If We Can Save Just One: Physician Suicide is a Disease that Deserves Attention

September 17 is National Physician Suicide Awareness Day, an opportunity to commemorate colleagues who have died by suicide while raising broader awareness of this issue.

Consider the following: In the United States, the 10th leading cause of death among the general population is suicide. But among the population of medical residents, suicide is the second leading cause of death. And for physicians overall, the suicide rate is more than two times higher than the general population: 400 or more physicians die by suicide annually, more than one every day.

Why are physicians, at every stage of their career path, so at risk to die by suicide? And more importantly, what can be done about this?

This is a personal issue for me — and for far too many others.

I had a friend and colleague die by suicide eight years ago, and I still think about how I might have helped. He was a physician, tremendously successful and beloved, a great guy, often laughing, poking fun, keeping things light. His clinic’s walls were filled with framed photographs, cards, and photos from patients he had cared for. He brought life and joy to so many. And he stayed in his patients’ lives, until one day, he died by suicide.

On National Physician Suicide Awareness Day, I hope to start a conversation that will extend far beyond just today. I want this to become an ongoing series in which we engage innovative leaders in conversations to better understand factors, land on potential solutions and make a difference.

There are many contributing factors for the high suicide rate among physicians and residents.?Physicians take pride in their ability to take care of others but often neglect to take care of themselves while working long hours under extreme pressure and dealing intimately with life and death every day.

This feeling of burnout and frustration can start early. Physicians come out of training, often burdened with student debt and disillusioned with the demands of the day-to-day job. Instead of spending time with patients, they find they’re spending an unexpected amount of time charting and doing paperwork. Compounding the issue, physicians who don’t have close ties with others feel isolated. Yet free time is hard to come by, and the gravity of their work is difficult for most others to understand.

The overwhelming responsibility and frustration associated with treating COVID-19 patients for the past 18 months has heightened the burden. As a result, many physicians are showing signs of post-traumatic stress disorder after facing situations they had not trained for.

What should we look at changing?

It is my belief that we need to start early in the education process —?employ a “trickle-up” theory. Today, medical schools do give emphasis to important topics like behavioral health, mental health issues and work-life balance. I think back to when I was in residency. It was a badge of honor to work 100+ hour weeks; now residents are limited by law to a still-extreme, but better, 80-hour work week. This represents an important shift in the right direction. But still, there is not enough done to encourage the caregivers to make time to take care of themselves.

As physicians, we have a responsibility to develop and nurture not only the next generation of clinicians, but also tend to the needs of our existing doctors who likely were not taught to focus on self-care.

We need to talk more honestly about mood disorders, anxiety and depression, train ourselves to recognize these in our colleagues and look out for each other. Support groups and physician wellness programs are important, understanding that, while useful, the people who attend these might not be the ones who need it most. We can take this even further.

I strongly believe seeking and creating organic opportunities for connection will be a difference-maker. Creating friendships and relationships around common interests, like running groups, book clubs or coffee meetups, can stave off depression, burnout and feelings of loneliness and isolation. As doctors, we want to do whatever we can to encourage relationships among ourselves and make room for open conversations.

A physician dies by suicide once every day, often after suffering in silence. My colleague’s suicide left a lasting impact. The trauma felt by his staff, his patients, his family —?and by me —?cannot be measured.

Together, we can move the daily number of physicians who die by suicide closer to zero.

If we can get to even one person, we will have done something.