Suicidal Ideation Of Concern Among American Surgeons *

Rate 1.5 to 3 times higher than in general public

A recent study has indicated reasons for concern about the rate of suicidal thought among practicing surgeons in the United States.¹ Suicide is a higher cause of mortality for physicians in general compared with other professions as well as the general public.  It would appear that a combination of general work related stress, job burnout, depression and pressures brought about by medical or surgical errors takes it toll.  The constant threat of litigation over imagined or real malpractice seems to be a major issue, particularly among surgeons for whom the risk of such actions is the greatest.  It also appears that surgeons are less likely to seek professional help for their depression than the general public and that the rate of suicidal thought is significantly higher among surgeons than the general public. ^{1, 3, 4, 5}

One in 16 surgeons reported suicidal ideation in the preceding year according to data reported in the Archives of Surgery.  The study was based on a questionnaire sent to members of the American College of Surgeons.  Nearly 8,000 surgeons responded. Among surgeons 45 and older, the rate was 1.5 to 3 times higher than the general US population.  Persons who are highly educated, employed and married have lower rates of suicidal thoughts.  This makes these findings more startling as surgeons in the study were mostly married (88%), clearly highly educated, and essentially fully employed.   Also of interest was the finding that suicidal thoughts were higher in surgeons in the 45-54 age group than in younger individuals, the exact reverse of the usual findings in the general population where 45-54 year olds have lower rates of suicidal ideation than  younger persons. Historically, the suicide risk rate among physicians has been reported as higher in female physicians, but the results of this study found no differences between the sexes in the risk of suicidal thought. Depression has long been associated with suicidal thoughts and actions.  However, burn out has only recently begun to be recognized as a major factor leading to depression, suicidal thought and action.  Previous studies in medical students had demonstrated the impact of burnout as well. ^{1, 2}

It is of concern that highly trained physicians and surgeons would not seek mental health services to deal with burnout, depression and suicidal thought. The most common reason given for this is that there appears to be great concern about licensing and loss of one’s professional career.  Licensing boards are generally focused on physician impairment as opposed to physician illness and treatment, so that the fact of a diagnosis of depression would generally not be sufficient to warrant any action in most cases, especially if treatment is ongoing.  Still, many physicians, surgeons in particular, have great distrust of medical licensing boards as well as other professional monitoring organizations. This may well stem from the very nature of surgical training, practice and art, where a surgeon is solely responsible for his/her actions in the operative theater, as well as the outcome,

be it positive or negative. ^{1, 3, 4, 5}

Health reform actions at the federal and state level will no doubt only add to the burden as more and more persons are brought into the mainstream of the medical care system.  Additionally, the rapidly expanding ranks of the elderly, due to the aging of the baby boomers is having an impact on the numbers of patients needing treatment and surgical interventions. All of this is occurring amidst an environment where medical school enrollments and residency training slots have not expanded rapidly enough to keep pace with demand.  Of particular concern is the effect of burnout in pushing experienced surgeons 50 and over into early retirement or reduced workload situations.  Another factor in play is the hostile reimbursement environment that forces physicians to deal with a plethora of varying rules across a spectrum of thousands of health insurance plans.  This is in addition to the intense pressures on payment implemented at the federal level though Medicare and at the state level though Medicaid.

All in all, a very worrisome picture is painted by this study.  We can only hope that bringing this data to light will encourage surgeons who may be facing some of these issues to seek help just as any patient would – and as they would advise their own patients to do.  We need all the experienced physicians and surgeons we can get, and we need them to be healthy in body and mind . . . obi jo and jomaxx

* Suicidal Ideation Raises Concern Among American Surgeons

1. Special Report, Suicidal Ideation Among American Surgeons (Arch Surg 2011;146(1):54-62)

2. Burnout and Suicidal Ideation among U.S. Medical Students

3. Study: Errors lead surgeons to contemplate suicide

4. Surgeons and suicide: a study in burnout

5. Depression, Burnout Make Surgeons Mull Suicide

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