Many physicians are struggling with their mental health, with almost 25% reporting that they were depressed, and 9% saying that they've experienced suicidal thoughts, according to Medscape's Physician Suicide Report 2023.
For the report, Medscape surveyed over 9,100 physicians in more than 29 specialties about their personal experiences with suicide, their support systems, and more.
Overall, 23% of all respondents said they were depressed. Among this group, 24% said they had clinical depression, or severe depression that had lasted some time, and 67% said they were experiencing "colloquial depression," such as feeling down, blue, or sad.
When asked about suicide, 9% of physicians said they had had suicidal thoughts, and 1% said they had attempted suicide before. According to the National Institute of Mental Health, physicians are significantly more likely to have suicidal thoughts or attempt suicide (4.9%) than the average U.S. adult (0.5%).
"Admitting to having felt suicidal but not attempted suicide does speak to how stressed a certain cohort of today's doctors are," said Michael Myers, a professor of clinical psychiatry at SUNY Downstate Health Sciences University.
Among the different specialties, those in otolaryngology were the most likely to report suicidal thoughts at 13%. Psychiatry, family medicine, anesthesiology, OB/GYN, and emergency medicine were all the next most likely at 12%
"The specialties with the highest reporting of physician suicidal thoughts are also those with the greatest physician shortages, based on the number of job openings posted by recruiting sites," said Peter Yellowlees, a professor of psychiatry and chief wellness officer at UC Davis Health.
Because doctors in these specialties are overworked, they can also experience more burnout. "While burnout doesn't cause depression, it's correlated with depression and suicidal ideation," Yellowlees said.
According to the report, 38% of physicians said they confide in a therapist about their suicidal thoughts, and 36% said they confide in a family member. However, 40% of physicians said they do not tell anyone about their suicidal thoughts.
Some common reasons physicians gave for not seeking professional help include feeling like they can handle the problem on their own, not wanting to disclose the information to a medical board, concern about it being on their insurance record, and concern about their colleagues finding out.
"Though as physicians we recognize suicidal ideation as an area of high concern and would take what a patient says very seriously, we are less likely to do this ourselves," said Perry Lin, national co-chair of the Physician Suicide Awareness Committee at the American Association of Suicidology. "There is a lot of stigma among help-seeking behavior."
Although some physicians may be reluctant to seek professional help, many are making efforts to engage in healthy behaviors to promote their own happiness and mental health. Some common behaviors include spending time with family and friends, engaging in activities and hobbies, and exercising.
According to Andrea Giedinghagen, an assistant professor of psychiatry at the Washington University School of Medicine in St. Louis, depression has been a serious problem in the medical community for about as long as it has been measured.
"Physicians are also still coping with a pandemic—the trauma from COVID-19 didn't disappear just because the full ICUs did—and with a fractured healthcare system that virtually guarantees moral distress," Giedinghagen said. "This is beyond individual solutions for individual problems. Systemic change is necessary."
In the report, respondents were asked whether medical schools or healthcare organizations should be held responsible for a student or physician suicide. While there wasn't a clear consensus among respondents, younger physicians were more likely to say "yes" than older physicians.
However, Myers said putting the ultimate responsibility on an institution was both bothersome and simplistic. "Most suicides are multifactorial, many stressors coming together all at once in a person's life, a so-called 'perfect storm'," he said. "When and if it appears that a vulnerable medical student or physician was very poorly treated by their medical school or healthcare organization, then yes, we might conclude that this was one of the drivers of their suicide."
"But there are suicides each year involving medical students and physicians that have nothing to do with the medical school or place of work," Myers added.
According to Leslie Kane, senior director at Medscape Business of Medicine, systematic change could make a difference in two areas for physicians: Fear of ramifications and burnout.
"Some physicians noted that after noting that they had received professional mental help, some coworkers or administrators in their organization used that information against them in competitive instances," Kane said. "There should be more oversight or change in attitude as to the use of such information."
Regarding burnout, Kane recommended hospitals slow down the pace of their productivity and allow physicians more time with patients so they feel less like "they are on a rushed hamster wheel." (Burky, Fierce Healthcare, 3/3; McKenna, Medscape, 3/3; Lehmann, Medscape, 3/7)
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