Today we celebrate hardworking Americans, the 40-hour work week, and safe working conditions with parades, picnics, and a day to rest.
Except doctors. They’re still at work.
At the height of the Industrial Revolution, Americans worked 12-hour days every day in unsafe factory-like settings with lack of breaks, water, food, and fresh air. Immigrants were treated even worse.
Industrialized assembly-line medicine now forces doctors to work up to 168-hour shifts with lack of access to food, sleep, fresh air, and breaks. Do the math: a 168-hour week means no sleep all week.
America’s hospitals and clinics are filled with doctors who are not only subjected to poor physical conditions; they also suffer from mental health issues. Suicide is an occupational hazard in medicine where bullying, hazing, sleep deprivation is the norm.
Why should you care? Why not just enjoy your picnic with the family and sit back and watch the parade?
Because if you get in a car wreck on the way to the picnic you may be treated by a physician in the ICU who is constipated, hypoglycemic, and has not slept in 168 hours. Is this the person you want controlling your ventilator?
Is it legal to work 168 hours per week in America? Hospitals may impose 7-day shifts for doctors. Yes they can and do. This physician whistleblower tells all.
In 2011 doctors-in-training in America were supposed to be protected with 80-hour work week restrictions (maximum 24-hour shifts). However, these work-hour restrictions are unenforced. I hear from doctors in training all the time who are terrified to declare their actual number of work hours per week (120+) because of harassment and other repercussions that may end their careers. Oh and J-1 Visa (foreign doctors) can be fired and deported if they complain about unsafe working conditions.
The Accreditation Council for Graduate Medical Education (ACGME) imposed these more stringent resident work-hour restrictions in 2011, prompted, in part, by a 2009 Institute of Medicine (IOM) report and based on substantial evidence that sleep deprivation in medical residents increases the risk of medical errors for patients and serious harms for residents (including motor vehicle accidents, needle stick injuries, and depression). Now there are proposals to roll back these resident work-hour restrictions.
Are you a physician who has been injured by sleep deprivation and unsafe working conditions? Are you a patient who is outraged that your physician is working 24-hour shifts? Or 168-hour work weeks? The time to speak up is now. Sign this petition to demand safe working conditions for doctors then leave your comment on this blog.
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Pamela Wible, M.D., is an investigative reporter and whistleblower who advocates for physicians and patients injured by unsafe working condition in America’s hospitals and clinics. Have a story to share? Please contact Dr. Wible.
In August 2016 more than 600 people came together in 11 cities across America to stand in solidarity—and to say “no more” to medical student and physician suicide. Here are some of the speakers from the event in New York where Dr. Wible delivered the keynote address.
(Dr. Wible begins speaking at 18:20. Transcription below)
I’m Dr. Wible. I want to share some personal stories that I think will be really memorable after today. A lot of times if we just approach [physician suicide] from a supratentorial angle it doesn’t hold our attention and make things memorable into the future [the statistics can be overwhelming and frightening]. Just telling personal stories will help you access just a little bit of what my life is like right now. So I want to share a friend of mine with you, a friend of mine named Cheryl, a new friend that I just made a few months ago. Cheryl belongs to a club that nobody wants to be a member of. It’s an online support group that I started for parents who have lost their children to suicide in medical school and beyond (so residency as well). There are more people joining our group every week and month because we continue to lose (unfortunately) medical students to suicide. Cheryl lost her only child, Sean, just 3 months ago. For the longest time I couldn’t talk to her because she was crying and couldn’t even speak on the phone. Now we talk for an hour and a half or two hours at a time. She is an amazing woman and I want to just share, like many of the parents who have lost their children to suicide in medical school, she was a very attentive mother. She was very forthright about wanting to be on top of her child’s safety (wearing helmets on the bicycle, training wheels, seat belts etc.) She had no idea that when she sent her child to medical school that would potentially be one of the most dangerous environments for his health. She actually did not know any of this until she got a call from the police that was they day after Mother’s Day when Sean took his life.
