You are listening to ReachMD XM 157, The Channel for
Medical Professionals. Physician suicide rates are often reported as being
higher than the general population or higher than other academics. What does
the research really say? Welcome to The Clinician's Roundtable. I am Dr.
Leslie Lundt, your host and with me today is Dr. Eva Scherhammer. Dr.
Scherhammer is Assistant Professor of Medicine at the Harvard Medical School
and Assistant Professor of the Epidemiology at the Harvard School of Public
Welcome to ReachMD.
Well, thank you Leslie. I am happy to be here. I look
forward to _______.
This is such an important topic of course for all of us.
What is the common knowledge about physicians and suicide?
Well, there have only been a few studies that have tried to
address that question with the true reason increased risk for physicians to
commit suicide and generally, what we think we see in those studies is that
there is an increased risk of suicide among physicians, particularly perhaps
still among female physicians.
Among female physicians?
Yes, as you probably know women have only entered medicine
couple of decades ago and the studies that we are looking at span the last
century. So, there is only about half of all studies that do include female
physicians. So, we are speaking about much smaller number of studies that have
been able to look into this, but though it seemed to suggest that women
encounter about 3 times higher risk of committing suicide than men do in this
So, female physicians are 3 times more likely to kill
themselves than male physicians?
Roughly. So, if you, we have stated that compare physicians
to the general population and if you look at the combined evidence, men have
about 40% higher risk of committing suicide, whereas women physicians commit
suicide at 130% higher rate than the general population.
So, in the general population, women attempt suicide more
frequently than men, but are nearly is, I hate this expression, a successful
which does not seem like success, but completor shall we say, it sounds like
women physicians that is not the case.
I think that is a very important observation, Leslie. It is
true that in the general population about 1 in 15 attempted suicides,
especially among women is successful. Among female physicians on the other
hand the rate of suicide attempts is actually lower than that of successful
suicides and I think what that point too is perhaps one of the reasons that
have been proposed for the increased rate of physician suicide among women and
that could pertain to the methods that are chosen by female physicians as
compared to women in the general population.
So, we know how to kill yourself better than the general
Perhaps so. We do know that in the general population, men
tend to choose methods that are more likely to lead success if you will. So
men tend to use firearms by far more often than women when they commit
suicide. Among physicians, you see that because of the access to drugs that
physicians have both men and women, they tend to use more safe methods if you
will and they know how to apply these drugs who also successfully commit
Now, you have actually done some research about physicians
and suicide. How did you get interested in this topic?
My interest in physician suicide is a very personal story.
It relates back to the time when I was still in a fellowship for oncology and I
remember the time when I was working around with a female colleague of mine who
I did not know too well, but I knew she was married. She has a small child and
one day, I would come to work and I would hear that my colleague wasn't able to
come because she had hung herself in the toilet of her apartment. That was
very traumatic in many ways to me because there is a sense of could I have done
anything to prevent this from happening, even though that I was working so
closely with her and that still I think is something a message perhaps for other
colleagues that clearly there could be something in the way colleagues may
interact or behave that could point towards an increased risk perhaps for them
to be suicidal and that certainly would be something to pay attention to and to
reach out to these colleagues.
Tell us about the work you have done.
Perhaps to continue that story, the reason why I am doing
this research is after my colleague committed suicide, three more colleagues in
the same hospital committed suicide which is not actually not uncommon, but
once we saw, it ends up leading to a suicide streak. So, that two years or so,
within that time, four colleagues of mine committed suicide, left an impression
on me and made me think that I would like to do some research that perhaps
could highlight that if there is any increased risk among physician suicide and
perhaps even stimulate more research in order to understand what the actual
risk factors are for a potentially higher rate of suicide among physicians.
If you are just joining us, you are listening to The
Clinician's Round Table on ReachMD, The Channel for Medical Professionals. I
am Dr. Leslie Lundt, your host and with me today is Dr. Eva Scherhammer. We
are discussing the high rates of physician suicide.
So, what have you found in terms of risk factors?
