“Hi Dr. Wible, I am a fourth-year resident in a combined five-year program and I am burned out. Last month, I totaled my car as I sleepily drove home after my 8th night shift in a row and am lucky to have walked away with only a broken clavicle. Of course I was required to show up the very next day despite the fact that I was so traumatized I broke into tears suddenly multiple times that day. The following week, my 28-year-old co-resident nearly died after having a seizure while on inpatient medicine due to sleep deprivation and intolerable stress. A patient on our team died yesterday and my first thought was, “great, that’s one less person I have to take care of.” I know it’s not safe to continue practicing like this, but this has become the norm. Everyone around me is like this and it becomes almost normal. But is it humane? I don’t know what happened to the younger version of me who wanted to comfort a dying patient or save a life or decrease a patient or family member’s suffering. I don’t know where I became lost, but after so many years of living as a cog in the wheel, I have become the hardened resident they trained me to be. And for that, I suffer and so do my patients. Thanks for letting me vent. Feel free to share my story but please omit my name because I would still like to graduate residency, if it doesn’t kill me first.” ~ Michelle
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Dear Michelle
I am so very sorry that our medical education system has destroyed your love for medicine and your compassion for your patients, that your residency nearly killed your colleague and almost took your own life. You do not deserve to be treated this way. Here are my thoughts.
1) You do not have “burnout.”You have been abused. Your human rights have been violated. You have not been allowed to sleep or eat properly, to take care of your own bodily needs (which you must do to stay alive on this planet). This is basic human physiology. Burnout is a victim blaming/shaming term that has been used to deflect attention to the victim and deflect attention from the perpetrator—your residency. Please use the correct terminology. We can’t solve a problem if it is shielded in euphemisms.
2) Your story matters. I am beyond grateful that you have the courage to share your pain with me and with the world. If we all keep pretending that this is okay, the mistreatment will continue. There is no excuse for a health care institution to place human beings in harms way. Sleep deprivation causes medical mistakes every day in every hospital. Sleep deprivation kills young doctors in the prime of their lives. We must all stand up and say enough to the rampant human right violations in medical education (especially residency).
3) You are a beautiful person who has been wounded. You care. You love. You have compassion for people innately. Your training program has snuffed that out and is sucking the very love our of your heart and the very joy out of your soul for healing and serving others. How? Because you have no time to care for yourself. You have been forced to live a fight-or-flight life. You are struggling for your very own survival (which is why you are having trouble caring for others).
4) The younger idealistic humanitarian still lives in you. You may need therapy to pull her out again. You are welcome to come to our retreats (scholarships available) so do let me know if you have any time off or want to set an elective in Oregon. I am here if you ever need to talk to me. I just tried to call you. No answer. You are probably at work. You can get your life back. You can once again comfort a dying patient. You can eventually help others with their suffering after you heal from the trauma of your medical training. Please know not all residencies are like this. I absolutely loved my residency. We can do better.
5) You are loved. Don’t ever give up. So many people love you. I am here for you. We are all here for you. Reach out to those of us who are resourced, who have survived what you are enduring now, those of us who are standing up to humanize medical education so that future generations of doctors do not have to suffer. Your life is too precious to give up. I have so much more to say. I’ll wait for you to call me. 541-345-2437
Ethan Stuart, RN, sent me this email. I’m publishing (with permission) exactly the way I responded. Ethan has severe anxiety. I strongly recommend those with pre-existing mental health issues consider the mental health impacts of a medical education given the suicide crisis among medical students and physicians.
Ethan: Hi Pamela, I have a question about my future career choice, and even though it is more complex than what I will write here, I will try to hit the main points. You seem like a smart, understanding, and compassionate person.
Pamela: I AM! 🙂
Ethan: So I thought I would send you an email.
Pamela: YAY!
Ethan: Basically, my struggle is this: I am a current RN and would like to do primary care in the future (family medicine). However, I am torn as to whether I should try to become a family physician or become a family nurse practitioner.
Pamela: My first thought is NP right off the bat.
