You Can Keep Your Doctor…If He Doesn’t Kill Himself

As the ACA (Obamacare) enters its comic relief phase, with the Jon Gruber videos; the “now you tell me” confessions of Democratic lawmakers who say that the bill should not have been passed; and the truly unwanted resurrection of Kathy Sebelius, maybe it’s time to get serious once again. In health care, it can’t get any more serious than physician suicide.

Official estimates put the annual toll of American physicians who die at their own hand as high as 400. But, given the stigma of suicide—especially among doctors—this figure is probably low. Indeed, what are the chances that a physician, fully trained in drugs and dosing, would die of an “accidental overdose”? Of course, such cases, using this favored method of physician suicide, are much easier to cover-up than firearms, the runner-up method.

Quite sadly, but also quite understandably, doctors exceed the suicide completion rate of the general public by more than a factor of two. After all, they do have greater knowledge of these matters, and have ready access to all sorts of dangerous substances. Notably, in all populations, suicide is usually the result of untreated or inadequately treated depression, coupled with knowledge of and access to lethal means.

So, what about depression in physicians? Studies based on confidential questionnaires find that 12% of male and 18% of female doctors are depressed. Given the unconscionable mess that is American health care, one wonders why the percentage isn’t even higher. How is it not depressing to assume massive student debt, to then face long hours; assembly line medical office practices; the realization that at best, you are working for the insurance industry; and the constant threat of...

The Indian medicos are a different breed than the H1B masses. Most Indian doctors who get to the states are top in their classes, and are essentially here to build up their resume for a while before heading back to take positions in prestigious hospitals in India, where they can apply the techniques and procedures they acquired here. They tend to be well-trained and highly knowledgeable, will often accept the lower salaries hospitals are offering now, and don’t have to face years of malpractice insurance premiums. The lower cost of their education means they don’t have the staggering education debt to service, and thus take home more net pay. This makes it just that much more of an obstacle for American doctors, who often can’t afford to upskill to stay competitive.

The H1Bs, on the other hand, are (as you point out) far more of a mixed bag. The tech schools there range anywhere from “quite good” to “diploma mill”, and there’s far less of a vetting process, so all kinds of phonies make it through into the hiring process.

http://www.medscape.com/viewarticle/834434

Recent discussion in medical lierature...

...an unacknowledged predicament for physicians who identify their struggle with substance abuse and/or depression is that they are often placed under the supervision of their State Medical Board’s Physicians Health Program. My son, Greg, was being monitored by such a program. He took his own life at age 29, one week before he was to enter an esteemed oncology fellowship. His final phone calls were to the PHP notifying them of his use of alcohol while on vacation, a disclosure he had previously described as a ‘career killer.’

...These programs, which often offer no psychiatric oversight, serve as both treating and policing agencies, a serious conflict of interest. Threatened loss of licensure deters vulnerable physicians from seeking help and may even trigger a suicidal crisis. Medical Boards have the duty to safeguard the public, but the assumption that mental illness equals medical incompetence is an archaic notion. Medical Boards must stop participating in the stigmatization of mental illness. We cannot afford to lose another physician to shame.

http://emedicine.medscape.com/article/806779-overview

...It has been reliably estimated that on average the United States loses as many as 400 physicians to suicide each year (the equivalent of at least one entire medical school).

...Sadly, although physicians globally have a lower mortality risk from cancer and heart disease relative to the general population (presumably related to self care and early diagnosis), they have a significantly higher risk of dying from suicide, the end stage of an eminently treatable disease process. Perhaps even more alarming is that, after accidents, suicide is the most common cause of death among medical students.

...In all populations, suicide is usually the result of untreated or inadequately treated depression, coupled with knowledge of and access to lethal means.[1] Depression is at least as common in the medical profession as in the general population, affecting an estimated 12% of males and 18% of females. Depression is even more common in medical students and residents, with 15-30% of them screening positive for depressive symptoms. A 2011 survey of 50,000 practicing physicians and medical students in Australia demonstrated a dramatically increased incidence of severe psychological distress and a twofold increased incidence of suicidal ideation in physicians compared with the general population.

...However, because of the stigma often associated with depression, self reporting likely underestimates the prevalence of the disease in both of the above populations. Indeed, although physicians seem to have generally heeded their own advice about avoiding smoking and other common risk factors for early mortality, they are decidedly reluctant to address depression, a significant cause of morbidity and mortality that disproportionately affects them. (Depression is also a leading risk factor for myocardial infarction in male physicians.)

...Perhaps in part because of their greater knowledge of and better access to lethal means, physicians have a far higher suicide completion rate than the general public; the most reliable estimates range from 1.4-2.3 times the rate in the general population. Although female physicians attempt suicide far less often than their counterparts in the general population, their completion rate equals that of male physicians and, thus, far exceeds that of the general population (2.5-4 times the rate by some estimates).

...A reasonable assumption is that underreporting of suicide as the cause of death by sympathetic colleagues may well skew these statistics; consequently, the real incidence of physician suicide is probably somewhat higher.

...The most common psychiatric diagnoses among physicians who complete suicide are affective disorders (eg, depression and bipolar disease), alcoholism, and substance abuse. The most common means of suicide by physicians are lethal medication overdoses and firearms.

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