Sean Petro at his Navy graduation. Courtesy: Cheryl Collier
A little bit about Sean: he’s just kind of a quirky, highly intelligent, compassionate guy who is really just a man of integrity and honor. He spent Mother’s Day with his mom and at the end of the day he stood in the doorway with his stepdad Russel and he thanked him for always being there for him and then he drove back to USC/Keck and late that evening or early the next morning he hung himself in his closet. And nobody saw this coming. There were no warning signs that anyone in his family could pick up (or his classmates). It just came completely out of the blue and this is what we hear and what I hear often. In the majority of these cases the person is doing fine, they are passing their tests, they’re doing well in medical school, they may even be at the top of their class and out of the blue they are gone.
It is very important for us to understand that there is a group of people who are aware of this problem and it is the medical profession. We, the medical profession, not necessarily each one of us but the medical profession itself has known about physicians being at high risk of suicide since 1858 in England when it was first reported. And 158 years later unfortunately we have not done enough to stop these deaths.
I can speak from personal experience. But first back to Cheryl, I made the point that she had no idea that physician and medical student suicide was such an issue. I had no idea. I never had a class in medical school about this. We didn’t talk about it. They never told us in residency and I went to a residency that was amazing, it was a family medicine residency that really focussed on behavioral health and mental health and nowhere in my residency experience do I recall ever hearing that I would have a high risk of suicide and depression myself. So when I was 36 years old and I developed suicidal thoughts as a physician that lasted for a 6 week period and were pretty intense, I thought I was the only one.
I thought I was the only one who cried my way through my first year of medical school. Everyone else looked like they were fine on the outside. I thought I was the only one who felt like my soul and heart were getting ripped out of my body during my medical training because nobody else seemed to talk about this. I thought I was the only one who felt like my only value to my profession was as a revenue-generating robot in an assembly-line clinic. Because everyone else was going to work and not complaining. It is a very lonely place to feel like you are the only one. It puts you into a spiral downward.
Come to find out I’m not the only one. As it turns out both the men I dated in medical school (once they became successful physicians) they both died by suicide. In my small town it turns out that we have lost 8 physicians to suicide. And nobody was talking about it. And I consider myself a pretty sharp person. I’m a very existential thinker and I have no fear of death. So it actually took me (remember I was 36 when I had my brush with suicide) it took me until I was 44 years old to realize that this was a crisis.
It was a day that I will never forget. It was October 28, 2012 at 2:00 pm and I was sitting at the memorial service for the third physician that we had lost to suicide [in 18 months] in my small town. I was sitting behind his 5 children and his wife. And I just started counting on my fingers the numbers of suspicious deaths and suicides among doctors that I knew about. In a very short period of time I had used all 10 fingers and then what was I going to start doing counting on my toes? I was overwhelmed with the thought. I felt like I had just fallen into this investigative reporting story and I needed to determine more about what was really going on and deliver this message to the world somehow and to solve this problem.
So immediately I did have to leave the memorial service early because I was teaching a business course for physicians that evening. When I arrived there I asked everyone, “How many of you have lost a colleague to suicide?” Every single hand was raised. Then I asked, “How many of you have considered suicide?” Every hand in the room was raised (including mine) except for one female nurse practitioner. I don’t need any more proof than that this is a huge problem. Even last week (just 5 days ago) we lost another bright medical student to suicide. That was on Wednesday. And I just learned today (on my way over here I got an email) there was an anesthesiologist who died that same day by suicide. So we lost 2 people last Wednesday. A lot of these [suicides] are covered up. I don’t know who they all are, but I do have a list of 320 plus cases that I have accumulated over the last couple of years of tracking these. It is just devastating.
I feel like these should be never events. We should not be losing medical students in medical school to suicide. We should not be losing our anesthesiologists who are dying of overdoses in call rooms. You know it is very interesting where people decide to die by suicide. They often do it at their medical school or at the hospital at the place where I feel like they have sustained the injury, where they are associating their pain.