Ethan: Here are the things that attract me to becoming a family MD/DO: #1 = Autonomy
Pamela: You can have autonomy as an NP – in your own practice. Listen to this interview I did with the happiest NP in Alaska. (Note: PAs actually can not practice with autonomy and require a collaborating physician so that makes the NP degree much more valuable in my opinion—especially if you want to launch your own independent practice one day!).
Ethan: #2 = Knowing that I became the best that I could be and didn’t settle because it was hard (probably the main reason).
Pamela: There are NPs who are better than doctors. DEFINITELY less abused and have more self-confidence as NPs.
Ethan: #3 = The opportunity to acquire a deeper and wider knowledge base (probably the next main reason).
Pamela: Your knowledge base is directly related to your level of curiosity and your dedication to being a lifetime learner.
Ethan: #4 = Ability to practice internationally.
Pamela: Not sure about this one.
Ethan: Here the things that attract me to becoming an FNP: #1 = Better work-life balance.
Pamela: YES.
Ethan: #2 = Faster/cheaper More flexible should my interests change I can work and go to school part time I can directly choose to study what I am interested in (rather than have to go through many rotations in medical school that I might not be interested in).
Pamela: YES.
Ethan: #3 = I must say, too, I am a person who does not want to train/work in a toxic environment, and I know medicine seems to have plenty of that. I see it daily as a nurse. I also have anxiety that can flare up pretty severely and tend to get burned out if I have to go through a demanding schedule for too long, as I naturally give a lot to people and have to have time to care for myself. If I could get down to the bottom of my indecisiveness, the thing that causes me the most uncertainty/anxiety, I think it would be this: I would like to pursue medicine because I prefer the medical model more and because I would like to be the best I can be, even if it is more difficult. But I am very worried about the price I would pay to get there and the toll it would take on me and my family—I am married now, and my wife will likely have kids by the time I would be in my training.
Pamela: YOUR MENTAL HEALTH & OVERALL HEALTH will be WAY better as an NP.
Ethan: As you know, you can’t help anyone if you can’t help yourself. I don’t mind becoming an FNP, as I think my dedication to learning will make me a great provider regardless. But I also am not sure I am philosophically on board with the nursing model per se, and it is mainly attractive me for PRACTICAL purposes, not intellectual ones.
Pamela: Your intellect can take you anywhere you want to go. Degree really doesn’t matter. It’s your initiative.
Ethan: The rub is I don’t want to pursue being an FNP (or an MD/DO, for that matter) for the wrong reasons. Lastly, I also have many hobbies, and though I would enjoy the knowledge base that physicians have and the autonomy, I am not sure I would like the stress and any longer hours that comes with it.
Pamela: NOT worth all the extra training. You could get an NP in an 12-18 month accelerated program for 10% the cost of getting an MD/DO. AND you can earn MORE than a doctor!! (see above video).
Ethan: And I realize one may not be able to have one without the other. I may just have to accept that there will be trade offs either way. What do you think?
Pamela: I think you should design your dream clinic/practice FIRST—then reverse engineer the steps to get there choosing the fastest, least costly method to get there.
Ethan: Based on your personal experience as a family MD, what would you advise me to do?
Pamela: Go for your NP degree.
Ethan: THANK YOU for your time and for all your wonderful work. No doubt you are such a treasure to many. Most sincerely, Ethan
Pamela: Can I publish this on my blog as I think lots of people would like to know the answers to these questions. Also after you read what I suggest tell me what you decide. I’m not attached either way.
Ethan: Thank you for the quick response and specific answers. I honestly have known which path would be better for me personally for a while, but there has been that small part of me that doesn’t want to completely rule out medicine because of the reasons I listed. Be that as it may, I want to be healthy and happy and do what’s best for me and my family—which will make me a better provider and family member.
And, of course you can publish this on your blog. I’m honored! You can even leave my name if you feel inclined, although I don’t think it’ll make me an overnight sensation.
Will keep following all your great work. I just have to say—I really, really admire your courage. Thanks for leading the way—hopefully the rest of us can follow suit. 🙂
ADDENDUM 11/29: This is my advice for Ethan. My advice for you may be totally different based on your life circumstances. I love doctors. I love being a doctor. I loved my residency and the last 2 years of medical school. I am the happiest I’ve ever been in my life practicing medicine in our community-designed ideal clinic (solo doc for 12+ years). My greatest joy is helping all health professionals find their joy no matter what the “official degree.” We are all valuable.
