Taking Action to Proactively Prevent Physician Suicide

September 17 is National Physician Suicide Awareness Day. It brings attention to a subject that is unpleasant to discuss but a pervasive problem plaguing the healthcare industry. First held in 2017, it’s a day dedicated to honoring the memory of physicians who have died by suicide. Just as important, its purpose is to continue to raise awareness and discussion on how to prevent it. 

An average of 132 Americans die by suicide each day. In 2020, almost 46,000 Americans – out of an estimated 1.2 million who attempted it — perished by committing suicide. Unfortunately, that number is much higher among physicians. 

Much has been published about physician burnout, which is a serious issue in its own right. The number varies, but an estimated 300 doctors annually die by suicide, with a rate as much as 40 percent higher than the general population. 

The suicide rate among male physicians is 1.41 times higher than the general male population. Among female doctors, it’s 2.27 times greater than the general female population. Anesthesiologists and psychiatrists are at an even higher risk. 

Suicidal ideation doesn’t only affect doctors who have been practicing for years. Suicide is the most common cause of death among medical students and the second in residents. Although some medical schools are incorporating self-care into professional development curricula, most suicides occur during the first two years of training. 

Common Risk Factors for Physician Suicide 

What’s the reason for an elevated rate of suicide in physicians? There are almost too many to count. 

Physicians choose an inherently stressful career, fraught with years of training, long hours, sleepless nights and a skewed work/life balance. They’re often required to make life-or-death decisions, all while being tasked with increasing organizational revenue while cutting costs. 

The COVID-19 pandemic has only exacerbated this stress. In addition to an already high administrative burden, doctors have risked being infected by the contagious virus. Many know a frontline healthcare worker who lost his or her life to COVID-19. 

Untreated or inadequately managed mental health conditions are the primary risk factors in physician suicide, but depression, emotional exhaustion and substance abuse also markedly contribute to the problem. Depression affects an estimated 12 percent of male doctors and up to 19.5 percent of female ones. Even more medical students and residents experience symptoms of depression. 

According to the American Medical Association (AMA), other risk factors for physician suicide include:

• Prior suicide attempt
• Adverse childhood experiences, such as experiences or witnessing violence, abuse or neglect
• Family history of mental health issues and/or suicidal behavior
• History of physical, psychological and/or sexual abuse
• Major life events that affect a person’s stability and support network
• Relationship problems or domestic violence
• Situational stressors, including:
  • Being named as a defendant in a lawsuit
  • General career concerns (e.g., job security, increased demands)
  • License restriction
  • Financial problems
  • Professional isolation
  • Recent patient with a poor outcome

Barriers to Mental Health Treatment

Knowing the risk factors and symptoms of suicidal ideation doesn’t mean doctors seek treatment. Physicians face unique barriers to mental health treatment, both real and perceived. 

Some reasons doctors who are suicidal don’t seek treatment are simple — work hours that preclude attending appointments during regular office hours, a lack of time in an already busy and sometimes unpredictable schedule or concerns about confidentiality. Physicians also may be reluctant to see a mental health professional because they’re afraid it will impact their ability to procure their medical licensure or professional liability insurance or damage their career prospects. For some, it’s the stigma associated with a physician seeking treatment for mental health. 

Warning Signs of Physician Suicide 

Whether you’re a physician harboring thoughts of suicide or know a colleague or someone else who is, knowing the warning signs is essential. The Physicians Foundation created a list of these physician suicide warning signs based on the acronym H.E.A.R.T.:

Health

• • Increasing the use of medications and/or alcohol or illicit drugs
  • Talking about wanting to hurt themselves or die

Emotions

• • • Experiencing extreme mood swings
    • Feeling hopeless or having no purpose

Attitude

• • • Being negative about professional and personal life
    • Having inappropriate outbursts of anger or sadness

Relationships

• • • Withdrawing or isolating themselves from family, friends and coworkers
    • Talking about being a burden to others

Temperament

• • • Acting anxious or agitated; behaving recklessly
    • Being uncomfortable, tired or in unbearable pain 

The Healthcare Industry’s Role in Preventing Physician Suicide 

If these warning signs sound familiar, it’s time to make your mental wellness a priority. Don’t be afraid to speak with a professional, colleague, friend or family member about taking the steps necessary to focus on yourself. You’re not alone — whether or not you know them, there are other physicians experiencing the same thing. 

Your self-care might start with taking small steps to maintain your health, including getting enough sleep, eating nutritionally and exercising regularly. Take personal time and vacation days you’re owed, and don’t hesitate to ask for more time off if you’re not able to provide adequate patient care in your current mindset. Understand that it’s okay to say no to unreasonable requests and those that interfere with an already hectic schedule. 

If you have a physician colleague you know is contemplating suicide, encourage them to seek help and give them resources necessary to do so. Take them seriously, and listen closely to their concerns. Offer to support them in any way reasonably possible, and follow up with them. 

Hospital, health system and physician practice leaders should take an active role in fostering a culture that enables doctors to seek mental health treatment and not be stigmatized or penalized for doing so. Try to support flexibility in your doctors’ schedules, and don’t prohibit requests for time off for vacations or sick leave. Regularly acknowledge the quality of care by physicians under your employ, even if it’s just a kind word or some other form of positive feedback. 

The American Psychiatric Association offers an online self-assessment tool to screen yourself for burnout and to gauge your well-being and the American Foundation for Suicide Prevention has resources to help prevent physician suicide and support the well-being of healthcare professionals. 

If you or a colleague are thinking about suicide, please contact the Suicide Hotline at 800-273-8255, which provides 24/7 free and confidential support.