Forced Retirement Spotlighted as Risk Factor for Physician SuicideJuly 5, 2022
Systemic support systems need to be implemented for physicians to prevent work-related stressors that could lead to suicide, a thematic analysis of 200 physician deaths suggested.
Among physician suicides included in the National Violent Death Reporting System database from 2003 to 2018, six themes were found to precede such deaths, including inability to work due to physical health, substance use, mental health issues, relationship conflicts, legal problems, and increased financial stress, all leading to work-related stress, reported Kristen Kim, MD, of the University of California San Diego, and colleagues.
The results further suggested that suicide risk is associated with premature retirement due to health issues that affect employment, they noted in Suicide and Life-Threatening Behavior.
Among 200 physician death narratives, nearly all that reported earlier-than-expected retirement were linked to a physical ailment, Kim told MedPage Today, including a surgeon with a tremor, a physician with dementia, and a physician with alcohol and prescription drug use problems who had lost hospital privileges.
Investigations by state medical boards, employers, and law enforcement were also common in the narratives, and a re-examination of the data found that a majority of the physicians who died by suicide during the study period were unemployed or “pending job loss and typically not by choice,” the authors noted.
While interpersonal conflicts, including those occurring at work, were common, “strained relationships with family members,” often in the context of a divorce or extramarital affair, were even more common, they added.
The study showed “substantial overlap” with a prior study on job-related problems preceding nurse suicides, with a few exceptions. While nurses experienced difficulty accessing mental health supports and medications following job loss, physicians did not. Furthermore, legal issues were a factor in the physician suicide data but not in the nurse data.
Clinicians often neglect physical health when identifying work stressors, but poor physical health affects work performance and increases work stress, the authors said, noting that legal and psychological supports, particularly during malpractice investigations and “fit for duty” evaluations, are sorely needed.
“Medicine must dispel the myth of never-ill physicians who place the needs of their patients before their own to the detriment of their own health,” they wrote.
Kim said that she hopes that this research will help physicians “give ourselves permission to attend to those needs … to prevent the dire consequences that we may see.”
To that end, Kim and team offered some anonymous screening tools and “confidential pathways” to treatment, including UC San Diego’s Healer Education Assessment and Referral Program, which links physicians to counseling and outpatient treatment.
In addition, the “Dr. Lorna Breen Health Care Provider Protection Act,” which was signed into law in March, includes funding for hospitals to implement suicide prevention initiatives and to promote help-seeking.
Kim also stressed the urgent need to reform the licensure application process to eliminate “invasive” questions about physicians’ mental health and substance use history, which serve to discourage help-seeking and have unintended consequences for patient care.
For this study, Kim and colleagues used a mixed methods approach combining thematic analysis and natural language processing to develop themes representing narratives of 200 physician suicides included in the National Violent Death Reporting System database from 2003 to 2018.
Of the 200 physicians, mean age was 53, 83.5% were men, 89.5% were white, and 62.5% were married. Over half had mental health problems, 16% had problems with alcohol, 14.5% had other substance use problems, and 22% had physical health problems.
Using natural language processing, the authors confirmed five of the six identified themes — except “incapacity to work due to deterioration of physical health” — which “was likely not identified by natural language processing because physical health issues were described as the various, specific conditions affecting work performance (e.g., back pain, tremor), which were not grouped as a common theme.”
Limitations to the study included the fact that the evaluations were conducted postmortem based on short narratives — usually two paragraphs long — developed following interviews with loved ones.
“We’re using the best available data that we have on the reasons for why they decided to do what they did,” Kim said, but most of the data, with the exception of quotes from suicide notes in the narratives, were not first-hand accounts.
In addition, because most of the physicians in the study were men and white, the results may not be reflective of the work-related stressors of underrepresented minorities.
Furthermore, the database used in the study is voluntary. While the number of states participating rose from six in 2003 to 42 in 2018, including the District of Columbia and Puerto Rico, 10 states still do not report these data.
If you or anyone you know is struggling with a mental health concern or having thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
Kim reported no conflicts of interest. One co-author reported receiving research support from COMPASS.