Dr. Jon Azkue dies by suicide and media reports his death as an “inconvenience to patients.” He’s treated as if he is guilty of a crime. No sympathy. No sadness for the loss of a man who dedicated his entire life to helping others. I contacted ABC News to express my concern about slandering and dishonoring this caring physician. I never heard back.
Dr. Trevor Wesson has been missing since October 6, 2017. Media accuses him of abandoning 1500 patients. He is also accused of not paying his rent. No concern about the doctor’s well-being. Doctors are at high risk for suicide. Dr. Wesson has been missing for 2 months. Police have not intervened on his behalf. Rather a court injunction is being issued to prevent him from accessing his patient files during his “mysterious absence.”
I wrote the reporter. I’ve not heard back.
I’m praying that Dr. Wesson is found alive and receives the care that he so desperately needs. As for Dr. Jon Azkue, he will be honored in the forthcoming documentary Do No Harm.
Dr. Kat Lopez: “Today I’d like to share with you some words used by the medical-industrial complex to blame doctors for the problems—including human rights abuses—that they are perpetrating upon these poor enslaved employees.
These words include burnout—blaming the victim who is enduring human rights abuse on a daily basis. RVUs. Work-life balance impossible to achieve. Benchmarks. Metrics. Inefficiencies. Efficiencies. Unprofessionalism. FTEs.
The word resilience is a frequently used word to blame doctors who are truly among the most resilient human beings on the planet and need no further training in how to be resilient; they simply need to be treated with respect and valued for the incredible value they have to society. Disruptive physicians who stand up and say no. Availability. Patient satisfaction surveys for 5-15 minute visits.
The concept of residents committing violation of their work hours for meeting the requirements of their residency programs. Patient contact hours which basically means working for free to complete the paperwork etcetera administrative work related to caring for the patients. Quality improvement metrics. Quality assurance. Maintenance of Certification—huge financial racket for unclear benefit in terms of patient care. Population health and its metrics. As well as our favorite, meaningful use.
Now the end result of these words that blame disempowered doctors for the abuses committed by the medical-industrial complex assembly-line medicine and corporate medicine itself is that unfortunately it creates disempowerment, hopelessness, feelings of being stuck, anxiety, and depression that at the end of the day, the year, the residency, the ten years—results in physician suicide.
Here we have an altar composed of our fallen brothers and sisters, beautiful photos of them and their families in their primes, as well as elegies to their love and their incredible patient care over the years of their careers.”
Pamela Wible: “This is psychological warfare on really amazing physicians by a system that perpetuates human rights violations on some of the most beautiful people in the world. What do y’all think about that?”
Doctors: “Yes”
Pamela Wible: “Is there anything else you want to add Kat or anyone? I think this speaks for itself.”
Kat Lopez: “I think this speaks for itself.”
Can you think of any others? Please submit additional words that blame doctors in comment section below.
Five years ago today I was at a memorial. Another suicide. Our third doctor in 18 months.
Everyone kept whispering, “Why?”
I was determined to find out.
So I started counting dead doctors. I left the service with a list of 10. Five years later (10/28/17) I have 547.
[As of 9/13/24 there are more than 2,000 doctor suicides on the registry. If you’ve lost a doctor or medical student to suicide, please (confidentially) submit names here.]
Immediately, I began writing and speaking about suicide. So many distressed doctors (and med students) wrote and phoned me. Soon I was running a de facto international suicide hotline from my home. To date, I’ve spoken to thousands of suicidal doctors; published a book of their suicide letters (free audiobook); attended more funerals; interviewed surviving physicians, families, and friends. I’ve spent nearly every waking moment over the past five years on a personal quest for the truth of “Why.” Here are 35 things I’ve discovered from the first 547 cases:
High doctor suicide rates have been reported since 1858. Yet more than 150 years later the root causes of these suicides remain unaddressed.