We can change this. We can change the culture. We don’t have to continue this. It is up to you. I love that you are embracing each other as family. It takes proper leadership from your medical school. I’ve heard wonderful things about your social worker. That is just fabulous that you have so much support here. That must be you [pointing to the social worker]. Awesome!
And I really want to shout out to the DO schools. You are way ahead of allopathic medicine on this. You are amazing and you’ll notice that all of the vigils that were held at medical schools were at osteopathic medical schools. So I want to congratulate you for that. It is about walking the talk.
I don’t want any of you in here to have a classmate or your own parents receive a phone call from the police at midnight that something has happened to you. What will stop this? You have to look out for each other. You are brothers and sisters in medicine and it really is a family and I want to encourage you all to relate to each other like family. To be caring and loving and look out for one another. If you see someone who is isolating, please reach out. A lot of these students who die by suicide are living alone in apartments off campus and they are isolating. They are studying in isolation and nobody has seen them for a while. Please look after each other. Maybe have a buddy system.
It is just very sad for me to be on the phone with parents who have lost their only child in medical school and to hear them recognize that this has been a problem for over 100 years, that we have known about this and nothing has been done and that their child could have potentially been saved. So I want you to join with me and be vocal about this. There is no shame in talking about mental health.
I want to share a story that I have just received in an email from a woman named Michelle that really puts it into perspective what’s missing in most medical schools today. And by the way a lot of the things I am suggesting are cost free. Like be nice to each other, look after each other, go out for tea, talk to the social worker who is here and who is an amazing resource. I don’t know if you all have had any sessions with her. She is a resource and she is here for you and it would be wonderful for you to access the wonderful people who are around you who do want to help you. Please don’t feel alone. Here’s what happened to Michelle who wrote me this letter. She is a medical student and she writes, “I was less stressed in Afghanistan as a as a combat medic in a war zone.” That’s pretty intense. I’m just going to read a few sentences she wrote me:
“During the first few missions, I was scared for my life. After that, I became numb to that fear and just focused on making sure I was able to save my guys’ lives if we were attacked. The stress was incredible, but I had their back, and they had mine. In an unsafe country and a future filled with uncertainty, I felt secure because we supported each other.”
Isn’t that amazing? Even if you have gunfire, even if you have an incredible number of tests, even if you have all these things that are so stressful, if you have each other it makes it possible to move through the most painful events. Having each others’ back is so important.
One other thing I’ll share. When I realized physician suicide was a problem I started speaking and writing about it. Then the flood gates opened. You may notice that when you start volunteering your mental health struggles, you’ll have many people that come up to you and want to share their mental health struggles. It is the normal human dynamic. Once you find somebody who is talking about what you are afraid to talk about, it releases you to start speaking.
As soon as I started blogging about [physician suicide] I started getting letters and phone calls from physicians and medical students from not only the Unites States but from all over the world. I am basically running a suicide hotline out of my house. You guys I am here for you: 541-345-2437. Call me anytime. IdealMedicalcare.org contact me anytime. I return every single phone call, every single email. Some people reach out to me because they don’t have amazing social workers that they feel comfortable with or counselors at their school and they don’t want to reveal this to their dean. They trust me and so they call me because I’m out of state and they feel that I won’t tell their school on them and that sort of thing. So whomever you feel comfortable with, please reach out.
It’s been really interesting. I have received so many letters that I published a book calledPhysician Suicide Letters—Answered, that is full of letters from physicians who are still alive (like a print version of my physician suicide hotline). Only 6 of the people have died and they died before I interacted with their families and the letters are from their mothers and siblings. I brought several copies of this book free for you all to have. They are up on the piano. I brought 25 copies. So if this is something that you feel like would help you, please take a free copy when we are done. What is interesting about this book is that when it came out it was banned by an anesthesia department at a prestigious east coast hospital, and they had just had a suicide of an anesthesiologist. Why do I bring all of this up? First of all when you ban a book it just increases readership so it kind of backfired. Censorship is not a solution for a medical problem. If we hid the bodied of people with Ebola or Zika, we would never solve it. So it is very important to be able to speak about this.
