Specialty and Age May Contribute to Suicidal Thoughts Among Physicians

Christine Lehmann, MA

March 07, 2023

A physician's specialty can make a difference when it comes to having suicidal thoughts. Doctors who specialize in family medicine, obstetrics-gynecology, and psychiatry reported double the rates of suicidal thoughts than doctors in oncology, rheumatology, and pulmonary medicine, according to Doctors' Burden: Medscape Physician Suicide Report 2023.

"The specialties with the highest reporting of physician suicidal thoughts are also those with the greatest physician shortages, based on the number of job openings posted by recruiting sites," said Peter Yellowlees, MD, professor of psychiatry and chief wellness officer at UC Davis Health.

Doctors in those specialties are overworked, which can lead to burnout, he said. "While burnout doesn't cause depression, it's correlated with depression and suicidal ideation."

There's also a generational divide among physicians who reported suicidal thoughts. Millennials (age 27-41) and Gen-X physicians (age 42-56) were more likely to report these thoughts than were baby boomers (age 57-75) and the Silent Generation (age 76-95).

"Younger physicians are more burned out — they may have less control over their lives and less meaning than some older doctors who can do what they want," said Yellowlees.

One millennial respondent commented that being on call and being required to chart detailed notes in the EHR has contributed to her burnout. "I'm more impatient and make less time and effort to see my friends and family."

One Silent Generation respondent commented, "I am semi-retired, I take no call, I work no weekends, I provide anesthesia care in my area of special expertise, I work clinically about 46 days a year. Life is good, particularly compared to my younger colleagues who are working 60-plus hours a week with evening work, weekend work, and call. I feel really sorry for them."    

When young people enter medical school, they're quite healthy, with low rates of depression and burnout, said Yellowlees. Yet, studies have shown that rates of burnout and suicidal thoughts increased within 2 years. "That reflects what happens when a group of idealistic young people hit a horrible system," he said.

Who's Responsible?

Millennials were three times as likely as baby boomers to say that a medical school or healthcare organization should be responsible when a student or physician commits suicide.

"Young physicians may expect more of their employers than my generation did, which we see in residency programs that have unionized," said Yellowlees, a baby boomer.

"As more young doctors are employed by healthcare organizations, they also may expect more resources to be available to them, such as wellness programs," he added.

Younger doctors also focus more on work-life balance than older doctors, including time off and having hobbies, he said. "They are much more rational in terms of their overall beliefs and expectations than the older generation."

Whom Doctors Confide In

Nearly 60% of physician-respondents with suicidal thoughts said they confided in a professional or someone they knew. Men were just as likely as women to reach out to a therapist (38%), whereas men were slightly more likely to confide in a family member and women were slightly more likely to confide in a colleague.

"It's interesting that women are more active in seeking support at work — they often have developed a network of colleagues to support each other's careers and whom they can confide in," said Yellowlees.

He emphasized that 40% of physicians said they didn't confide in anyone when they had suicidal thoughts. Of those, just over half said they could cope without professional help.

One respondent commented, "It's just a thought; nothing I would actually do." Another commented, "Mental health professionals can't fix the underlying reason for the problem."

Many doctors were concerned about risking disclosure to their medical boards (42%); that it would show up on their insurance records (33%); and that their colleagues would find out (25%), according to the report.

One respondent commented, "I don't trust doctors to keep it to themselves."

Another barrier doctors mentioned was a lack of time to seek help. One commented, "Time. I have none, when am I supposed to find an hour for counseling?"

Christine Lehmann, MA, is a senior editor and writer for Medscape Business of Medicine based in the DC area. She has been published in WebMD News, Psychiatric News, and The Washington Post. Contact Christine at clehmann@medscape or via Twitter @writing_health

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