Physician suicide is a public health crisis. One million Americans lose their doctors to suicide each year.
Most doctors have lost a colleague to suicide. Some have lost up to eight during their career—with no opportunity to grieve.
We lose way more men than women. For every woman who dies by suicide in medicine, we lose four men. (amended 3/7/19)
Suicide methods vary by region and gender. Women prefer to overdose and men choose firearms. Gunshot wounds prevail out West. Jumping is popular in New York City. In India doctors are found hanging from ceiling fans.
Male anesthesiologists are at highest risk. Most die by overdose. Many are found dead in hospital call rooms.
Lots of doctors die in hospitals. Doctors jump from hospital windows or rooftops. They shoot or stab themselves in hospital parking lots. They’re found hanging in hospital chapels. Physicians often choose to die where they’ve been wounded.
“Happy” doctors die by suicide. Many doctors who die by suicide are the happiest most well-adjusted people on the outside. Just back from Disneyland, just bought tickets for a family cruise, just gave a thumbs up to the team after a successful surgery—and hours later they shoot themselves in the head. Doctors are masters of disguise. Even fun-loving happy docs who crack jokes and make patients smile all day may be suffering in silence. We are all at risk.
Doctors’ family members are at high risk of suicide. By the same method. One physician died using the same gun his son used to kill himself. Kaitlyn Elkins, a star third-year medical student, chose suicide by helium inhalation. One year later her mother Rhonda died by the same method. At Rhonda’s funeral, I asked her husband if he thought his wife and daughter would still be alive had Kaitlyn not pursued medicine. He replied, “Yes. Medical school has killed half my family.”
Suicidal doctors are rarely homicidal. Of the first 547 suicides I’ve compiled, only 2% (15) involve homicide. Half (7) are male physicians who killed a female spouse/girlfriend (all in health care—4 nurses, a nursing student, pharmacy tech, and dentist). Three male physicians murdered their young children. Another strangled his disabled adult daughter before killing himself. Less than 1% of all doctor suicides involve homicide of their children. Here’s why surgeon Dr. Chris Dawson shot his kids before turning the gun on himself. Of the 3 cases involving young children, all suicide victims were having marital/relationship problems with the mother. One also killed the mother.
Doctors have personal problems—like everyone else. We get divorced, have custody battles, infidelity, disabled children, deaths in our families. Working 100+ hours per week immersed in our patients’ pain, we’ve got no time to deal with our own pain. (Spending so much time at work actually leads to divorce and completely dysfunctional personal lives).
Patient deaths hurt doctors.A lot. Even when there’s no medical error, doctors may never forgive themselves for losing a patient. Suicide is the ultimate self-punishment.
Malpractice suits kill doctors. Humans make mistakes. Yet when doctors make mistakes, they’re publicly shamed in court on TV, and in newspapers (that live online forever). We continue to suffer the agony of harming someone else—unintentionally—for the rest of our lives.
Doctors who do illegal things kill themselves. Medicare fraud, sex with a patient, DUIs may lead to loss of medical license, prison time, and suicide.
Academic distress kills medical students’ dreams. Failing boards exams and being unmatched into a specialty of choice has led to suicides.
Doctors without residencies may die by suicide.Dr. Robert Chu, unmatched to residency, wrote a letter to medical officials and government leaders calling out the flawed system that undermined his career prior to his suicide.
Assembly-line medicine kills doctors. Brilliant, compassionate people can’t care for complex patients in 10-minute slots. When punished or fired for “inefficiency” or “low productivity” doctors may choose suicide. Pressure from insurance companies and government mandates further crush the souls of these talented people who just want to help their patients. Many doctors cite inhumane working conditions in their suicide notes.
Bullying, hazing, and sleep deprivation increase suicide risk. Medical training is rampant with human rights violations illegal in all other industries.
Sleep deprivation is a (deadly) torture technique. Physicians have suffered hallucinations, life-threatening seizures, depression, and suicide solely related to sleep deprivation. Sleep-deprived doctors disclose hospital horrors that kill or injure patients. Others die in fatigue-related car crashes after long shifts. Resident physicians are now “capped” at 28-hour shifts and 80-hour weeks. If they “violate” work hours (by caring for patients) they are forced to lie on their time cards or be written up as “inefficient” and sent to a psychiatrist for stimulant medications. Some doctors kill themselves for fear of harming a patient from extreme sleep deprivation.
