We are not immune: Recognizing National Physician Suicide Awareness Day

In September 2021, legislators brought forward bills in the House and Senate to recognize Sept. 17 as “National Physician Suicide Awareness Day.” The bills were a bipartisan effort to highlight the importance of destigmatizing physicians who seek mental health care and recognize the ongoing, devastating number of physicians lost each year to suicide.

Although recent strains on health care systems nationwide have prompted greater awareness of this crisis outside of medicine, physician burnout and suicide have often been a silent problem in the profession for decades. The United States loses approximately 300-400 doctors to suicide annually. These deaths are a tragedy by any measure, and doubly so when preventive measures can be taken legislatively, institutionally and personally.

Physicians who are struggling are not alone

Many of us have friends or peers who have completed suicide, and some may even have personal experiences with suicidal thoughts. Physicians may perceive themselves as alone with these struggles, not knowing that they are relatively common in the profession.

Approximately one in 10 physicians admit to past suicidal thoughts or actions, and physicians are twice as likely to complete suicide as the general population. Despite these numbers, physicians are less likely to seek help, with only an estimated 13-36% of suffering physicians presenting for mental health support. These personal experiences and statistics raise important questions—why are so many bright, talented people who spend their lives helping others suffering in silence?

Some risks stem from internal factors that are often underacknowledged in medical education and training. Physicians tend to be highly driven, perfectionistic, and on some level, naturally anxious individuals. Many of us have leveraged critical self-appraisal and anxiety to propel us in our careers, always seeking to do better and score higher. As physicians, we are often tasked with coping with the stress of managing life-and-death situations.

The common personality and coping styles among physicians may contribute to worsened wellness outcomes, including difficulty managing faults and failures. Malpractice suits significantly increase the risk of burnout, mental health crises, and suicides. Physicians may consider their profession to be an integral part of their identity, and as a result, a threat to professional well-being can generalize to a greater crisis of self-identity.

Physicians can take pride in working excessive hours and overcoming other professional hardships as part of “what it takes” to be a physician, like a badge of honor. The culture of medicine systematically minimizes the impact of these difficult experiences on a person’s mental health, which further isolates and silences the many physicians who need help.

Doctors, particularly doctors in training, are motivated to avoid appearing “weak” or incompetent around their peers, but supporting our colleagues and tending to ourselves is necessary to address physician suicide, including destigmatizing our language around mental health, recognizing hardships’ impact on our wellness and sharing common experiences.

Care and consideration should be given to physicians of marginalized identities, including race, gender, sexual orientation and class identities, who may experience additional personal and professional challenges.

Institutional changes needed

On an institutional level, health care organizations may perpetuate damage to physician wellness through cost-cutting initiatives, leading to understaffed and overworked systems. A common barrier for physicians seeking their own care is a lack of time to attend appointments. Some employers may offer employee assistance plans (EAPs) to access a specified number of therapy sessions quickly, however, for many physicians taking an hour out of their workday may prove difficult if not impossible without institutional support.

Some therapists offer after-hours and weekend appointments, though even these options may not be common enough or appropriately timed to allow a busy physician to access care. Institutions offering integrated care or readily available mental health support services tailored to the needs of physicians, as well as those willing to be flexible to accommodate the health care needs of their employees, improve access to care.

Burnout-prevention initiatives focusing on changes to the system, rather than putting the onus on individuals to create change, can help prevent or identify the early warning signs before a crisis.

Policies negatively affecting physicians seeking care are, unfortunately, still common. As of July 2023, only 23 states were identified as having licensing documents that did not discourage physicians from seeking mental health care.

Efforts by the Dr. Lorna Breen Foundation, a nonprofit organization seeking to improve physician mental health and wellness throughout the United States, have made strides to reduce these barriers through legislative change. In March 2022, the Dr. Lorna Breen Healthcare Provider Protection Act was signed into law, offering grants to institutions supporting physician wellness and tasking U.S. Health and Human Services with launching campaigns across the country to reduce physician suicides.

As a profession, we are not immune from the effects of long work hours, stressful clinical situations, criticism and mental health crises. We deserve cultures, systems and policies that give us the tools to heal and ultimately thrive. I encourage you to take the time to honor and talk about the importance of National Physician Suicide Awareness Day with your colleagues and your trainees—these conversations can save lives.

Suicide prevention and mental health resources

If you are or someone you know is experiencing a mental health crisis, there are resources available now:

• You can seek immediate help in an emergency room or dial the suicide and crisis lifeline at 988
• The national crisis text line can be reached by texting HOME to 741741
• The Physician Support Line is a free, confidential support service run by volunteer psychiatrists (accessible even if not in crisis) and can be reached at 1-888-409-0141
• The AOA offers a robust physician and student wellness toolkit on their website designed to help you build and maintain wellness throughout your career
• The American Psychiatric Association offers a website with a variety of self-guided tools for physicians experiencing burnout
• The Substance Abuse and Mental Health Services Administration answers substance abuse treatment referral calls 24/7 at 1-800-662-HELP (4357)