In closing I just want to share 3 things that have not been working so well and 3 things that I think will work well.
1) Censorship, banning books, and using euphemisms are not going to help us solve this. If we say “my classmate suddenly passed this weekend” and we do not say the word suicide out loud it makes it very hard to solve a problem if we won’t even say it out loud. I want to encourage you to talk about suicide like we talk about high blood pressure or diabetes or anything else. It is a medical condition that we can solve if we are not afraid to say it out loud.
2) Zero tolerance for bullying and hazing and abuse at our medical schools, our clinics, and our hospitals. The bullying, hazing, and abuse that goes on in certain medical schools and residency programs (yours seems like a really great place, but I’m sure you’ve heard from other people who have been bullied and abused) that is not a great way to stabilize your medical students’ mental health. Right? We are not allowed to bully kids in elementary schools and hazing has been outlawed in fraternities. Certainly we should have a zero tolerance for bullying and hazing and abuse at our medical schools, our clinics, and our hospitals.
3) Stop labeling victims with “burnout.”Don’t blame, shame the victims. This is a dangerous and slippery slope. Sometimes we use a word that I actually can not stand—burnout—to describe people who are having trouble, who can’t keep up. Burnout is a victim blaming and shaming term that makes the individual feel defective when actually it is a system’s issue often that is causing this. Maybe they are having sexual harassment at work or bullying or they haven’t slept for 72 hours. These sorts of things are very destabilizing. Recommending that victims just take a deep breath and do yoga is kind of hard to do if you are in a work environment that is inhumane. I want to draw your attention to the idea that we not label and blame the victim because they will start to feel defective. When you feel defective like you can’t keep up you start to feel like maybe the world would be better without me. I want to encourage you to embrace each other and not to label each other because you want to empower one another not destabilize someone with a term that they makes the individual feel different. Lift them up with you.
In summary, #1 Tell the truth. We don;t have to censor or ban anything, Just tell the truth. #2 Please a zero tolerance for bullying, hazing, and abuse in our medical schools, clinics, and hospitals. If you see a colleague who has been pimped to the point of crying, who has had a scalpel thrown out them in the OR, please stand up for your colleagues. Do not allow other people to be injured during the training process. #3 Please do not label people with terms that are not real helpful, like burnout. It might make them feel worse.
My final statement is that we really need to have awareness and action. That is what is important right now. Physician suicide is a public health crisis because more than one million Americans lose their doctors to suicide each year. It is a public health crisis.
If physician suicide were an infectious disease it would be on the evening news every night and we would have a body count.
People ask me all the time, “How many people are actually dying by suicide?” We don’t exactly know. We are kind of probably underestimating it when we say 400 doctors die each year (and that is not even counting medical students). So I would like us to have a body count like we do with every other disease and we should be talking about this on the news, with each other. there is no shame in talking about this and certainly parents like Cheryl and Michele (that you will see in this Do No Harm movie trailer) deserve to know. These parents had no idea their children were at high risk of suicide. This is informed consent. Medical students should know before they enter medical school that this is a risk. Parents should know because we would interact with each other differently and we would be more likely to save lives. So thank you very much for standing with me on this.
Join the more than 600 people who stood together in solidarity in 11 cities to say “no more.”
Pamela Wible, M.D., is a family physician who has dedicated her life to ending the medical student and physician suicide crisis. Need help? Please contact Dr. Wible. Video credits Jaryd Frankel, TouroCOM. Photo credits Cheryl Collier, Elnaz Mahbub.
Let me start off by telling you that I am a warrior, a protector, and a healer. I am an Army Veteran. I’ve worked as an EMT, completed a bachelors degree and 2 years of medical school, plus I’m raising a family. I’ve achieved amazing things, but I have never been defeated like I’ve been over these past few years.
Honestly, I was less stressed in Afghanistan. Medical school is worse than my deployment experience.
