Q&A: ACP president discusses ‘silent epidemic’ of physician suicide

ByJanel Miller

The death of Lorna Breen, MD, FAEP, the New York-Presbyterian Allen Hospital clinician who took her own life in April 2020, drew new attention to physician suicide, and led to an act of legislation that bears her name.

According to the Dr. Lorna Breen Heroes Foundation, the act “aims to reduce and prevent suicide, burnout, and mental and behavioral health conditions among health care professionals.”

The quote is: “Physicians are expected to be the people who never get exhausted and never complain about themselves.” The source of the quote is: George M. Abraham, MD, MPH, FACP, FIDS.

A February article in Perspectives in Psychiatric Care reported that 26 health care professionals have died by suicide during the COVID-19 pandemic.

Amanda Kingston, MD, wrote in a Missouri Medicine article that there has been an increased rate of suicide among physicians for at least 150 years, yet this “silent epidemic” has only recently started to draw significant attention.

A 2019 systematic review and meta-analysis in PLoS One indicated that physicians in the U.S. were at a higher risk for suicide than anywhere else in the world. Last month, an analysis in Mayo Clinic Proceedings of a survey taken before the COVID-19 pandemic revealed that 1 in 15 U.S. physicians had thoughts of taking their own life in the past 12 months. A survey recently released by The Physicians Foundation indicated 55% of respondents "know of a physician who has either considered, attempted or died by suicide" in their professional lifetime.

“Comprehensive efforts are needed to increase access to emotional support for physicians, to reduce the stigma associated with seeking help and to cultivate self-valuation among medical students, residents and physicians,” the authors of the Mayo Clinic Proceedings paper wrote.

ACP has embarked on such an effort. The organization recently published a policy paper titled “Physician suicide prevention and the ethics and role of a healing community” that stated interventions for suicide prevention need to take place at individual, interpersonal, community and societal levels.

“The medical community has an obligation to foster a culture that supports education, screening and access to mental health treatment, beginning at the earliest stages of medical training,” ACP wrote.

Healio Primary Care interviewed ACP President George M. Abraham, MD, MPH, FACP, FIDSA, professor of medicine at the University of Massachusetts Medical School and emeritus medical staff president of St. Vincent Hospital in Worchester, Mass., to learn more about the policy paper.

Healio Primary Care: What spurred the recent ACP policy paper on physician suicide?

Abraham: The ACP has continuously looked for ways to improve physician well-being and lower the occurrence of physician suicide. Thus, the position paper was to keep the topic of physician suicide at the forefront.

Healio Primary Care: Data suggest the rate of physician suicide has declined over time in several European countries; however, a similar statistically significant decrease has not occurred in the U.S. Why do you think this is so?

Abraham: We think this is for two reasons.

No. 1, different data sources are being referenced. No. 2, in the United States and probably even in Europe, there is probably some under-reporting and stigma around mental health issues, especially among physicians.

Most importantly, we feel that pressure of practicing medicine in the U.S. in today's environment is extremely stressful. Physicians, particularly primary care physicians, are frustrated with electronic medical records and keeping up with workload and demands.

Primary care physicians are in charge of controlling costs of medications, high-end imaging and tests. They are also responsible for prior authorizations and just about everything else. Many patients also expect and express frustration with their primary care physicians when they do not get instant results for their condition.

I cannot motivate any of my trainees to go into primary care, because everybody views this as one of those sinkholes where they are overworked and underpaid. Everybody wants to be a sub-specialist.

Healio Primary Care: Why are physicians so reluctant to seek mental health care ? What is your message to these physicians?

Abraham: Physicians are expected to be those people who never get exhausted and never complain about themselves and are always available for others, so seeking mental health carries the stigma that they are not able to perform their work appropriately.

In some states, seeking mental health care puts one’s medical license in jeopardy. In a broader sense, one might think seeking mental health means their employer might no longer want them at work. So, physicians try to cover up their mental health issues as much as they can, until they crack and can no longer take care of patients. Physicians need to be able to have open conversations that treat mental health conditions as any other illness and that they can seek help without feeling intimidated or embarrassed. If we can return to or maintain wellness, we should have fewer and fewer instances where someone feels so stressed and burned out to go to the extreme of committing suicide.

Patients also need to realize that everyone is human, whether a person is a physician or not, and that the expectations we have for physicians should be the same ones we have for all non-physicians.

Healio Primary Care: What are some community‐level activities aimed at improving physician well‐being that have shown some success?

Abraham: Community groups that focus on wellness and self-care are a good place to start. There are also pharmacological options available, but these community groups should be explored before going that route.

*Editor's note: According to ACP, physicians who feel overwhelmed, stressed or depressed can access peer support through the Physician Support Line, and receive affordable, confidential counseling through The Emotional PPE Project and The Therapy Aid Coalition.