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By Sara Reader, MD, MPH for KevinMD.com
The recent suicides of an NYU resident and a medical student highlight the growing mental health problem among physicians and physicians-in-training in this country. This crisis is certainly not exclusive to physicians, as evidenced by the suicides of designer Kate Spade and television personality Anthony Bourdain. However, suicide among physicians is of particular concern. A literature review of physician suicide in Medline and PubMed yielded alarming results indicating that physicians in the United States have the highest suicide rate of any profession in the country. Moreover, physicians have a suicide rate greater than twice that of the general population. The etiology of depression and other mental illnesses among physicians leading to this high rate of suicide is important to discuss, but is perhaps a topic for future discussion.
The reluctance of physicians to seek treatment for mental health conditions is the focus of this article. In the aforementioned study, investigators note that stigma surrounding mental illness is a considerable hindrance to physicians seeking treatment. Physicians may be concerned about stigma from colleagues, patients, and even friends and family. Financial penalties for seeking treatment for mental illness may also be a concern. For instance, physician disability insurance may be completely denied based on a history of mental illness, including anxiety and depression. At the very least, there are frequently “nervous/mental disorder” limitations on the policies, meaning that insurers will pay a much smaller portion of the insurance payout if the physician’s inability to work is due to a mental health condition.
Furthermore, many medical licensing boards across the country persist in requiring information about current and previous mental health disorder diagnoses on initial and renewal medical license applications. This practice is potentially in violation of the Americans with Disabilities Act of 1990. For this reason, the Federation of State Medical Boards has recommended that medical licensing boards cease inquiries into physicians’ history of mental illness. Unfortunately, two-thirds of state medical boards remain non-compliant with these recommendations, as issued by the Federation of State Medical Boards, the American Medical Association, and the American Psychiatric Association. A study published in 2017 indicates that approximately 40 percent of physicians are hesitant to seek treatment for mental health conditions due to concerns about repercussions to their medical licensure.
Physicians are a population already susceptible to mental health disorders and suicide. The potential stigma, financial penalties and licensing repercussions leading to reluctance to seek care clearly exacerbate the physician suicide crisis. The culture surrounding physician mental health must be revised such that those struggling can comfortably seek treatment with the same privacy and dignity with which we are expected to treat our patients. “Physician, heal thyself” is a proverb easier said than done.