It’s not easy to share this so bear with me. When I finished undergrad, I decided to be a doctor. So off I went. Completed my sciences at a local community college, volunteered at hospitals, and worked as an EMT to beef up my resume for med school applications. I got all my applications in then boom, I was deployed to Afghanistan. I was recruited to deploy with Military Police as a combat medic. During the first few missions I was scared for my life. After that, I became numb to that fear and just focused on making sure I was able to save my guys’ lives if we were attacked. The stress was incredible, but I had their back and they had mine. In an unsafe country and a future filled with uncertainty I felt secure because we supported each other.
Once I was home I started medical school and I was SO excited! I was finally living out my dream. I’ve always been able to make friends with no problem and I’ve always done well in school, so I was good to go. I am not the traditional medical student. I’m 30 with a family and it turns out my life is very different than my peers, so I isolated myself. The course material was incredibly difficult for me. I struggled. I barely passed some exams and always wondered if I would make it to the next course. I worked so hard to do well, but couldn’t hack it. I was just in awe at how much more intelligent everyone else around me was.
This was it, I had put all of my eggs in this basket and my basket was falling apart. I cried almost every single day. My family was there to support me but no one could understand what I was going through. Or so I thought. I never really opened up to other medical students because they seemed so smart and were doing well. It was bad. Here’s the worst part: I thought it would be easier to die than continue living like this. I started to see a therapist and we identified that I was persistently depressed and passively SUICIDAL.
I know I’m a strong, intelligent woman. But medical school broke me down.
I’m in my 3rd year now and have realized what is most important to me: self care, my family, and close friends. I can’t help others at my own expense anymore. I get that I’m learning information that will save peoples lives and I need to take it seriously. Believe me, I do. Yeah, I get nervous that I will be pimped and not know the answer to a question or do bad on a test again. But I am DONE letting that stop me from living a life I love. Regardless of my transcript and test scores, I will be an amazing doctor! I already make a difference in people’s lives and will continue to do so.
I hope other med students can learn something from my story. You are all amazing! Please take care of yourselves.
Pamela, thank you for standing up for us. It means the world.
You’ll never guess what happened to me today. Hours after the National Day of Solidarity to Prevent Physician Suicide volunteer webpage went live, I received an email stating that I am officially terminated from my psychiatry residency program. On this webpage, I spoke about the fact that I had become interested in this event during my struggle to get the medical care I needed throughout my residency for my cancer diagnosis. I heard that people from my department were reading it today. Some stated I was very brave, others, well, others do not appreciate such outspokenness. I was even told by some not to participate in the Solidarity event. What are they afraid of? I speak out because I dream of a future where medical students and residents can live without fear of bullying, harassment, and retaliation. I want doctors to be able to care for themselves as well as others. I documented the obstacles I faced in residency so that I could propose solutions to incorporate into a physician wellness program. I hope that chronically ill residents, as well as residents who need routine care such as therapy, could use this program in the future. In describing the difficulties I faced, I quoted the words spoken to me by my attending physician on the day I was diagnosed with cancer, “you need to choose whether you are a doctor or a patient.”
My program had been punishing me and accusing me of being “unprofessional” for attending appointments despite my informing them in advance and providing doctor’s notes. On the webpage launched today, I stated it was also very difficult for us to get mental health treatment. During my research into why this was the case, I found many examples of other residents who have experienced negative consequences after revealing their need for mental health services. It upset me that stigma is so prevalent in this field. Everyone needs help sometimes and doctors can get sick too. I am not sure how many people are aware of the obstacles physicians face when striving to care for themselves physically and mentally. Once the issue is recognized, we can do something to stop it.
Standing up to this is going to be extremely tough. When I began standing up for my basic human right to lifesaving medical care, I was repeatedly retaliated against. This retaliation occurred even after I pointed out the fact that my doctor stated had I not received the treatment they punished me for, I would not likely be alive today. That fact did not appear to register with my superiors. I then went to the dean’s office, then to the ombudsman, then to the institution’s president. It was a game of hot potato. It was a problem passed around the institution so fast that no one held on long enough to burn their hands. It was as if they thought that, if they ignored me, I would simply go away. I decided to go outside of the institution. That surely got their attention as not even a month after going to the government I received an email from my institution stating there was a vote for my termination. At least they stopped ignoring me.
