Christopher Doty, MD, is a professor of emergency medicine at the University of Kentucky College of Medicine. He also chairs the college’s wellness committee, helping find solutions for wellness concerns of faculty, staff, and learners.
Dr. Doty has been heavily involved in helping with the prevention of physician suicide. For National Physician Suicide Awareness Day on Sept. 17, he shares information and resources about this issue.
Q: How big of an issue is physician suicide in the U.S.?
A: Over 400 physicians per year die by suicide. This data comes from an article by Frank et al. in 2000 and has significant methodological errors that most likely underestimate the true number significantly. When I was faced with looking at how common this was after I lost a resident in my program, I was not particularly impressed by that number. However, as I thought more about it, it dawned on me that those physicians had to be replaced every year. This means it takes the size of two full UK medical school classes to graduate enough physicians to make up for the loss due to suicide. When I thought about it in that way, I found the number staggering. Additionally, the 400 number is probably quite low in actuality.
Q: How has the COVID-19 pandemic impacted this issue?
A: Health care workers across the country are at the breaking point. They suffer from fatigue, depression, exhaustion, moral injury, and a separation from other physicians and from their patients. COVID-19 patients, when they are sick, die alone and in isolation. This tears at the moral fiber of physicians and other caretakers when they have to watch this. Additionally, maintenance of the doctor-patient relationship is one of the documented factors of maintaining provider resiliency. COVID-19 systematically separates physicians from the patients physically and emotionally.
The number of people dying from COVID-19 is overwhelming, and the extra steps that physicians have to take to protect themselves and their family is exhausting. At the same time, many physicians feel like the public is not doing all that they can do to protect themselves by getting vaccinated, wearing masks, and social distancing. Though many providers are doing all that they can do to help people, and we take an oath to always care for the patient, it is exceptionally hard on the caretakers to maintain compassion for people who do not appear to be protecting themselves.
Q: How have you been involved in helping prevent physician suicide?
A: I became interested in physician resiliency and physician suicide after I lost a resident in 2016. I had been meeting with this resident regularly because I knew they were going through a very difficult personal time. I had my eye on the resident. I thought they were managing the stresses. However, I was wrong. The resident took their own life, and the rest of the program was left to make sense of the situation and pick up the pieces in the decimation. I made a decision at that time that I would champion physician wellness and physician suicide awareness. I had spent 15 years training residents and had never really spent much time training them how to be resilient. I had no idea the risk that physicians were at.
I have had the honor of being involved in a national organization of medical educators. While serving on the board of that organization, the Council of Residency Directors in Emergency Medicine (CORD EM), I was able to work with several people to conceptualize and operationalize a National Physician Suicide Awareness Day. This effort grew out of CORD EM and is now an international movement.
Q: What can institutions do to help with physicians’ mental health?
A: The problems facing positions today are mostly cultural and systems-based. Many institutions focus on individual and personal resiliency. However, in my mind, it is like victim shaming. We will not be able to “granola bar” our way out of this crisis. It will take cultural changes within our ranks and true organizational change to put providers’ physical and mental well-being as a priority. As academic medical centers begin to recognize that provider wellness affects patient safety and the bottom line, they can begin to see a return on investment and how to prioritize this in an ever-tightening world of health care reimbursement. These priorities must fit with the other missions of the medical center, but are important in provider retention, provider productivity, and patient safety. Happy physicians are better physicians. Formation of wellness committees with budgets and decision-making power is a great first step. Formation of an office of provider wellness is also an excellent step. At UK, we have begun a national search for a chief wellness officer that will be hired at the associate dean level.
Q: Where can physicians turn to if they’re struggling with burnout and other mental health issues?
A: First, I would like to highly recommend that people who are suffering or at the end of their rope reach out to a trusted colleague or friend. Physicians traditionally do not disclose mental health issues or personal struggles. This leads to a strangulating cultural prison of silence. Reaching out to someone you trust is a low-risk first step and is almost always beneficial. Conversely, letting people know that you care about them and are concerned about them is a great way to connect with somebody who may be suffering. If you see something, say something.
There are presently several resources that our faculty and learners can use. The College of Medicine has counseling services that are confidential and free through Lexington Medical Society and the Woodland Group, a private counseling group here in Lexington.
There is a national physician provider help line that is staffed by volunteer physicians (1-888-409-0141) for 17 hours a day where any physician or medical student can get peer-support for a crisis they are having. There is a local peer-support network called the SOAR program that is organized by UK HealthCare Pastoral Care. The College of Medicine also hosts a website with an exhaustive listing of well-being resources (including mental health resources) at https://mednet.mc.uky.edu/wellbeing.
Lastly, there are a host of helplines for people that are considering self-harm. The national help line is 1-800-273-8255 and the text line is 741741. The most important thing to do is ask for help.