Mourning the silent epidemic: the physician suicide crisis and suggestions for change

This article was originally published on KevinMD

I am rattled as I read the headlines. Another bright, incredible physician has ended her life. I feel numb with horror as I read the details. I want to scream, cry, and punch the wall. Wiping my tears away, I try to focus on the needs of my whining toddler as she tugs at my dress.

I am in mourning for every doctor’s death by suicide. Yes, for every one of those human beings who just became an inconvenient statistic for this society. Why is it hard to talk about this openly? Why are these brilliant professionals, most with no prior mental illness record, extinguishing the light of their lives? What circumstances are being created that push them to the very edge? I agree that every individual might have unique variables contributing to these occurrences, but when a particular group faces an issue on an epidemic level, the entire system has to be called into question. Yes, I am calling physician suicide an epidemic.

Even one life lost to suicide is an unfortunate, irreparable event. It shocks me how callous we have become as a society in response to the news of doctors taking their own lives. According to the Medscape Physician Suicide Report 2022, physicians have twice the rate of suicide compared to the general population. According to the American College of Graduate Medical Education, suicide is the second leading cause of death among residents. Medical students are three times more likely than their peers to die by suicide. Female physicians are at an exponentially higher risk of suicide (up to 400 percent) compared to their counterparts in other professions (The American Foundation for Suicide Prevention). The horrifying statistics go on and on.

It is an uncomfortable and normalized reality that physicians are always held to a subliminal and omnipotent standard. Or maybe this is just hypocrisy, where physicians are the scapegoats. We are expected to completely ignore our physical and emotional needs, a lesson taught early on in medical education and perpetuated through our careers. We are expected to cope with extreme conditions such as sleeplessness and disconnect from all normal bodily cues, such as hunger, thirst, bathroom breaks, as well as physical pain, all the while making life-and-death decisions for our patients. We are taught to be empathetic but discouraged from displaying any emotions, whether personal or when we truly feel the suffering of our patients. There is never a “right time” for women physicians to start a family, and they continue to face challenges in postpartum support. Maternity and paternity leaves are suboptimal and, in some institutes, unpaid. We are in a system where no one advocates for us and only expects from us. We, the physicians, are being crushed under the weight of these expectations. A handout on mindfulness, telling us to “write down three things you are grateful for,” or a “Zen Room,” is not going to fix this issue.

It is going to take gargantuan efforts to move the needle on this issue. But all large tasks can start with small steps forward.

I have laid out ten humble suggestions which by no means are perfect or complete, as this is an extremely complex issue. However, I am sharing these suggestions in an effort to open a dialogue.

1. Name it for what it is. Let’s publicly acknowledge and recognize the epidemic of physician suicide.
2. Remove regulatory hurdles. Supervisory bodies such as licensing boards must stop using language that deters physicians from seeking mental health help.
3. Leadership wellness. Organizational leadership should have physicians at the core who have experienced life in the trenches, rather than non-clinical administrators. These physician leaders should then receive maximum support through coaching, counseling, and therapy so they can lead from a space of wellness.
4. Lead from service. Organizational leaders should routinely engage in a “real check-in” with their physician employees, not just focused on metrics and assessments. They should take the time to ask physician employees if their support needs are being met.
5. Leadership accountability. Organizational leaders’ effectiveness should be measured with tangible metrics that center around physician wellness, such as physician job satisfaction, retention percentage, and turnover rate, to name a few.
6. Support. Organizational parental leave and postpartum support policies need to be thoroughly reviewed. Sick leave and paid time off should also be reevaluated.
7. Involving patients. The majority of our patients deeply care for us. We should empower and educate them since they are our “direct consumers.” They also suffer when good doctors suffer. Every patient, especially those in large hospital systems, should pause and inquire about how their doctors are being cared for. What wellness initiatives are in place for them? How are they supported in times of crisis?
8. Suicide risk and warnings. Medical trainees, starting from medical school, need to receive appropriate suicide warnings and relevant education so they are aware of risks and signs to look for, and can seek help accordingly.
9. Easy access to help. From medical trainees to attending physicians, support needs to be readily available for scheduling and cost coverage of health care visits, therapy, counseling, and coaching.
10. Stop waiting until it’s too late. Wellness is not just the absence of disease. Given the harrowing data on physician suicide and burnout, doctors should have consistent wellness support in the form of coaching, therapy, and counseling. This could be integrated as a longitudinal curriculum, stretching from medical school throughout professional careers. Imagine a world where every medical student was supported from day one onwards. How different would their journey look?

Some of you might be feeling optimistic reading these suggestions, while others are experiencing a range of emotions from anger, skepticism, exhaustion, and defeat to pure sadness. All of these emotions are valid.

Let’s not experience these emotions in silence and isolation. Please share your stories, opinions, feelings, and ideas. They matter. You matter. You might have been made to believe that they don’t matter, but dearest friend, they do. It is not okay to suffer. Let’s make physician voices louder than ever before.