According to a 2004 study in the American Journal of Psychology. The suicide rate among men who are physicians is 1.41 times higher than the general population of men. For women who are physicians, the relative risk is even higher —- 2.27 times greater than the general population of women.  This is heartbreaking but not surprising.  What’s surprising is that medical training programs are doing very little to address this problem.  Why?  I believe that they been the proverbial Ostrich sticking their heads in the sand in the hope that the problem will pass.  Meanwhile, as with the Ostrich, the medical programs are leaving their most vulnerable to deal with depression on their own.  For physicians to admit that they are having suicidal thoughts or battling depression, they are essentially admitting that they are unstable in the eyes of the medical program and will likely face licensing restrictions.

Most physicians are unlikely to admit they have a problem as long as the repercussions of such an admission are met by unsympathetic actions and harsh sanctions on the part of the medical program and licensing boards. 

 

In addition to the label placed on them by the training institution, they also have to deal with their colleagues demeaning them for not being able to handle the pressure.  This cruelty is often one of primary factors that drive the physician to suicide.  Physicians must be free to seek help without running the risk of being labeled, sanctioned or ridiculed when doing so.  “In a survey answered by more than 2,100 female physicians who are also mothers, nearly half believed they had met the definition for a mental illness at least some time during their career, but had not sought treatment. Two-thirds reported that fear of stigma drove them to keep their worries quiet.”[1]

Numerous studies have shown that substance issues can affect a physician’s ability to practice medicine, there have been very few studies conducted that look at non-substance-related mental health conditions and whether they impair a physician’s ability to provide quality medicine.  What other professions are asked to relentlessly serve the sickest amongst us and are actually punished when they’re not perfect.  Accidents in medicine are simply not tolerated, in fact, even if the physician is proven innocent, it still goes on their record and leads to skyrocketing malpractice premiums.

With the growing physician shortage crisis, you would think that the medical programs would take more initiative in identifying the warning signs of depression and develop a plan to combat the high risk of suicide.

The stress, sleep deprivation, workload and anxiety associated with medical training has to be dealt with.  Physicians describe medical school as a soul crushing boot camp and a dehumanizing nightmare.  Within many of the training programs, there is an intentional effort to stretch the students beyond their breaking point.  In many locations, trainee doctors commonly work 80 to 100 hours a week, with residents occasionally logging 136 (out of 168) hours in a week.  There are studies that show that about 40% of this work is not direct patient care, but ancillary care, such as paperwork.  Limits on working hours have led to misreporting, where the resident works more hours than they record.  With the 80 hour work week limitations, we’ve seen a decrease in many programs but most physicians feel obligated to jump in and help even if they’ve reached the limit.  They are ridiculed if they stand up for themselves and state that they’ve reached their limits.

Medical resident work hours have become a hot topic of discussion due to the potential negative results of sleep deprivation on both residents and their patients. According to a study of 4510 obstetric-gynecologic residents, 71.3% reported sleeping less than 3 hours while on night call.  In a survey of 3604 first- and second-year residents, 20% reported sleeping an average of 5 hours or less per night, and 66% averaged 6 hours or less per night.  

It has been known for more than 150 years that physicians have an increased propensity to die by suicide. In 1977, it was estimated that the United States loses the equivalent an average of at least one medical school class to suicide.  Depression is at least as common in the medical profession as in the general population, affecting an estimated 12% of males and up to 19.5% of females.  Depression is even more common in medical students and residents, with 15-30% of them screening positive for depressive symptoms.

Physicians Should Not Feel Alone

Read and read again, this first hand account taken from a forum in the nurse practitioner community.  This simply should not be happening.  WE HAVE TO DO SOMETHING!

“I am a medical student in Chicago looking to make a career change and have been considering this for two years.  I’ve finished a year and am on a leave of absence. I was depressed, and one of our classmates and a resident died of an OD last semester. My own father, a physician, died of an OD when I was young. The school has ramped up suicide prevention measures in the wake of increased attempts, but this all seems very normal for the administration.  To keep things short, every day I’ve become more concerned about my own mental health in this setting and training, and how it has changed me.

This is not the only reason I think NP would be a better fit. I don’t have enough space to go on and on. But I wonder how NP students have felt about their training.  I am applying to all the direct entry MSN Chicago schools, and any others nationally that I have the prereqs for. I just feel very alone.