do we know about physician suicide, and how can we prevent this tragedy?

Firstly, we know that physicians are at a higher risk for suicide than the general population.  The Kaiser Family Foundation estimates that there are 968,000 active physicians in the US in 2018.  About 35-40 percent of them are female.  The American Foundation for Suicide Prevention estimates that 300-400 US physicians commit suicide each year, including about 150-200 of each gender.  The total number is likely an underestimate as it is well known that some possible physician suicides end up not being recorder as such.

The suicide rate for female physicians in particular is markedly elevated, with a relative risk of 2.27 compared to US women in general, while that if male physicians is also above the US national average with a relative risk of 1.4.  The fact that physicians are more likely t kill themselves than non-physician equivalent adults in the general population is hardly surprising, as physicians have the  knowledge and skills to make sure that they are successful in a suicide attempt.

Secondly, we know that risk factors for suicide in the general population include major depression or other mood disorders, substance abuse, adverse life events, access to lethal means, medical illness, a family history of mental illness, age (50 or older), and gender (male more common overall).  e also know that in their lifetime, approximately 15 percent of physicians will develop a substance use and/or a mental health-related condition (usually depression or anxiety) that could potentially impair their ability to practice medicine, and that 30-50 percent of physicians at some stage exhibit symptoms of burnout, which may lead to anxiety, depression or substance use disorder.

Thirdly, we know that physicians look after themselves inadequately.  They rarely report depression or suicidal ideas, suffering in silence, or attempting to treat themselves, such is the stigma of psychiatric disorder, even among physicians.  These behaviors are embedded in the medical subculture, which encourage denial and self-reliance, and are at least partly learned implicitly during training.

Why is this happening and what can we do?  There are any possible intervention to reduce this tragedy.  These range from the need for organizational and systemic work changes to reduce administrative requirements and tame electronic medical records to personal and lifestyle changes to aid resilience and reduce burnout, including learning how to better recognize at-risk colleagues.  Some like myself, argue that the Triple Aim of healthcare (improving the patient experience of care, including quality and satisfaction, improving the health of populations, and reducing the per capita cost of health care) should become the Quadruple Aim with the fourth aim being improving the work life of health providers.

The National Academy of Medicine is very active in this field, and has set up an impressive well organized and resourced Action Collaborative on Clinician Wellbeing and Resilience (See https://nam.edu/initiatives/clincian-resilience-and well-being).  This is an excellent website to visit for all interested in this topic.  The American Medical Association, like several other colleges and professional associations, is also committed to this issue and has created five excellent modules in their nine "step forward" program on physician health and wellbeing that are replete with good practical examples of how to reduce levels of burnout and improve organizational and individual responses to stress.

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Jeanine Joy on Friday, September 06, 2019 4:52 PM
I completely agree about taking care of providers. In North Carolina, one of the things we did was make it mandatory to seek help if they are struggling and end mandatory reporting as long as the physician is cutting back on any activities that put patients at risk due to their mental illness. Not punishing clinicians for help-seeking behavior is an important first step. In our book, Burnout: Prevention and Recovery, Resilience and Retention, Evidence-based, experience-informed, root cause solutions, we also suggest that lawmakers should have to consider the impact of new regulations and laws on clinicians much in the same way the EPA has to consider the environmental impact. The drastic increase in burnout during the first half of this decade can be largely attributed to the onslaught of new regulations. We approach burnout on two fronts. What can clinicians do to increase resilience and what can organizations do to make resilience less necessary? The good news is that individuals can do a lot even if their employers don't do the right thing. We also made suggestions about ways burnout can be addressed by improving the public perception of physicians to counter the decline we've seen in recent decades. Together things can be better. I will be in your area next year although the date is not yet set. Let me know if you'd like to chat. Take care, Jeanine
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