Physician Suicide: Why Doctors Don’t Seek Mental Health Intervention
Physician recruiters and healthcare staffing agencies have long pointed out that a manageable workload and a good fit with company culture are top considerations in matching candidates with employers. Without true compatibility, healthcare workers are more susceptible to stress, burnout and even depression. The latter is of dire concern for physicians in particular. Though it may seem counterintuitive, doctors have higher rates of suicide than the general population. Studies dating back to the early 70’s have rendered some conflicting statistics, with one study recording only slightly higher incidence among physicians and others suggesting that practitioners are more than twice as likely to take their own lives. Analysis of death records indicate that somewhere between 300 and 400 doctors die by suicide each year in the United States – and this number may be low as pathologists are hesitant to make that call when it comes to colleagues in the medical profession. No matter what numbers you apply, the bottom line is that medicine is a high-pressure profession and doctors need help they aren’t getting.
Hesitance to seek out intervention is a common problem for anyone experiencing mental health challenges. Despite some gains over the last couple of decades, the stigma surrounding mental illness remains a formidable obstacle. Unfortunately, doctors seldom follow the advice they would offer their own patients, depriving themselves of the sort of prevention methods that have been shown to have an effect on suicide rates. Recent data indicates that, of those who took their own lives, healthcare workers were actually less likely than the general population to leverage the benefits of antidepressant medication. And for physicians, resistance to reaching out is the product of even more than fear of humiliation and judgement. In fact, there are real consequences that may seem like impenetrable barriers to treatment.
Though it flies in the face of legislation aiming to protect against discrimination, medical licensure and renewal applications often require the disclosure of mental illness, whether managed through treatment or not. When applying for employment or credentialing, failure to disclose anything at all often results in negative consequences including job loss and revocation of credentials. Health programs might also automatically refer an applicant to services, sparking fear of wider disclosure for physicians who may find themselves face to face with coworkers.
The acquisition of professional insurance can be problematic for physicians with mental health disorders. Not only may they face bias when trying to obtain health, disability, life and liability insurance, but anti-discrimination laws are not likely to provide any protection. Practicing medicine without legal protection may prohibit physicians from being able to work in most of the country. Non-disclosure in this case is equally as problematic as it is with licensure; liability coverage is rendered void if details are withheld, at least in part because mental illness has been correlated with a higher rate of medical error.
Workload and Role Perceptions
Being a physician is stressful. Many doctors work long hours. Others are constantly surrounded by issues of death and dying. But a world-wide physician shortage, worsened by the pandemic, has made for heavy workloads across the board and has led to an epidemic of burnout. Physician recruiters often point out that health outcomes are better with lower staff to patient ratios. Those improved results are seen not only in patients but in the healthcare workers who treat them.
While burnout does not necessarily cause practitioners to struggle with mental illness, symptoms are unsettlingly similar. For doctors who may already grapple with depression, burnout leads to worsening symptoms. Severe burnout has been associated with suicidal ideation, a good indicator that a life-threatening crisis has potential to develop if no intervention is initiated.
But again, the higher rate of suicide among physicians is not necessarily correlated to a higher rate of mental illness but rather to a lack of appropriate treatment. Physicians often believe that, as educated and experienced medical professionals, they are meant to be capable of leveraging training to overcome symptoms like burnout.
Depression is characterized by a tendency to view the world and oneself through a negative lens and those who suffer from it face an uphill battle as they try to muster the motivation to initiate intervention and believe in its potential efficacy. For physicians, the expected consequences of seeking treatment can add to this already distorted thinking, leading him or her to believe that there is little in the way of good options.
For now, re-approaching the legal aspects of disclosure with an eye to protecting physicians from discrimination promises to have a big impact on physician suicide rates. In the meantime, we may need to concede that physicians — given a very real barrier to seeking help – may require more manageable environments than are currently on offer. One could argue that any population with a high suicide rate should benefit from measures to make the workplace less stressful than average, rather than reenforce notions of super-human doctors. Larger providers might seek staffing help from physician recruiters and healthcare staffing agencies to lighten the loads that lead to burnout and intensify depressive symptoms. After all, we rely on physicians to care for us. First, we may need to better care for them.