Physicians commit suicide more often than even than active duty combat military–which is considered the most stressful of all professions.
Male and female physicians commit suicide at about the same rates. Suicide rates are highest among medical students and residents.
Although this information has been known for a number of years, the most recent study sought to evaluate the efficacy of suicide prevention programs that have been put in place to address this issue.
While the rates of depression and other mood disorders among physicians do not differ significantly from their non-medical peers, physicians are less likely to seek professional mental health treatment.
Physicians also have better knowledge of drugs & their effects than their non-medical peers and have better access to lethal medications. Medication overdose is the most common method of physician suicide. (Firearms is a distance second.)
It must be incredibly difficult when you simply don’t have the ability to save a life. Or to live with the fact that one single bad call on your part could result I the death of an innocent person.
This. Or even the feeling of not keeping up with family or other expectations due to the needs of the job.
One doesn’t have to go far to find the majority of people thinking doctors should be superhuman just as the Hollywood docs are. They often forget they are people too - usually trying to do their best even when they have to guess. They’re not superhuman with the rest of their live either (parenting, etc). If/when things go wrong, I can only imagine that stress. Add stress to opportunity and knowledge… the stats don’t surprise me.
We have kids in our school who join EMT groups. One young lad dealt with his first death of someone he was trying to save about a month ago. It’s a hard hit to the mind. I know one has to become sort of desensitized, but I suspect the feeling of “what if” never totally goes away. A good doctor (or EMT) wants to save folks.
Human bodies are tricky at times. There’s a ton of variability. Even with my own health issues, I’ve flat out told my family that they are not to hold any doctor responsible for any sort of “wrong” decision should awful things happen. I can see things from their POV even if I disagree with some decisions. I dislike the system that they get the final say when there’s a disagreement, but that’s the system, not them.
Like teachers… there are some who shouldn’t be in their jobs but the only one of those I’ve met to date has been my mom’s. I’m sure there are others, but I doubt they are the ones who are getting stressed to the point of suicide. The personality seems quite different.
I see no signs of depression in my own med school lad, but he’s a perfectionist so I say my prayers and hope his decisions are all good ones as he goes along.
D2 who is finishing up her M3 year talked to me about this - she went to undergrad with a classmate of the NYU med student who committed suicide. D has always been one of the happiest, most confident people I know, but med school can beat you down at times. And the stakes are much higher for residents and attendings. D said she cannot think of a single one of her med school friends who didn’t at some point feel they had symptoms of depression, and she cannot imagine how difficult it would be for someone who was clinically depressed. I thought the article linked above made an interesting point about how the suggestions/ remedies for dealing with the stress of medicine are superficial:
“Dr. Pamela Wible, an outspoken advocate for suicide prevention and awareness believes schools and hospitals are not adequately addressing the system that is leading so many bright and promising people to die by suicide, but are instead focused on superficial remedies. “Yoga, meditation, and forced wellness modules won’t stop these suicide clusters at NYU and Mount Sinai,” Dr. Wible told Refinery29 in an interview. “The medical system must finally take responsibility for perpetuating the toxic working conditions that destabilize our doctors-in-training and lead to these suicides.””
I would say that few doctors who kill themselves are fretting about inability to save patients. That notion is drummed out early on.
I don’t think medical schools, or any schools, are responsible for ferreting out and fixing problems in their students. Sure, they can help, but they can’t be responsible for everything. It is not remarkable, that high stress jobs have higher rates of stress related problems.
Residents often work in toxic work environments: Long hours, sleep deprivation, loss of autonomy, constant criticism from attendings and senior residents, malpractice litigation, back stabbing from fellow residents, burnout. Some residents even develop PTSD from the traumatic experience.
Interesting. And yet the few times I’ve come in contact with those in the medical profession socially (generally on airplanes) and we got talking about down sides, this one is always brought up, usually with personal examples - along with the hours, etc. It might get hidden, but I don’t think it gets drummed out. I don’t know that it leads to depression, of course. That’s musing based upon the stats. It wouldn’t surprise me if it’s a brick on the camel’s back. Doubt it’s the straw that breaks the back.
With recent deaths at NYU and Mount Sinai, I wonder if NYC training programs have additional/greater stressors that lead to suicide? I often hear about malignant training programs in NYC.
