The Death of Our Doctors: Selected Articles on Physician Suicide

A Collection of Op-Eds, Videos, and Articles on Physician and Med Student Stress, Burnout, and Suicide

Once upon a time, I sought out to research and write about physician wellness. Well, actually the mental “wellness”, or lack thereof, among med students, residents, and attending physicians. This topic has been taking up some of my brain space for about two years. In the Fall of 2014, I read an article in The Advisory Board’s Daily Briefing series about physician suicide and I found the statistics staggering. In big, bold print right under the title the following was written:

The Advisory Board’s piece was covering an article by Pamela Wible in The Washington Post on physician suicide, which further contextualized this shocking statistic: “Given that a typical doctor has about 2,300 patients, under his or her care, that means more than a million Americans will lose a physician to suicide [each] year.” As a #PHNerd concerned with the health of others, and most personally, someone who has numerous acquaintances and friends along the medical career spectrum I became consumed with wanting to better understand the mechanisms at play in creating and perpetuating this epidemic, learn more about efforts at medical schools, in residency programs, and in professional organizations to promote wellness and mitigate risk, and discover prevailing thoughts on remaining gaps and recommendations for how to address these vulnerabilities.

Also, from a slightly less “investigatory” of point of view, I was genuinely concerned about just how many of my friends and colleagues who have chosen this path would disappear over the next few decades. Not just for the sake our personal relationships, or their current/future patients, but because physicians are just as infallible and mortal as the rest of us. I admit that I have been quick to forget this fact and I know others who have also been. Perhaps it is because so many of the people I know that have made it through the ultra-competitive medical admissions process are truly extraordinary people, who will, accordingly, be held to extraordinary standards as they progress through their careers. They have chosen to perpetually preoccupy themselves with the health and well-being of others, and, yet, they are infrequently afforded the the same level of constant preoccupation with their own health and wellness, physical and mental.

So, about two months ago I enlisted a writing partner — who was exceedingly gracious in offering to help, started jotting down thoughts, compiled some resources, and sent out informal interview requests to nearly everyone I know along the medical career spectrum. To be honest, I fully expected to get no responses, given that med students and residents are very busy, but I feverishly checked my e-mail anyway. Much to my surprise and delight my inquiries were quickly met with lots of support, engagement, and several personal stories (on this note, in particular, I graciously thank those of you who shared tidbits of your medical and personal life with me).

With this information I wanted to write something that dug deep to the heart of the issue, interwove personal anecdotes and evidence, and coupled fair critique with meaningful recommendations. Turns out, several people have already done that, or, at least, some version of it. I didn’t want to simply summarize everything I found and end up producing an op-Ed with lots of information and very little opinion — which is what would have happened since I was completely out of ideas for a new, different angle with which to present this information and motivate this issue — but I felt compelled to share the information I found. What to do?!?!

I have decided to compile and share the information I found here — it seemed the best way to accommodate my current reduced bandwidth, ever-present impatience with regards to getting stories out, and the internal sense of obligation I feel to share this important information. Below I have provided links to several of the op-Eds, videos, and journal articles on this topic that I found particularly informative, illuminating, and/or poignant.

Please feel to read and share this information. Also feel free to suggest additions, I plan to update this list periodically.

*LAST UPDATED August 10, 2016*

American Foundation for Suicide Prevention. (2013). ASFP’S Struggling in Silence: Physician Depression and Suicide Series.

• Video Clip 1 (1 min 30 seconds)
• Video Clip 2 (1 min 07 seconds)
• Video Clip 3 (1 min 17 seconds)

Andrew, Louise B. (Updated 2016). Physician Suicide. Medscape.

Bright, Robert P. and Krahn, Lois. (2011). Depression and suicide among physicians. Current Psychiatry.

• “This article examines physicians’ risk for depression and suicide, licensing concerns and other barriers to effective treatment, and what can be done to overcome such obstacles.”

Drake, Daniela. (2014). How Being a Doctor Became the Most Miserable Profession. The Daily Beast.