Well, we conducted a study where we were trying to combine
all the evidence that have been published and in that combined evidence, we did
see that there is a gender difference among male and female physicians. Now,
we did not have data to actually look into the causality of that increased risk
of suicide, but there is some literature out there that tries to sort of look
at known suicide risk factors and how that pertains to this physician community
and having said that, I also would like to point out that apart from this,
perhaps higher suicide rate among my colleagues, there is also a lot of good
things to be said about physicians, which in many ways are living a role model
life in terms of the smoking rates, pertaining to great diets, exercising at a
higher level than the general population and it has also been shown that
physicians tend to live a couple of years longer than non-physicians. So,
generally that profession is doing very well, but there are certain things they
may encounter in the profession and may actually add to underlying risk factors
such as perhaps the high prevalence of psychiatric disorders or social factors
that then may lead to a crisis and in the combination of an underlying risk
factors can perhaps leads to an acute increase in the risk of committing
Does specialty seems to matter?
There are some studies that support this. So, especially
specialties that have better access to drugs such as anesthesiologist perhaps,
but there are also studies supporting that psychiatrist have a higher rate of
suicide, even higher than colleagues from other sub disciplines and there is
also evidence that physicians working in the emergency room may also have a
So, we see gender differences, some specialty differences,
risk of comorbid psychiatric problems, substance abuse, any other factors that
seem to increase the rate of suicide among physicians?
Well, there has been arguments given the particularly higher
rate among female physicians that perhaps gender-based harassment may play a
role and there are also some interesting studies supporting especially in
male-dominated professions, for instance among female surgeons that there is a
really high rate of gender-based harassment. There are data supporting that up
to 50% to 75% of all women in that profession have at one point or more than
once been gender-based harassed or sexually harassed and clearly that could add
to the stress that female and male physicians already encounter in their
profession. So, there has been talk about that gender inequality in certain
subspecialties that may contribute to perhaps higher risk among the women.
Now, any idea as what we as a profession can do to prevent
Well, my advice would be based on my own experience to
clearly watch out for your colleagues for one and if you do notice any
differences, if you know the colleague is encountering a crisis and such crisis
could be the loss of relative, of a child, of a spouse, could be retirement or
woman going through menopause, all sorts of crisis that you might encounter in
your colleagues that you think warrants perhaps your particular attention.
When I say this particularly because there is also evidence that physicians
have a harder time reaching out for help if they need help and in addition if
they do reach out for help, often times they do not receive the type of help
they would perhaps receive if they were not physicians themselves. So, I think
it is one thing is for us to look out for colleagues who might be in need and
then there has also been suggestions that perhaps one should try to establish
more visually confidential access to psychotherapy to perhaps encourage an open
discussion about the stressors that physicians encounter in their daily
practice and of course also to equalize professional conditions and this is
going back again perhaps to gender-based differences and the stresses that
women as opposed to male physicians encounter.
Are there any resources that our listeners might turn into
for more information?
The American Medical Association, I am sure would have information,
definitely each hospital should already have in place some sort of access to
help for physicians who are in need of either psychotherapy or counseling. So,
probably to check with the individual hospital or with the American Medical
Association would seem the best starting place for more information.
It seems like confidentiality is such a huge issue for
physicians in need of treatment that seems like a perfect opportunity for some
sort of internet-based treatment or evaluation service. I wonder if anybody is
working on that?
Yes, that is a good suggestion. I do not know whether
anyone is working on that, but I truly think that new technology may open up
new venues and ways how one could do this in a very confidential way because
you are right, there is this threat of losing their medical licence for
physicians if they do seek help for certain psychiatric problem. So, clearly,
there is a need for confidentiality, particularly when it comes to counseling
physicians. So, yes, I think your suggestion is a good one, I am not aware
of. I need particular effort if that currently is being undertaken in that
Certainly, at least in Idaho where I practiced every time
you renew your medical life and if you have to answer that question, you know
on the license renewal form, if ever in the past year received any sort of
psychiatric treatments, I wonder if it does prevent people from seeking help.
It might, it might, and that clearly is something that could
perhaps be improved by ensuring that these types of reasons for counseling do
not threaten the loss of licenses among physicians.
Do you have any other studies planned in this area?
I would love to explore the risk factors for suicide and
perhaps cohered of nurses to sort of see what especially in medical professions
where chronic stressors are for sure more prevalent than in any other
professions, what sort of risk factors we could find and perhaps eventually by
preventing certain risks, reduce the risk of suicide in this profession.
Thank you so much for sharing your work with us today.
It was my pleasure. Thanks Leslie.
We have been speaking with Dr. Eva Scherhammer about
physicians and suicides. I am Dr. Leslie Lundt. You are listening to ReachMD,
The Channel For Medical Professionals. For a complete program guide and
downloadable pod cast, visit our website at www.reachmd.com. Thank you for