As a spouse of a Doc, I’d say the working conditions, and stress caused by them, are a major culprit. Almost all of the managements of the companies that she’s worked for (over 10, and in numerous states) have also been just flat out bad, in most cases. Adversarial, only interested in money, and completely unwilling to listen or ask employees for feedback. My theory is that the medical field is such a cash cow that even an idiot can’t screw it up, but they are trying!
There’s data shows that while the rate of suicide is highest among med students and residents, attending physicians still have a much higher than average suicide rate.
While it’s important to listen to what Dr. Wibble has to say, it’s also important to remember that she has a major financial interest in the topic. She runs a lecture/consulting business on physician wellness/suicide reduction. She has been banned from this site and other message boards for her rather aggressive self-promotion.
Generally speaking all the reports of the med students who commit suicide have said that they seemed “fine” and displayed no outward noticeable signs of depression or suicidal ideation. (Internalization) Perfectionism (the "living up to other people’s expectations type) is strongly associated with an elevated risk of suicide. Medicine, unfortunately, tend to select for individuals who are both perfectionists and who internalize all their emotional/behavioral issues.
@freshlysqueezed In the “big 4” Manhattan hospitals (Cornell, Columbia, NYU, Sinai and I only mean the main hospitals, not their affiliates), I think the bigger issue for NYC students/residents is cost of living in NYC, not the programs themselves. Outside of those 4 you have mostly IMGs and so the programs are probably more likely to be malignant because the power dynamic is even further amplified given how limited opportunities can be for IMGs.
This exists in all the companies. Anyone worked in corporate America probably know - management only care themselves, never about employees…if management ask your feedback, it’s most likely to be used against you later. For toxic and high-pressure environments like investment banks, if you said anything wrong, you would be fired on the spot and escorted out by security.
The OP is talking about physicians not medical students. But in my experience, it has never been easier to be a medical student in terms of how they are treated. Even residents have work restrictions. I am sure they are not followed to the letter, but if they are followed 1% of the time they have it easier. We were wanting to utilize residents at our hospital but the work restrictions made it irrational to give them any on-call responsibilities. They also had pretty severe restrictions on the number of cases they could manage, again making it almost too much of a bother to have them. I am sure that is different in larger programs in large cities but my point is that medical school and residency are nothing like “the old days.” Maybe that is a good think in some respects.
As for IMG’s, I would say they have different circumstances than domestic residents. They tend to come from countries with more abject economic circumstances, e.g. more from Nigeria than Finland. They also have extended families dependent on them and are probably more likely to be married in medical school and residency. In my experience, many of them love the work restrictions on residency so they can moonlight of top of it. I wonder if they parse suicide stats based on country of origin but I would bet the rate is lower for IMG’s.
Employers of doctors are not the only ones concerned about money. so are the doctor’s. Just go to a medical staff meeting and mention “pay cut” as an administrator and feel the outpouring of empathy from the physicians. You won’t find a more rancorous meeting. And many medical practices are not cash cows. Regulation prohibits most doctors from owning the means of production (e.g. hospitals). The government and their allied insurance companies have devalued the practice of seeing patients face to face and incentive procedures, devices, drugs, etc. The money is not in the direct patient care. So a lot of doctors do face financial stressors despite making good money. Because of a foreshortened work career due to length of training, debt taken on to finance education, debt from poor financial choices early in their careers, dysfunctional marriages because of all the above, and with personality deficits selected for by the process of becoming a physician, rates of maladjustment like suicide should be higher than average.
Nothing about medicine is like the old days anymore. The epidemiology, the treatments, the insurance companies, the salaries, the mid levels, let alone the training.
I’ll take that bet (assuming I get “equal” in addition to “higher”). The Mount Sinai resident suicides of the last few years were IMGs as was the person who shot/killed a colleague in a Bronx hospital last year.
@iwannabe_Brown Yikes. Not good stories. One problem is that the big tragedies are more sporadic and anecdotal. But it would be interesting to see more granular information. In my day, there were two residents that I knew of who committed suicide. One was a very narcissistic guy who contracted AIDS and decided to go. The other was a fairly golden, good looking guy at a good program who got into cocaine and other problems. There were lots of other stories, less than death, but almost as tragic.
@WISdad23 yeah, could be recency/publicity bias I don’t know, but between that and my interactions with IMGs on rotations and the interview trail, I am certainly going to hesitate before I say that level of desperation is “protective.”