Drummond, Dike. (2015). Physician Burnout Rates Top 50% in latest Mayo Study. The Health Care Blog.

Glaser, Gabrielle. (2015). American Doctors Are Killing Themselves and No One Is Talking About It. The Daily Beast.

Goldman, Matthew L. (2015). Depression and Suicide Among Physician Trainees Recommendations for a National Response. JAMA Psychiatry.

• “This Viewpoint suggests that national organizations should address the mental health of residents and fellows by proposing strategies for comprehensive education, screening, and treatment. […] Physician suicide is a common occurrence. According to the American Foundation for Suicide Prevention, 300 to 400 physicians commit suicide each year, approximately 1 physician per day. Medical training involves numerous risk factors for mental illness, such as role transition, decreased sleep, relocation resulting in fewer available support systems, and feelings of isolation. A substantial body of evidence has demonstrated that trainees in particular are at high risk for depression and suicidal thinking, but many training programs have not been able to identify and provide treatment for these residents and fellows in a systematic way. National organizations, such as the Accreditation Council for Graduate Medical Education (ACGME), should address the mental health of residents and fellows by proposing strategies for comprehensive education, screening, and treatment.”

Grossman, Dana C. (2015). Reducing the Stigma: Faculty Speak Out About Suicide Rates Among Medical Students, Physicians. Association of American Medical Colleges Reporter.

• “Among medical students, suicide is the second most common cause of death, after accidents. A study published in the February 2009 issue of Academic Medicine found that 13.6 percent of medical students exhibited probable major depression and 6.6 percent reported suicidal ideation.”
• “[…] physicians, more than people in other professions, fear that admitting to suicidal thoughts will affect their livelihood. ‘They’re often afraid they won’t be able to practice, they’ll lose privileges,’”
• “Despite the apparent complexity of the problem, experts suggest down-to-earth solutions such as talking about the problem, normalizing it to dispel the stigma, reaching out to troubled colleagues, and taking care of one another.”
• “Medical schools and teaching hospitals are actively working to prevent suicides by cultivating a learning environment that is supportive when mental health issues arise. Many are educating students and faculty about the risk factors and warning signs that could precede suicidal thoughts. In addition, there has been a push to screen for fatigue and burnout throughout the education continuum and during medical practice.”
• “The Accreditation Council for Graduate Medical Education requires that programs provide confidential counseling for trainees who may be experiencing suicidal ideation. To ensure anonymity, medical schools have implemented policies that separate mental health services from the academic environment.”

Minicozzi, Alessia. (2015). The Truth About Burnout and Suicide Among Physicians. Impakter.

• “Once the physician completes the training process the notion that doctors no longer require support and guidance is unrealistic. Medicine is a field that is emotionally filled with traumatic events and senior physicians will continue to face these occurrences throughout their career. There is never a time when physicians will not need some level of support. This reality is relevant and necessary to accept. Until medical administrators, fellow doctors, and educators realize that drastic changes are necessary to save physicians’ lives, the level of burnout will increase and the rate of suicide will accelerate.”

Ofri, Danielle. (2014). Tyranny of Perfection. Slate.

• “Medical schools and residency programs have come to realize that it takes more than factual competence to make a good doctor. There is an increasing emphasis on student well-being, and an acknowledgement that stress is more than just a tolerated byproduct of our educational system. We faculty are exhorted to keep our eyes out for the earliest signs of strain so that help can come earlier. We’re also learning to do the same for ourselves and our colleagues. Nevertheless, many struggling students and physicians manage to stay under the radar. […]”
• “When trying to help our patients achieve their best health, we would never steer them toward situations associated with relentless stress. We would never subject them to impossible-to-attain goals that lead to a persistent sense of failure. We would never prescribe anything with side effects of depression, substance abuse and suicide. Why would we allow this for ourselves or our trainees?”

Parks, Troy. (2016). Out of tragedy comes a new focus on resident health. AMA Wire.

• “After news that a star surgical resident, who had recently left Stanford to pursue a fellowship, had committed suicide, the residency program leadership decided to create a new structure that addresses the underlying issues affecting resident health and promotes a healthier work-life balance.”

