Membership & Fellowship: A Candle in the Dark—Illuminating the Physician Suicide Epidemic

A fatal crisis has been eroding the fabric of modern medicine for decades. But this emergency isn't one of towering treatment costs, viral outbreaks, or convoluted bureaucracy. No—this is a battalion of foes hell-bent on agonizing our healers from the inside out.

Who are these tormentors?

Depression. Anxiety. Burnout. Addiction.

As we kick off the ACOG Member Insurance Program's work-life balance article series, we take the first steps toward pushing these emotional demons back into the abyss where they belong.


Behind Enemy Lines

Performing a proper diagnosis is the first step in treating any malady. So what do the stats tell us?

The numbers are grim, as practicing medicine comes with one of the highest suicide rates of any career. Among physicians, the male suicide rate is 1.4 times higher than the national average, with women being 2.3 times more likely to die by their own hand.

That translates to somewhere between 300–400 preventable doctor deaths each year, in addition to the thousands of physicians slogging through daily life in a shroud of misery. And that's without even factoring in medical students, who run a 27.2% risk of experiencing depression and an 11.1% chance of contemplating suicide, according to JAMA.

JAMA also examined peer-reviewed studies conducted between 1963 and 2015 on depression rates among medical residents. Ranges stretched from 20.9% to 43.2% throughout the years, with JAMA ultimately concluding 28.8% of those in residency experience depression or depressive symptoms.

Perhaps none of you find these stats surprising, as you're all firsthand survivors of the medical profession's demanding culture. Long hours, difficult patients, unmanageable workloads, complex bureaucracy, demands for perfection, and front-row seats to the depths of human grief and suffering are all par for the course during a typical workweek.

If you feel like you're collapsing under the weight of the world, you aren't alone.

 

Silence is Deafening

The longer a mood disorder goes unacknowledged, the more power it has to carve emotional scars across the victim's psyche. And though these untreated mental afflictions culminate in suicide far too often, the medical community has largely ignored the problem. Why

According to Pamela Wible, MD, a leading voice on the physician suicide crisis, medical training is "a profoundly dehumanizing experience, and it's drilled into you: Do not show your heart or tears to anyone, ever again."

On the surface, there's a twisted logic to burying your feelings. The thinking goes that a patient's needs take priority over everything else, so there's no time to waste on internal distress when so many cases demand your undivided attention. Besides, if a physician can't even handle their own emotions, how can their medical skills be trusted?

But it's the medical performance of those who don't seek help that's causing problems. Untreated physician depression has been linked with higher rates of medical errors, and it's easy to understand why. Modern medicine has many complexities that require razor-sharp focus, and while physicians are undoubtedly heroes, medical school doesn't come with the supernatural power to bulletproof your emotions. There's only so much stress the mind can take before optimism mutates into pain, isolation, or apathy.

Yet the culture of silence still persists. Though the factors causing this crisis are readily apparent, many doctors fear professional retribution for seeking help. In one study, more than 60% of suicidal physicians revealed they were dissuaded from seeking mental health treatment because it could adversely affect their medical license.

It's a tragic reality that disclosing mental health struggles can harm a physician's career. The specifics vary depending on employer policy, but there are reports of doctors facing licensure restrictions, discriminatory employment decisions, mandatory on-the-job supervision, and more… all because they had the courage to extend the same compassion to themselves that they extend to their patients.

Sometimes, suffering in silence can feel like the only option. But if you're caught in the raging winds of a psychological storm and don't trust your employer to handle the disclosure with compassion, you still don't have to resign yourself to defeat. Discuss your struggles with trusted coworkers. Chances are, they can relate. And likewise, if you know a peer who is battling inner turmoil, extend a helping hand. Having an interpersonal support system in place is a crucial step in building positive mental momentum and stopping this perpetual cycle of emotional suppression.

 

Calling All Leaders

There has been a systematic failure throughout the decades to recognize the anguish caused by untreated mental problems, but it's never too late to change course. Thankfully, some facilities are already removing barriers that have scared physicians into silence for so long. In addition to breaking the stigma, some groups are implementing programs designed to reduce employee stress through improving work-life balance.

Stanford Hospital is one example of an organization rising to the occasion. They recently ran a pilot program allowing physicians to convert time spent on the more thankless side of medical work (mentoring, serving on committees, covering extra shifts, etc.) into credits. These credits could then be used as currency for laundry services, housecleaning, movie tickets, home repairs, and more.

The program was a resounding success, leading to sizable improvements in both job satisfaction and work-life balance. Even though this initiative wasn't aimed specifically at mental health, it still indirectly alleviated inner tension by removing mundane or time-consuming chores from physicians' to-do lists. And while there's no one-size-fits-all solution, organizations like Stanford should be commended for putting significant effort into extending employees the lifelines they so desperately need.

If you're in a position of influence or power at your organization, you have tremendous potential to save the sanity, and maybe even the lives, of distraught colleagues. Investigate realistic options for your organization. Let employees know they can open up about their struggles without fear of judgment or punishment. Lead by example.

Even small actions can have a tremendous impact on someone's life. Don't waste your opportunity to make a difference.

 

Grassroots Healing

Statistically, most of you reading this aren't in leadership positions. That does not mean you're powerless.

One of depression's ugliest tactics is robbing you of hope, deluding you into believing positive change is impossible. But these thoughts are far from an impartial, objective analysis of reality. No—these are fabricated stories the mind tells itself, and believing them is optional.

This isn't some naïve admonition suggesting the power of positive thinking is enough to neutralize mental disorders (though practicing gratitude and optimism has been shown to improve physical health, mental health, self-esteem, and even sleep schedules). But recognizing how dark thoughts warp our perception of reality is a critical component of emotional management.