I had documentation of what I had been through since my diagnosis and proof that my performance was at or above average. Despite major surgery, tubes, drains, fainting, constant vomiting, and panic attacks I was still able to be a good doctor. I always put the safety of my patients first and I don’t think there is anyone in this world who can contest that, not even those who voted for my termination. I was BOTH a doctor and a patient and despite pressure from above I received excellent evaluations from my attendings. So how on earth did they have justification to fire me? I had hoped that the dean’s office would look at the facts. Apparently, they didn’t. They chose to officially terminate my employment right after the National Day of Solidarity to Prevent Physician Suicide volunteer webpage went live. I am not sure what to do at this point. Next week I am scheduled to have an MRI and I do not know if I will have a paycheck or even health insurance to cover it. I know you have helped so many other physicians and you are truly an inspiration to me. I can’t wait to meet you on August 20th. I hope all that I have been through will jumpstart a change in the current medical culture. I want future physicians to not be forced to choose between being a doctor or a patient.
Thank you so much,
Stephanie
Outraged that a hospital would fire a doctor for having cancer? Appalled that a hospital would fire a psychiatric resident for helping suicidal physicians?Show your support. Stand with Stephanie on August 20th.
Please support Stephanie by attending our Solidarity Vigils across America on Saturday, August 20, 2016. Find a Vigil near you on this map. Come meet Stephanie at the Washington DC Vigil or attend one of the other events in Philadelphia, Chicago, Austin, Cleveland, Kansas City, St. Louis, Athens (OH), Dublin(OH), Harrogate (TN) on August 20th. Middletown (NY) Vigil will be on August 22. Dr. Wible will be speaking at the DC and NY Vigils. Thank you for caring about the people who care for you!
I just received this letter from a physician in the Unites States of America:
Like thousands of medical school graduates each year, I did not get a residency [a residency is an additional 3+ years of medical training after 4 years of medical school and is required to get a medical license]. We might as well be lepers…I did manage to get a very part-time job in the IT department at the hospital for $10 per hour.
Funny thing is that we were launching this automated refill protocol for docs so that they would be less inundated with refill emails…the IT department thought it wasn’t sufficient to have an MA or LPN make such a decision…they said at least an RN…no one wants to do it…they are all too busy…I offered to do it and they said I don’t have a license so it will be the MA that decides whether or not to refill a script. Is there something wrong with this picture or is it just me…
Anyway I have to go back to the cafe and make my living waitressing…can’t draw blood, can’t take BP or pulse nor weight or height yet the MA can and little me with an MD and a masters from an Ivy League school is not qualified without an MA license. Not enough graduate medical education spots despite a complete physician shortage…
I have tried to go abroad and be a doc but they won’t take me. I gave up until I started working in a teaching hospital as an IT intern and I realize every second of the day that these residents are no better than me…anyway even though I would do a better job than an RN, MA or LPN…one of those 3 will be making the refill decisions for our hospital and not me…my MD has to mean something right? Nope …truth is…an MA will get this huge responsibility…bc one needs a license to do anything…and I have no license…my almost illiterate cousin is an LPN in Texas and makes 4 times what I make a year…she knows nothing and even worse she could care less to know anything more than what she absolutely must know…but she will care for patients for the next 40 years and I won’t be able to take a pulse …
My issue is that I know I am better than having to mooch off the state as I am on Medicaid and I qualify for food stamps…mostly bc my loans are so high that if my dad didn’t show mercy on me I would be homeless.
Fact: 35,476 medical school graduates applied for the 30,750 residency positions in 2016. That’s 4,726 more doctors this year who are not permitted to take a blood pressure.
This is a fabulous video that summarizes why all of this is happened:
https://vimeo.com/77727683
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Pamela Wible, M.D., is a family physician and author of Physician Suicide Letters—Answered. She advocates for humane medical education free from bullying, hazing, and abuse in which all medical students are valued.