Poorman, Elisabeth (2016). I Felt Alone But I Wasn’t: Depression Is Rampant Among Doctors In Training. WBUR.

• “I thought I was alone. I wasn’t. After interviewing several residents at Boston teaching hospitals […] and reviewing the research, I’m starting to understand the scale of mental health disorders in residency and why this problem seems to be growing worse. Residency’s long hours, trauma, sleeplessness and social isolation inevitably erode our healthy coping mechanisms. At the same time, there is a powerful culture of fear, stigma and lack of self-care that prevents residents from seeking help. The resources that are in place in residency programs are simply not adequate.”

Shanafelt, Tait D. et al (2015). Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clinic Proceedings.

• “Burnout and satisfaction with work-life balance in US physicians worsened from 2011 to 2014. More than half of US physicians are now experiencing professional burnout.”
• Note: This study was covered in some depth by Dike Drummond on The Health Care Blog (see reference under “Drummond, Dike” above)

Sinha, Pranay. (2014). Why Do Doctors Commit Suicide? The New York Times.

• “We need to be able to voice these doubts and fears. We need to be able to talk about the sadness of that first death certificate we signed, the mortification at the first incorrect prescription we ordered, the embarrassment of not knowing an answer on rounds that a medical student knew. A medical culture that encourages us to share these vulnerabilities could help us realize that we are not alone and find comfort and increased connection with our peers. It could also make it easier for residents who are at risk to ask for help. And I believe it would make us all better doctors.”

The Advisory Board Company. (2014). Physicians have the highest suicide rate of any profession. So why haven’t you heard about it? The Daily Briefing, The Advisory Board.

Ungerleider, Neal. (2016). The Hidden Epidemic of Doctor Suicides. Fast Company.

• “The challenge is that there are no easy answers. [Pamela] Wible calls for a wholesale overhaul of the way doctors talk about their own mental health. A big part of this is greater understanding from the medical establishment about the high rate of depression among doctors and that it shouldn’t just be repressed; another part is creating treatment options for physicians and medical students that won’t offer what she calls “punitive” stigma for their careers. In the meantime, the fact that her book [Physician Suicide Letters] is an Amazon best seller signifies one promising change: Medical professionals are, at the very least, acknowledging that there’s a problem.”

Wible, Pamela. (2016). The scary reason 1 million Americans can never see their doctors again. Quartz.

• “Medical school knocked me to my knees. I haven’t been the same since. […] Like most students, I just wanted to help people. I wanted to heal the broken world, the injured hearts and souls of patients who would one day entrust me with their lives. Instead, I nearly lost my own life. The memorization-regurgitation method of medical education disturbed my creative, non-linear mind. I studied constantly — spitting back medical minutiae for multiple-choice tests. I’m an average test-taker, though I excel with patients. I’m happiest helping people. But it’s difficult to be happy (or to help people) in a medical culture that condones hazing, bullying, sexual harassment, and teaching by public humiliation. […]”
• “Why is the plague of physician and medical student suicide such a secret? Why am I the one piecing this together? 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 did both doctors I dated in med school die by suicide? Why did eight doctors kill themselves — just in my sweet little Oregon town? There are answers. Finding them requires being willing to look at some very disturbing facts. It also requires the willingness to engage with people who have experienced and who continue to experience a great deal of pain. 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 all over the world.”

Wible, Pamela. (2014). Physician suicide letters. KevinMD.

Wible, Pamela. (2014). When doctors commit suicide, it’s often hushed up. The Washington Post.

Wible, Pamela. (2014). How to get naked with your doctor. TEDxSalem.

• “In a TEDx talk I gave to help break the silence on physician suicide, I pointed out why so many doctors and medical students are burning out: We see far too much pain; to ask for help is considered a weakness; to visit a psychiatrist can be professional suicide, meaning that we risk loss of license and hospital privileges, not to mention wariness from patients if our emotional distress becomes known.” — From Dr. Wible’s WaPo Article