Physician burnout and suicide are a growing public health concern, with 1 in 15 physicians experiencing suicidal ideation. Studies consistently show that physicians are more likely than non-physicians to experience work-related stressors prior to suicide. Still, the exact nature of these stressors was unknown.
To better understand and characterize the job stressors that contribute to physician suicide, researchers at UC San Diego Health reviewed the death investigation narratives from 200 physician suicides collected by a national database between 2003 and 2018. Using natural language processing and thematic analysis — tools for extracting and interpreting data from the reports — the team was able to identify the main issues contributing to physician job stress and suicide.
The study, published June 29, 2022 in Suicide and Life-Threatening Behavior, found six overarching themes in the reports. These included an incapacity to work due to deterioration of physical health, substance use that was jeopardizing employment, the interaction between mental health and work-related issues, relationship conflicts affecting work, legal problems and increased financial stress.
Kristen Kim, MD, is a resident physician in psychiatry at UC San Diego Health.
“We often overlook the physical health of our health care workers, but poor health can lead to difficulty performing tasks at work, which then leads to job stress and mental health issues,” said corresponding author Kristen Kim, MD, a resident physician in psychiatry at UC San Diego Health.
The authors outlined several short- and long-term solutions for health care systems to consider.
In the short-term, they stressed the need to improve physicians’ access to primary care services, minimize their scheduling challenges, and address their concerns about confidentiality. Kim encouraged health care workers to utilize resources like the UC San Diego Healer Education Assessment and Referral (HEAR) program, which provides access to confidential mental health counseling and was recently endorsed by the U.S. Surgeon General’s Advisory on Health Worker Burnout.
In the long-term, the authors called for broader structural and cultural changes to address workplace stress and poor physician self-care.
“The unspoken culture of medicine encourages self-sacrifice, deferred needs and delayed rewards,” said Kim. “We always want to put our patients first, but healers cannot optimally heal unless they themselves are first whole.”
The authors highlighted the importance of cultivating a sense of safety and community among physicians. They also suggested that health care systems and medical schools provide additional personal finance education and legal support.
“There is a lot of work to be done,” said Kim, “but identifying and acknowledging the problem is always the first step towards a solution, and that’s exactly what we’re doing.”
Co-authors include: Gordon Y. Ye, Nicholas Kos, Sidney Zisook and Judy E. Davidson at UC San Diego, as well as Angela Maria Haddad at Universidad Autónoma de Guadalajara.