While no organization collects official data on physician suicides, Pamela Wible, a family medicine doctor in Eugene, Oregon, who writes about the phenomenon, says that at least 400 doctors kill themselves annually. That’s the size of an entire medical school class.
Wible believes that the numbers are higher than that, since doctors close ranks around each other and prod coroners to rule the cause of doctor deaths as “unplanned”—even when they are obviously not. “Accidental overdoses?” Wible asks. “You’ve got to be kidding me. Doctors calculate doses for a living.”
Because doctors have the knowledge of anatomy as well as access to lethal doses of drugs, they have a far higher suicide “completion” rate than the general population. A 2005 essay published in JAMA found that male doctors killed themselves at a rate 70 percent higher than other professionals; among female doctors, that rate ranged from 250 to 400 percent higher.
“Unfortunately,” says Bradley Hall, a Bridgeport, West Virginia, addiction medicine physician, “suicide is one thing doctors are pretty good at.”
The little-noticed, little-discussed trend has enormous implications. Since the average annual caseload of most family doctors is roughly 2,300 patients, 400 physician deaths could mean that a million Americans lose their doctors to suicide each year.
There are many theories about why so many doctors kill themselves. They face the pressures of “assembly-line medicine,” merciless scheduling demands, fights with insurance companies, growing regulations, and an explosion in scientific literature with which their knowledge must remain current. Their debt burdens often total hundreds of thousands of dollars, and they work in constant fear of malpractice suits.
Internists routinely screen their patients for depression and anxiety—it’s considered the standard of care for an annual physical. But doctors, Wible says, must live up to a different set of standards. In medical school, professors teach their driven young students to put their own emotions aside, even as they attend to tragedy. “In general, we’re in a profession that will shun you if you show weakness or suffering in any way,” she says.
But the taboo on discussing mental illness in medicine is beginning to waver. Wible’s 2014 “Medscape” story on doctor suicide had more than 100,000 readers and attracted 800 comments, the most in the website’s 20-year history. In a related article, she recounted the story of a retired surgeon whose medical school professor told his students that if they decided to commit suicide, they should do it right. He then provided detailed instructions...
In most states, doctors must disclose a mental health diagnosis or treatment history when applying for or renewing their medical license. A 2011 Current Psychiatry article notes that medical boards increasingly ask applicants about their mental health.
Doctors who acknowledge problems with substances or mental health are typically referred to a physicians health program, or PHP. These organizations evaluate, monitor, and treat physicians.
“Acknowledging a history of mental health or substance abuse treatment triggers a more in-depth inquiry by the medical board,” wrote Dr. Robert Bright, a psychiatry professor at the Mayo Clinic in Scottsdale, Arizona. “The lack of distinction between diagnosis and impairment further stigmatizes physicians who seek care and impedes treatment.”...
J. Wesley Boyd, a Harvard psychiatrist who left his post as assistant director of the Massachusetts PHP over a disagreement about practices there, says PHPs routinely intimidate their clients. In an article he co-wrote for the Journal of Addictions Medicine in 2012, Boyd noted that many doctors who seek or are referred by colleagues for treatment are mandated to attend pre-selected rehabilitation facilities for 60 to 90 days. Afterward, they must agree to monitoring and drug testing, typically at their own cost. When doctors resist PHP recommendations, they risk losing their livelihood and their licenses.