Physician suicide: Know signs, embrace awkward conversations

May is Mental Health Awareness Month. Regrettably, the education, training, and experience we have as physicians doesn’t protect us from the same health issues our patients face, including mental health concerns.

Studies show the prevalence of substance use disorders among physicians is 10-15%, which is a sizable number and similar to that of the general population. But studies have shown the prevalence of depression among U.S. physicians is around 25-30%, or four times higher than the general population. The incidence of completed suicide among physicians is on average 1.5 to two times higher than that of the general population, with female physicians at higher risk than their male counterparts.

Each year, 300 to 400 physicians tragically lose their lives to suicide. This affects not only their loved ones, but their communities as well. The loss of a single physician, who will on average contribute 30,000 hours of care, is immense. An estimated 1 million Americans will lose their physician to suicide each year.

What can we do about this? Thankfully, there are many resources available if you or someone you know is struggling with mental health, depression or suicidality. Many medical groups, including the AAFP, are supporting organizations of VitalSigns: The Campaign to Prevent Physician Suicide. The campaign lists actions we can all take to make an impact in this area. This starts with recognizing the “vital signs” of someone who is struggling—unhealthy behaviors, mood swings, irritability, withdrawing from relationships—in both others and in ourselves.

We can and should encourage self-reflection, both to affirm what is positive in our lives and to remain mindful of our potential warning signs and coping strategies. We should embrace rather than avoid the often-awkward conversation about individual mental well-being. And we should work where we can on system-level change to promote wellness and remove barriers to people seeking and receiving the help they need.

As a residency program director, I have faced this challenge with our residents. But alarmingly, I was not as aware of this critical issue as I should have been. Data from a Canadian study showed that 33% of family medicine residents experienced suicidality; 18% of residents had a plan; and 3% of residents made an actual attempt. In my program with 36 residents, this could mean that six residents are suicidal with a plan and that one of them may have attempted suicide. These are sobering statistics.

Though I will not share a specific story due to potentially violating someone’s privacy, I would like to share a composite story based on real events with residents with whom I’ve worked in the past. It began on a Sunday with a phone call from a resident to one of our chief residents, asking for another resident to cover their practice call shift due to a “personal emergency.” No further details were provided or requested, and another resident was identified to cover the call shift.

The next day, when the chief residents followed up to check in, this resident appeared somber and shared that they were having “mental health issues,” including a feeling of “not wanting to be here.” They requested a modification to their current rotation schedule. The chief residents brought their concerns to program leadership, who immediately met with this resident. Though they wanted to remain at work and their therapist indicated that they were appropriate to remain at work, the program did not feel comfortable with that and assigned the resident to educational and administrative work not involving direct patient care.

In hindsight, that was a regrettable decision that should have been left to physicians involved with this resident’s care or an independent evaluator with experience in determining someone’s return-to-work status. Ultimately, this resident did receive the care they needed and returned to work successfully. We connected them with our institution’s return-to-work office, as well as the disability intercessor in our university’s ombuds office to see if any reasonable work accommodations would be required. We also considered a referral to our state’s physician health program. These programs specialize in confidential assessment, referral for treatment, and ongoing monitoring, and are a helpful alternative to official reporting that may otherwise have disciplinary consequences. Forty eight states and the District of Columbia have such programs, which can be especially valuable resources for smaller programs or organizations who may not have as many internal services.

Many years ago, for another specialty program at our institution, a similar situation sadly turned out differently. A trainee thought to be at high risk did not arrive for an assigned duty shift, leading the program leadership to send the police to perform a wellness check. The trainee was found dead by suicide in their apartment.

If you are a resident and have had or are having similar struggles, please reach out for help. There are many helpful resources including 988 Lifeline, the American Foundation for Suicide Prevention, and the International Association for Suicide Prevention. Your program and institution also have their own processes in place and resources for you to get the help you may need. Your privacy will be paramount.

If you see a colleague struggling, please approach them directly or reach out to your program for guidance. The effort could literally mean the difference between life and death.

David Holub, M.D., FAAFP, is the family medicine program director and an associate professor in the Department of Family Medicine at the University of Rochester School of Medicine and Dentistry. This post was written, in part, based on a presentation he gave in March at the AAFP’s Residency Leadership Summit.