Physicians have one of the highest suicide rates of any profession.1 According to the American Foundation for Suicide Prevention, an estimated 300 physicians die by suicide each year across the United States—nearly 1 per day.2 Physicians who choose to end their own lives frequently suffer from undertreated or underdiagnosed depression, a significant risk factor for suicide.
September 17, 2023, is the 6th Annual National Physician Suicide Awareness Day, a day dedicated to raising awareness of this serious issue and ways that we can prevent physician suicide.
Oncology Practice Management (OPM) recently spoke with Gary Price, MD, President of The Physicians Foundation, who discussed the ongoing issue of physician suicide, why so many professionals have difficulty getting the assistance they need, and what is being done to help them.
OPM: What are some of the factors that contribute to the disproportionately high rates of suicide among physicians?
Dr Price: Physicians continue to experience burnout at record-high levels (58%), and our 2023 Survey of America’s Current and Future Physicians demonstrates that this concerning trend is true for our future physicians, including residents (61%) and medical students (71%).3
Furthermore, three-quarters of medical students have felt inappropriate feelings of anger, tearfulness, or anxiety, as well as 7 in 10 residents and more than one-half of physicians. More than one-half of medical students, 4 in 10 residents, and one-third of physicians have felt hopeless or that they have no purpose. More than two-thirds of medical students report withdrawing from family, friends, and coworkers, as well as more than one-half of residents and 4 in 10 physicians. These feelings can lead to burnout and, when left untreated, cause more cases of depression, anxiety, and posttraumatic stress disorder, and lead to suicidal thoughts for physicians, directly affecting physician suicide rates.3
For too long, there has been an assumption that physicians just need to be more resilient, and strategies for eliminating burnout have focused on this approach. It is undeniable our physicians need and deserve better.
The time we spend documenting our care has now grown beyond double the time we spend caring for patients. Physicians, residents, and medical students have identified solutions they need to improve their mental health and well-being, many of which involve addressing administrative burdens. Nearly all the evidence-based, proposed actions identified in our survey to support physicians are viewed as helpful by most residents and students, with removing low-value work, encouraging using paid time off and breaks, giving physicians more flexibility to adjust quality and patient experience goals, and eliminating insurance approvals and unnecessary mandatory training rising to the top of the list.
Action is still required to address physician well-being. While most physicians assign high ratings of helpfulness, residents and students assign even higher ratings for confidential therapy, peer-to-peer support groups, and the change or removal of credentialing application questions. This latter strategy is one that has seen significant progress in the past year due to the actions of ALL IN: WellBeing First for Healthcare and The Dr. Lorna Breen Heroes’ Foundation, which continue to champion and provide resources for the removal of intrusive mental health questions from licensure and credentialing applications throughout the United States.
OPM: What do the statistics show regarding the impact of the COVID-19 pandemic on already high suicide rates?
Dr Price: Our 2023 Survey of America’s Current and Future Physicians finds that the state of physician well-being—for both current and future physicians—remains low. For the third year in a row, approximately 6 in 10 physicians frequently have feelings of burnout. This is significantly higher than what was reported during prepandemic times (40% in 2018). More than one-half of physicians (51%) know of a physician who has ever considered, attempted, or died by suicide, remaining consistent since 2021. One-fifth (20%) know a colleague who has considered, attempted, or died by suicide specifically in just the past 12 months.3
Residents also report a low state of well-being—while medical students report an even lower state of well-being, compared with both physicians and residents. More than 6 in 10 residents and 7 in 10 students report experiencing feelings of burnout. Although they are just beginning their careers, a shocking percentage of students (45%) know a colleague or peer who has considered suicide, compared with residents (38%) and physicians (36%).3
Gary Price, MD
Physicians continue to experience burnout at record-high levels (58%), and our 2023 Survey of America’s Current and Future Physicians demonstrates that this concerning trend is true for our future physicians, including residents (61%) and medical students (71%).—Gary Price, MD
OPM: What are some of the major obstacles to physicians getting the help they need?
Dr Price: Physician burnout has not gone unnoticed by our profession or by society, and yet what we found most concerning is that there is still rampant stigma surrounding seeking mental healthcare and that underlying system barriers are preventing physicians from accessing this care.
Our survey shows that most physicians (78%) still agree that there is stigma surrounding mental healthcare for physicians, while the proportion of physicians who report seeking medical attention for a mental health problem (19%) has remained stagnant since 2022. Within the past year, nearly one-quarter (24%) of physicians know a colleague who has said they would not seek mental health support. Furthermore, less than one-third of physicians (31%) agree that their workplace culture prioritizes physician well-being, declining from 36% a year ago.3
We knew stigmatizing and intrusive mental health questions on medical licensure and hospital credentialing applications was a barrier, and the survey reinforced how important this issue is.
OPM: Tell us about The Physicians Foundation and what it is doing to address suicidality among physicians.
Dr Price: Driving change to address physician suicide continues to be one of the core areas of focus for The Physicians Foundation. In 2019, we launched Vital Signs, a campaign around National Physician Suicide Awareness Day to provide resources and actions for organizations, physicians, colleagues, and peers to use.
Throughout the immense challenges of the past few years, The Physicians Foundation’s Survey of America’s Physicians has become an annual barometer to gauge the experiences, struggles, and aspirations of physicians across the United States. This year, we reached a pivotal milestone by expanding our survey’s scope to encompass not only physician perspectives but also those of residents and medical students.
Our survey findings reiterate that being a physician today is challenging—but the future of the profession does not have to be. As a worsening physician shortage casts a shadow on the future of healthcare, incoming physicians are poised to fill an increasingly invaluable role. As the architects of our healthcare future, the residents and students of today will shape medicine for decades to come. The Physicians Foundation strives to support future physician leaders in creating a healthcare system that is strong and sustainable in providing high-quality, cost-efficient healthcare to all.
The Physicians Foundation strives to support future physician leaders in creating a healthcare system that is strong and sustainable in providing high-quality, cost-efficient healthcare to all.—Gary Price, MD
OPM: What other resources are available to help residents, medical students, and physicians?
Dr Price: We know that medical students, residents, and young physicians are not immune to burnout. To better support the future physician workforce, The Physicians Foundation launched Dear FutureDoc, a new initiative from the Vital Signs campaign around National Physician Suicide Awareness Day. The goals of Dear FutureDoc are to encourage future physicians to reflect on their own mental health and well-being, to support each other, and to share their hopes for the future of physician well-being.
Dear FutureDoc includes 3 main resources:
- Note to Self. A notecard that medical students, residents, and physicians can use to write a personal message to their future selves for encouragement.
- Note to Others. A notecard that future and current physicians can use to write an encouraging message to a peer or colleague.
- Selfie Sign. A sign to use as a background to take a selfie and post on social media with a message about their hopes for the well-being of physicians in 20 years.
Individuals who want to learn more about this initiative can visit: https://npsaday.org/wp-content/uploads/2023/08/PF23_DearFutureDoc_EncourageMentalHealthReflection_V1h.pdf.
References
- Nelson J. Physician suicide: investigating its prevalence and cause. Medscape. March 15, 2023. Accessed September 5, 2023. www.medscape.com/viewarticle/989674
- Healthcare professionals' mental health and suicide risk. American Foundation for Suicide Prevention. Accessed September 5, 2023. https://afsp.org/healthcare-professionals-mental-health-and-suicide-risk/
- 2023 survey of America's current and future physicians. The Physicians Foundation. September 14, 2023. Accessed September 15, 2023. https://physiciansfoundation.org/surveys/