Learning to process thoughts and emotions in a helpful way is one of cognitive behavioral therapy's (CBT) key goals. Though there are many psychological improvement techniques out there, web-based CBT programs have proven effective in preliminary tests performed on medical interns. After just four weekly 30-minute training sessions, only 12% of participants reported having suicidal thoughts (as opposed to 21.2% in the control group). This therapy holds real promise for the medical community, despite there still being a long way to go until it's available for every physician and medical student across the country.

In the meantime, several excellent, self-guided CBT books are available for those interested in exploring the concept for themselves. And if you're willing to see a trained therapist, even better! It's always best to receive personalized, one-on-one guidance for mental disorders—but there are still alternatives for those worried about the potential repercussions of seeking professional help.

Another weapon to add to the emotional management arsenal is mindfulness meditation. This technique cultivates equanimity, which is the mental ability to maintain feelings of calm in all situations—even the difficult ones. And though the mindfulness movement has been gaining traction in the western world over recent years, it's far from a fad.

The underlying principles of meditation have existed for millennia, and modern science is now catching up. In 2016, Neuroscience and Biobehavioral Reviews published a meta-analysis of 78 different studies examining meditation's effect on the brain. They concluded the preliminary evidence is "broadly speaking … consistent with the methods, aims, and putative psychological results of the practices examined." In other words, meditation can work as advertised.

Here's another battle-tested strategy: exercise. The mind and body are intrinsically linked, and studies show regular exercise can be just as effective in treating mood disorders as medication or therapy. That's not to say the power of prescription drugs or therapists are mere placebos, but exercise is a universally accessible treatment method anyone can do. Working out might be just the catalyst you need to start turning the tides of your emotional war.

These starting points are only suggestions, because everyone's road to mental recovery will look different. The most important lesson is that proactivity is your greatest ally—neglecting the problem just emboldens nasty thoughts to stay on the offensive.

And if taking those first steps seems overwhelming, here's some uplifting news: afflictions like depression and anxiety are more treatable in medical professionals when compared to the general population. After all, becoming a physician is impossible without an innate ability to conjure motivation and determination from within. It took genuine talent and effort to launch your career in medicine. Draw upon those same character strengths, and start fighting back.

Don't put it off any longer—your path to recovery can start today.

 

Resuscitated Hope

The sheer magnitude of this problem may seem alarming, but there is a light at the end of the tunnel. Though it takes courage, research, and persistence, helping yourself or those around you escape these mental torture chambers is one of the most worthwhile things you can do.

As Stanford Medicine professor Bryan Bohman said to the Washington Post,

“When a physician drops off the precipice because they’re overstressed, the amount of damage it does to the medical care system is tremendous."

You're an indispensable asset, making tangible differences in the lives of patients every single day. The world needs your help, so keep healing—but this time, start with yourself.

 

CITATIONS

Andrew, Louise B., MD, JD. "Physician Suicide." Medscape. Ed. Barry E. Brenner. 3 October 2016. Web. 3 February 2017.

Graham, Judith. "Why are doctors plagued by depression and suicide? A crisis comes into focus." STAT. 21 July 2016. Web. 3 February 2017.

"Physician and Medical Student Depression and Suicide Prevention." American Foundation for Suicide Prevention. Web. 3 February 2017.

Poorman, Elisabeth, MD. "To the doctors struggling with depression: You are not alone." KevinMD. 30 August 2016. Web. 3 February 2017.

Mata, Douglas A., MD, MPH, Marco A. Ramos, MPhil, MSEd, and Narinder Bansal, PhD. "Prevalence of Depression and Depressive Symptoms Among Resident Physicians." The JAMA Network (2015) Web. 3 February 2017.

Rotenstein, Lisa S., BA, Marco A. Ramos, MPhil, and Matthew Torre, MD. "Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students." The JAMA Network (2016) Web. 3 February 2017.

Hester, Jessica Leigh. "The Misery of a Doctor's First Days." The Atlantic. 1 October 2015. Web. 3 February 2017.

Cox, Elaine, M.D. "Doctor Burnout, Stress and Depression: Not an Easy Fix." U.S. News & WORLD REPORT. 12 April 2016. Web. 3 February 2017.

Guille, Constance, MD, Zhuo Zhao, MS, and John Krystal, MD. "Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical Interns." The JAMA Network (2015) Web. 3 February 2017.

Schulte, Brigid. "Time in the bank: A Stanford plan to save doctors from burnout." Washington Post. 20 August 2015. Web. 3 February 2017.

Morin, Amy. "7 Scientifically Proven Benefits of Gratitude." Psychology Today. 3 April 2015. Web. 3 February 2017.

Fox, Kieran C.R., Matthew L. Dixon, Savannah Nijeboer, Manesh Girn, James L. Floman, Michael Lifshitz, Melissa Ellamil, Peter Sedlmeier, and Kalina Christoff. "Functional neuroanatomy of meditation: A review and meta-analysis of 78 functional neuroimaging investigations." Neuroscience and Biobehavioral Reviews 65 (2016): 208-28. ResearchGate. Web. 13 February 2017.

Pillay, Srini, MD. "How simply moving benefits your mental health." Harvard Health Publications. Harvard Medical School, 28 March 2016. Web. 7 February 2017.

The purpose of this article is to provide information, rather than advice or opinion. It is accurate to the best of the author’s knowledge as of the publication date. Accordingly, this article should not be viewed as a substitute for the guidance and recommendations of a retained professional. Any references to external websites are provided solely for convenience. The ACOG Member Insurance Program disclaims any responsibility with respect to such websites.

American Congress of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188 | Mailing Address: PO Box 70620, Washington, DC 20024-9998