Imperfection in a field of perfection: Why some physicians don't get mental health treatment

Many physicians face high pressure and trauma while working, yet structural barriers — often enforced by medical boards and hospital systems — can discourage them from accessing potentially life-saving care, reports Vox.

Vox spoke to co-workers, family members and friends of physicians who died by or attempted suicide, along with physicians who have attempted or considered suicide. 

"If it's a problem anyone actually cares about, then there should be publicly available tracking and some effort to stop it," said a Boston physician who has lost two colleagues to suicide and spoke on condition of anonymity for fear of workplace retaliation. "In what other industry would it be acceptable for talented and high-profile people to be jumping off buildings and everyone to stand by, scared to comment?"

An average of 119 U.S. physicians commit suicide each year, according to a study cited by Vox. That statistic is similar to the general population suicide rate, but is likely an underestimate, said Katherine Gold, MD, lead study author and associate professor at Ann Arbor-based University of Michigan Medical School.  

About a third of U.S. physicians across all residency programs meet the diagnostic criteria for major depression, reports Vox. From 2004-14, suicide was the second most common cause of death among new physicians, according to an analysis cited by Vox.

The phenomenon often referred to as burnout can be "a misnomer for what's happening," said Pamela Wible, MD, a physician in Oregon and mental health activist. "It severely minimizes and blames the victim for the situation."

Dr. Wible began studying physician suicide after three of her colleagues died by suicide. Over nine years, she has recorded more than 1,600 physician deaths, finding systemic contributors "that are the norm in medical training and practice."

Half of U.S. physicians are employed as independent contractors and therefore unprotected by some labor laws, allowing many issues to fester, Dr. Wible told Vox.

"Our moral compass is incredibly compromised by the systemic barriers in the U.S. that have made it about the bottom line rather than what we can do for patients," said Mona Masood, DO, a Philadelphia psychiatrist who treats physicians in crisis. The profession itself also attracts high-achieving perfectionists who put significant pressure on themselves, increasing their risk for mental health problems, Dr. Masood told Vox.

"Emotions, struggling, are an imperfection, and medicine is a field of perfection," noted Jessi Gold, a psychiatrist at Washington University in St. Louis.

Nearly 40 percent of physicians said they were reluctant to get care for a mental health condition because of medical license repercussions, according to a 2017 survey published in Mayo Clinic Proceedings. Medical boards in many states ask physicians about their health histories, requiring them to report diagnosis or treatment for mental illness. Similar questions come up when applying for hospital credentials or insurance reimbursements. 

Most physicians who talked to Vox said they've avoided care, left the state for treatment or paid out of pocket to avoid billing their health insurer, which is often tied to the system they work at. 

Many medical groups and advocates, including the American Medical Association and American Psychiatric Association, have argued that regulators should only ask about mental illnesses that currently affect ability to safely practice medicine. Overly broad questions may discourage physicians from getting support and may even violate the Americans with Disabilities Act. But "the biggest systemic fix is simply to remove the mental health questions," Dr. Katherine Gold said.  

It's not yet known how COVID-19 has affected the physician suicide rate.

Click here for a list of mental healthcare support services for healthcare workers.


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