Blaming doctors increases suicides. Words like “burnout” and “resilience” are often employed by medical institutions as psychological warfare to blame and shame doctors while deflecting attention from inhumane working conditions. When doctors are punished for occupationally induced mental health conditions (while underlying human rights violations are not addressed), they become even more hopeless and desperate.
Sweet, sensitive souls are at highest risk. Some of the most caring, compassionate, and intelligent doctors choose suicide rather than continuing to work in such callous, uncaring and ruthlessly greedy medical corporations.
Doctors can’t get confidential mental health care. So they drive out of town, pay cash, and use fake names to hide from state medical boards, hospitals, and insurance plans that ask doctors about their mental health care and may then exclude them from state licensure, hospital privileges, and health plan participation. (Even if confidential care were available, physicians have little time to access care when working 80-100+ hours per week).
Doctors have trouble caring for doctors. Doctors treat physician patients differently by downplaying psychiatric issues to protect physicians from medical board mental health investigations. Untreated mental health conditions may lead to suicide.
Medical board investigations increase suicide risk. One doctor hanged himself from a tree outside the Florida medical board office after being denied his license. He was told to “come back in a year and we will reinstate your license.” Meanwhile he lost everything and was living in a halfway house.
Physician Health Programs (PHPs) may increase suicide risk. Forcing doctors with occupationally induced mental health issues into these 12-step programs with witnessed random urine drug screens (when they’ve never had a drug problem!) is humiliating and unethical. So doctors hide their mental health conditions for fear of being punished by PHPs. [Note: PHPs have helped some doctors with substance abuse especially]
Substance abuse is a late-stage effect of lack of mental health care. Since doctors may lose their license for seeking mental health care or get locked into PHPs; they self-medicate with alcohol, illicit drugs, or self-prescribe psychotropic medications.
Doctors develop on-the-job PTSD. Especially true in emergency medicine. Then one day they “snap” like this guy.
Cultural taboos reinforce secrecy. Suicide is a sin in many religions. Islam and Christian families have asked that I hide the suicides of family members. Indian families often claim a suicide is a homicide or an accident, even when it’s obviously self-inflicted.
Media offers incomplete coverage of suspicious deaths. Articles about doctors found dead in hospital call rooms claim “no foul play.” No follow-up stories.
Medical schools and hospitals lie (or omit the truth) to cover up suicides—even when media and family report cause of death. Medical student Ari Frosch stood in front of a train, yet his school reported he died at home with his family. Though the family of psychiatrist Christine Petrich shared that she bought a gun and killed herself (after just getting her hair done and planning a surprise trip to Lego Land and Disney for her kids) on their GoFundMe page, her employer wrote she “passed away.” Shouldn’t the department of psychiatry take a more active interest in physician suicide?
Euphemisms cover up doctor suicides. Suicide is omitted from obituaries, funerals, clinics, hospitals, and medical schools. Instead we hear “passed away unexpectedly in her sleep” and “he went to be with the Lord.”
Secrets will not save us. We’re unlikely to make a medical breakthrough on a hidden medical condition.
Doctors choose suicide to end their pain (not because they want to die). Suicide is preventable. We can help doctors who are suffering if we stop with all the secrecy and punishment.
I’ve been shunned for speaking about doctor suicide. After being invited by the AMA to deliver my TEDMED talk, I was disinvited shortly before the event because they were “uncomfortable” with physician suicide.
Ignoring doctor suicides leads to more doctor suicides. Thankfully, an Emmy-winning filmmaker is completing a documentary on physician suicide this year. To honor a doctor or medical student who has died by suicide in the film, submit name here. Contact filmmaker for a screening at your medical school or hospital.
If you are currently suffering and need help, contact Dr. Wible. Monthly physician retreats ongoing. Have you lost a medical student or doctor in your family to suicide? Request to join our Facebook support group here.
