It’s no secret that doctors often work shifts of more than 24 hours without time to adequately rest or eat. It’s no secret either that many practicing physicians and medical students are tasked with punishing workloads, and either blame themselves when something goes wrong or become frustrated at a work culture that is rapidly changing.
And for many in the medical community, there's another thing that's no secret. Physicians and residents have a high suicide rate.
Pamela Wible, a physician in Eugene, Oregon, self-published a book last month that promptly became Amazon’s top best-seller for medicine and psychology. It was a book of suicide letters from doctors and medical students. And many of the book’s purchasers, she says, are other physicians.
According to a study published in 1996, physicians are more than twice as likely to kill themselves as non-physicians—and female physicians are three times more likely than males. A separate 2005 project found similar metrics. It isn’t a new phenomenon, but the rise of social media and changing social mores are making some health care professionals more comfortable talking about it.
Onstage at the 2015 TEDMED conference in Palm Springs this past November, Wible talked to an audience of prominent health care experts about suicides in the medical community. She told attendees something astounding: That approximately 1 million Americans lose their primary care practitioners to suicide each year.
Wible says that statistic reflects low-end estimates of approximately 400 doctors committing suicide yearly. Each of those doctors, if they work in primary care, cares for approximately 2,300 patients. That equals 920,000 people a year, she says, who cope with the loss of a physician.
In the TEDMED talk, she blamed two different phenomenons for a high suicide rate among doctors: A medical school culture of "hazing, bullying, and name-calling" that continues into residency and results in poor medical care for patients and occupational-induced depression for both students and residents, and a professional culture for practicing doctors that dissuades them from seeking mental health treatment.
Wible believes the suicide rate among physicians is even higher than the National Institutes of Health’s cited rate. She says that she believes many death certificates for physicians are miscoded, and that many practicing physicians and residents commit suicide through ambiguous methods such as car crashes.
Her crusade, as it turns out, is personal.
"I realized there was an epidemic when I had gone to my third memorial service in a year and a half," Wible told Fast Company. "A third doctor in my town had died of suicide in 18 months—a top-notch pediatrician shot himself in the head. I was at his memorial service, and started counting on my fingers how many suspicious deaths among doctors and potential suicides I knew, including men I dated in medical school. I was suicidal in medical school, too . . . and it was occupational induced."
In 2012, Wible started blogging about mental health issues among medical professionals; suicide letters sent to her by loved ones and other physicians comprise the core of her new book.
One of the biggest problems reformers like Wible face is the fact that health care professionals have been aware of the anomalously high suicide rate in their field for a long time. Every once in a while, a medical journal or a trade publication will run an article about the problem. It’s not unknown.
Robert P. Bright and Lois Krahn of the Mayo Clinic sum up the problem as follows:
Physicians have a much higher rate of suicide than the general population, but are less likely to seek treatment because of fears of losing their licenses or being thrown out of medical school, fear of losing patients if word gets out they are seeking mental health treatment, or simply not having time to seek treatment due to their workloads.
Certain traits they say are common to physicians and medical students, such as perfectionism and a tendency toward self-criticism, also lead to raised suicide risks.
"Residents dealing with this issue don’t want anyone to know who they are because they can lose their position," Wible added. "That means they lost $350,000 to get their education. They’re kind of pushed into a corner, but are happy to reach out to me and confident I’ll protect their anonymity. They want someone they can talk to who won’t rat on them."
According to a massive study published late last year in the Journal of the American Medical Association, a staggering 29% of young doctors struggle with depression. The authors of that study also cite causes ranging from workload to sleep deprivation to bullying by other doctors to a culture that stigmatizes mental health treatment.
This affects everyone, Wible says. "The outcome for patients isn’t great when you have wounded healers staggering around, trying to help others. It’s a recipe for poor patient care, which should be obvious to everyone. Do you want someone who is being bullied controlling your ventilator? Is that a good scenario?" Wible says.
The challenge is that there are no easy answers. Wible calls for a wholesale overhaul of the way doctors talk about their own mental health. A big part of this is greater understanding from the medical establishment about the high rate of depression among doctors and that it shouldn't just be repressed; another part is creating treatment options for physicians and medical students that won't offer what she calls "punitive" stigma for their careers. In the meantime, the fact that her book is an Amazon best seller signifies one promising change: Medical professionals are, at the very least, acknowledging that there’s a problem.