September is National Suicide Prevention month, and September 17th of each year is is National Physician Suicide Awareness Day. While this day is named to specifically call awareness to physician suicide, it allows us all to use this month to recognize the health concerns of our entire licensed healthcare workforce. And there are many.
In the United States of America, according to the American Foundation for Suicide Prevention and data presented at the 2018 American Psychiatric Association national meeting, more than 300-400 doctors die by suicide each year. One a day. And while the risk of dying by suicide is higher for physicians compared to the general population, a study in JAMA in September 2023 showed that it is higher for nurses – specifically registered nurses – as well. This awareness day is a call to action to healthcare leaders and policy makers to continue to create environments that support optimal physical and mental wellness for all healthcare personnel.
Physicians are 40% more likely than workers in other fields to report suicidal ideation – 7.1% versus 4.3% according to a 2021 study by Dr. Tait Shanafelt and colleagues. Our nation’s caregivers do not enter the profession to have it end prematurely by suicide. As we move further away from the COVID pandemic, licensed healthcare personnel are still facing the same issues they were prior: One meta-analysis from researchers at Harvard estimated the depression rate among doctors in training at 29% compared to 8% of non-physicians. These feelings can lead to burnout and, when left untreated, can cause more cases of depression, anxiety, post-traumatic stress disorder (PTSD) and substance misuse. The American Medical Association and the Federation of State Physician Health Programs have highlighted this for years.
Beyond the basic and tragic loss of life, over 1 million patients a year are impacted by losing a physician due to suicide.
Licensed healthcare professionals with mental illness face particular stigma. Medical licensing and credentialing bodies as well as hospitals, clinics and insurance companies traditionally have required applicants to disclose any history of psychiatric treatment or impairment. The mental health questions typically focus on whether the applicant merely has a history of a psychiatric diagnosis or has ever received treatment for mental illness. There is no similar requirement for reporting physical health diagnoses or treatment.
The Joint Commission, which accredits hospitals, has emphasized since 2020 that it doesn’t require hospitals to ask about an applicant’s mental health history beyond conditions that currently impair the clinicians’ ability to perform their job. “We strongly encourage organizations to not ask about past history of mental health conditions or treatment” the Commission has said. Yet for most institutions this has not changed and these questions are still asked. This deters many health workers from seeking treatment they need – that their patients need them to get – to deliver safe, high quality and efficient care. Hospitals, clinics and organizations that have not changed this can – and should. For the lives of our country’s health workers, indeed, they must.
Douglas Olson is Medical Director of HAVEN, Connecticut’s only Licensed Healthcare Professional Health Program, and a practicing internal medicine and addiction medicine physician.