Every year it is estimated that more than one million Americans lose their doctor… to suicide. Pamela Wible, M.D. has been on the front lines of this growing problem:
Across the country, our doctors are jumping from hospital rooftops, overdosing in call rooms, found hanging in hospital chapels. It’s medicine’s dirty secret. And it’s covered up by our hospitals, clinics, and medical schools.
No medical school wants to be known as the suicide school. No hospital wants to be #1 for interns jumping from rooftops. No one wants to become a doctor — to kill themselves. It’s the ultimate oxymoron: the barefoot shoemaker, the starving chef, the suicidal doctor.
So why? What the hell is going on? And why is this such a secret? And why am I piecing this together between patients? I’m a solo family doc, yet somehow I’ve become an investigative reporter, a specialist in physician suicide. Why? Mostly because I can’t stop asking why. Why both doctors I dated in med school died by suicide. Why eight doctors killed themselves — just in my sweet little town. So I keep talking and writing — and listening for the truth. And because I’m listening with my heart and soul 24/7, my cell phone has turned into a suicide hotline, and I’ve received hundreds of letters from suicidal physicians.
Dr. Pranay Simha cites “fatigue, emotional exhaustion and crippling self doubt” as reasons why about 400 doctors — the size of entire medical schools — commit suicide in the U.S. annually:
The statistics on physician suicide are frightening: Physicians are more than twice as likely to kill themselves as nonphysicians (and female physicians three times more likely than their male counterparts). Some 400 doctors commit suicide every year. Young physicians at the beginning of their training are particularly vulnerable: In a recent study, 9.4 percent of fourth-year medical students and interns — as first-year residents are called — reported having suicidal thoughts in the previous two weeks.
But stress as the principle culprit, while convenient, is “incomplete at best,” argues medical student Ajay Koti:
At first glance, the genesis of this problem seems obvious: stress. Beginning with the application process and increasing with cutthroat tests and hours of toiling away in the wards, medical school can be a crucible of intensity. Students are under more pressure than ever to achieve, particularly because residencies haven’t kept pace with growing medical schools. Things don’t look too stable on the other side of graduation either: tectonic shifts in insurance markets, new payment and delivery systems, reductions in reimbursement, student loan debt, and tens of millions of patients added to already bursting patient panels. This is an intimidating list of challenges, and it is telling that an article labeling ours as “the most miserable profession” went viral in medical circles. A kind of malaise has settled over the field.
The American Foundation for Suicide Prevention says that unaddressed mental health conditions may be the most important factor leading to so many suicides among medical students and physicians. Physicians are more likely to self-medicate to treat anxiety, insomnia, depression, and other symptoms with drugs and alcohol than they are to seek professional psychiatric help:
Physicians have higher rates of burnout, depressive symptoms, and suicide risk than the general population. Physicians and trainees can experience high degrees of mental health distress and are less likely than other members of the public to seek mental health treatment. Physicians report several barriers to seeking mental health care, including time constraints, hesitancy to draw attention to self-perceived weakness, and concerns about reputation and confidentiality.
David Muller, M.D., searches for solutions in the New England Journal of Medicine as he and the rest of his fellow medical school faculty mourn the sudden loss of a widely admired fourth-year medical student named Kathryn:
But in my opinion they will fall far short of addressing one of the root causes of this national epidemic of burnout, depression, and suicide: a culture of performance and achievement that for most of our students begins in middle school and relentlessly intensifies for the remainder of their adult lives. Every time students achieve what looks to the rest of us like a successful milestone — getting into a great college, the medical school of their choice, a residency in a competitive clinical specialty — it is to some of them the opening of another door to a haunted house, behind which lie demons, suffocating uncertainty, and unimaginable challenges. Students bravely meet these challenges head-on while we continue to blindly ratchet up our expectations.
From their very first shadowing experience to their first foray in the lab; from high school advanced-placement courses and college admissions tests to grade point averages and the Medical College Admissions Test (MCAT); with helicopter parents, peer pressure, violins and varsity soccer, college rankings, medical school rankings, medical licensing exams, and the residency Match, we never let up on them — and it’s killing them.
Removing the stigma and providing compassionate care in addressing mental health issues plaguing so many medical students and physicians will allow many of these healers to carry on with optimism and hope, to be able to compassionately care for the rest of us.