Health-care workers are committing suicide in unprecedented numbers

As America focuses on one epidemic — the opioid crisis — another goes entirely ignored. American health-care workers are dying by suicide in unprecedented numbers. Earlier this month, a medical student and a resident at NYU medical school completed suicide less than a week apart.

My junior colleague took her life just 11 days before her 35th birthday. I had supervised her as she transitioned into practice from fellowship. She said that the way I said her name foretold if the conversation pointed to a weakness or a strength in her patient assessment. My last sight of her was as she drove off to her new job. Less than six months later, she made a life-ending choice.

A scan of her suicide note, asking that I be notified, was emailed to me. I did not show it to anyone. The news of her suicide was announced by an email in the department. We all went about our business, as if suicide by a young colleague is usual. And perhaps, in a way it is.

After all, physician suicide — and more broadly health-care worker suicide — is a huge issue in the U.S. In my own experience, I have lost six colleagues to suicide — five physicians and one physician assistant. That does not include the suicides that I have heard about through the whisper network at work.

My junior colleague was among an estimated 400 physicians who took their lives in 2016. Many physicians know more doctors than patients who have taken their lives. Physicians and nurses complete suicide more often than do average Americans; rates are even higher for women in bothprofessions. Respect, fear and love for our colleagues often leads us to list the cause of death differently on death certificates. We frequently self-medicate, so suicides may instead be listed as accidental. Phrases to describe the scope like “an entire medical school class a year” or “a doctor a day” have particularly ominous meanings for physicians.

All of the physicians that I knew who took their lives were American medical graduates, a worrisome statistic if it reflects the general trend. A full 24 percent of physicians in the U.S. are international medical graduates; my specialty, pathology, is about 40 percent international graduates.

Although a recent report of suicides among residents does not suggest differential suicide rates among international and American medical graduates, the data may be limited by the nature of the study. The number for nurse or other health-care worker suicide is unknown, since we do not even track these numbers. Earlier this year, the National Academy of Medicine released a paper to raise awareness of nurse suicide, calling for a closer look at another facet of this epidemic. The high suicide rates correlate with the high rates of depression among physicians and nurses.

Why physicians and health-care workers are more likely to complete suicide is unknown. It perhaps has to do with a work-related mental health syndrome called disengagement and burnout, which has reached epidemic proportions in health-care providers and nurses. Excessive pressures and expectations at work, paired with seemingly unattainable goals for quality and productivity as well as societal loss of trust in physicians, has led to a loss of meaning of work and of self for physicians. This is not the norm that physicians or nurses expected when we answered the call to be care-providers.

Regardless of why medical workers tend to die by suicide, there needs to be a call to arms to do something about it. Health-care organizations need to more proactively report suicide in their workforce, so we can begin to understand the drivers for suicide in health-care workers. The information needs to be granular enough to identify risks by specialty and work-type.

More immediately, institutions need to develop procedures and processes for grief recovery support for colleagues of the deceased. Many institutions shy away from even mentioning suicide at the workplace. There is concern for suicide contagion, an increased tendency toward suicide in the already predisposed upon hearing of a suicide. There is stigma to talking about suicide among leaders, and fear that it will cast a shadow on them or their organization.

But, that is the wrong response. Colleagues suffer when one of their own is lost to suicide. One spends a third of one’s life at work. Sustained relationships at work are particularly important in an environment that is so stressful. The responsibility for another’s well-being and the ever-present risk for potential harm to another from a misjudgment extracts a heavy emotional toll on health-care providers.

We perhaps even blame ourselves more when we lose a colleague to suicide. Why did I not see it? Could I have done something to prevent it? One wonders about one’s self worth and one’s ability to care for patients when one fails a colleague and friend. One institution at least, UCSD, has heard this call to action and created the Healer Education and Assessment Referral program, which promotes self-assessment for depression and provides support for all health-care workers in the setting of a coworker’s suicide. But more needs to be done — at a department level, at an institutional level and at a national level.

Postvention programs to provide support for survivors of a co-worker suicide need to be developed in the profession. Structured prevention strategies to reduce suicide need to be developed as has been done for the police and military — two other at-risk professions for suicide. Leaders need to be trained to give support to their providers, so providers can heal and continue in their job of caring for their patients, after one of theirs is lost to suicide.

Vinita Parkash M.D. is an associate professor of pathology at the Yale School of Medicine. She is a Public Voices fellow with the OpEd Project, which is an organization that focuses on increasing the number of women thought leaders contributing to key commentary forums and media outlets.

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