Mental health data have shown that physicians in the United States have a higher suicide rate than many professions and are more likely than the general population to die by suicide. Although there is no single cause for suicide, it most often occurs when a person’s life circumstances, stressors, and health issues—especially inadequately treated or untreated mental health issues—lead to feelings of hopelessness and despair.
According to family physician and mental health researcher Katherine Gold, MD, MSW, MS, physicians are stuck in a Catch-22: the high self-expectations, intense professional pressure, and prevailing culture of the medical profession contribute to the rise in mental health issues among physicians, but these factors also discourage struggling physicians from seeking help. The Medscape National Physician Burnout & Depression Report 2018 showed that 66% of male physicians and 58% of female physicians who reported burnout, depression, or both had never received professional help, were not currently seeking professional help, and did not plan to seek professional help.
Through her research at the University of Michigan Depression Center in Ann Arbor, Gold seeks to understand why physician mental health issues remain largely untreated. “There’s definitely a stigma inside medicine around mental health,” she says. She has found that physicians as a group tend to hold themselves to high standards, so a mental health issue is often perceived as a weakness. “Physicians don’t want to appear as if they can’t do their job,” says Gold. “We tend to be great masqueraders.”
Gold notes that this situation is exacerbated by the fact that most U.S. state medical licensing boards include questions about the physician’s mental health history on their applications, despite new recommendations to the contrary from the Federation of State Medical Boards (FSMB), American Medical Association (AMA), and American Psychiatric Association (APA). In a recent study of physician medical licensing applications, Gold and her colleagues found that “mental health receives far greater scrutiny than physical health in many states, particularly regarding past history that may no longer be relevant to current function.” There is evidence that such questions make physicians afraid that seeking help for a mental health issue will affect their ability to practice medicine or damage their professional reputation.
Based on her research findings, Gold says that one fundamental starting point to help combat the mental health stigma in medicine is for physicians to acknowledge and share their struggles and mistakes. At times, it may feel as if you are the only one who feels overwhelmed with doubt about patient care or grief about outcomes, but you’re not. “I encourage people to talk to each other,” says Gold. “Knowing that they’re not alone can go a really long way toward making people feel accepted and making it easier for them to open up.” To cope with feelings of isolation or shame, make a habit of sharing your questions and emotions with a trusted colleague or a mental health counselor. If you have a mental health issue that requires treatment, it’s important to reach out to a family physician, therapist, or psychiatrist for professional care rather than trying to self-treat or ignoring the problem.
Organizations and employers can help by creating a forum for physicians to openly recognize and discuss issues in medicine that impact their mental health. For example, more than 440 health care organizations around the world offer The Schwartz Center’s Schwartz Rounds® program in an effort to provide a safe space for physicians and other health care professionals to honestly share their experiences, thoughts, and feelings about topics drawn from actual patient cases. In Gold’s experience, this type of open communication “helps normalize [the reality] that a lot of tough things happen in medicine.” She also notes that it is essential for organizations to “make counseling available for physicians in a safe and confidential place, and at a time the physicians can actually go.”
It’s also crucial to take action if you’re worried that a colleague is in distress or is thinking about suicide. You don’t need to have all the answers or solutions in order to talk to someone about your concerns, and Gold notes that asking about suicidal feelings will not give someone the idea or push them to act on their feelings. For specific language to use, she suggests, “It seems like you’re feeling really bad, and I know when [people are] feeling this bad, they sometimes think about hurting or killing themselves.” If your colleague says he or she is having suicidal thoughts, the National Suicide Prevention Lifeline recommends the following next steps:
Healthcare Professional Burnout, Depression and Suicide Prevention - American Foundation for Suicide Prevention
Katherine J. Gold, MD, MSW, MS is a family physician and researcher and is an assistant professor in the Department of Family Medicine and the Department of Obstetrics and Gynecology at the University of Michigan Medical School, Ann Arbor. She sees patients at an outpatient clinic and delivers babies and cares for newborns. Her research is focused on physician wellness, mental health, and suicide. Another focus of her research is the impact of poor obstetrical outcomes on parents, families, and providers, with particular interest in mental and physical health outcomes and health behaviors in subsequent pregnancies.
Dr. Gold completed a two-year research training program for physicians through the Robert Wood Johnson Clinical Scholars Program, as well as a National Institutes of Health (NIH) research fellowship through the Building Interdisciplinary Careers in Women's Health (BIRCWH) program. She recently completed the James C. Puffer, MD/American Board of Family Medicine (ABFM) Fellowship at the National Academy of Medicine (NAM).