For many people in the general public, there is an air of invincibility about their physicians. Walking into a doctor’s office seems like a one-way street: a patient comes in with a problem, and their doctor is there to solve it. But the painful truth is that not only are doctors human, they actually suffer from depression and are victims of suicide at approximately double the rate of the general population. Female physicians are extremely vulnerable, with suicide rates about four times higher than for women in general.
While it is self-evident for many people to practice basic elements of self-care: a good diet, proper sleep hygiene, exercise, and retaining a positive outlook, medical students and interns have a much harder time taking care of themselves. The extreme demands of medical training coupled with the fear of censure by their colleagues and superiors for being vulnerable can have lethal consequences later in life.
As far back in the 1980s, AMA and APA data conducted extensive research and found that depression was a common occurrence during medical training, and that as many as 25% of interns experienced suicidal ideation. While medical students are trained to identify signs of depression and suicide risk in patients, there is often a gap in terms of relating the prospective risk of these conditions in the students themselves.
Vulnerability Spikes During Internships for Physicians
The entrenched medical internship culture demands 80-hour workweeks and pays a minimal amount relative to the work involved. It is hardly surprising then that a 2006 University of Pennsylvania study found an astonishing increase—from 4.3% to 55.3%– in symptoms that underpin depression, including emotional exhaustion, depersonalization, and decreased personal accomplishment.
Among affected interns, only about half of them received mental health services. One major factor inhibiting young doctors from seeking help is a fear that their colleagues will judge them for seeking psychiatric care. Among practicing physicians, a 2015 survey (source: Archives of Internal Medicine) noted a wide range (varying between 30-65%) of “burnout,” among different specialties, with emergency and primary physicians at the higher end and dermatologists and psychiatrists at the lower end of the spectrum.
In studying physicians who are suicide victims, substance abuse has been discovered at about the same levels as that for the general population, but there are perhaps some specific risks associated with several substances that are abused at a higher rate by physicians versus the general population.
The 2008 PBS documentary Struggling in Silence describes many of the hidden challenges of being a physician. More recently in a 2016 TEDMED talk, the physician Pamela Wible dramatizes some individual episodes of despair and pleas for reevaluating the medical training process from young physicians.
The lives of our colleagues and the safety of our patients demand that we address the stigma of mental health within the medical community, provide confidential, effective treatment for physicians (as opposed to always defaulting to disciplinary measures,) and actively make it known that psychiatric illness and substance use disorders are illnesses we find among all human populations — even doctors — and that seeking treatment for a psychiatric concern is not shameful, but rather requires courage.
For additional information, please feel free to email our office at Amanda.Itzkoff@gmail.com. To schedule an appointment, call our offices at 917-609-4990.
Dr. Amanda Itzkoff