The Alarming Rise of Physician Suicide

The recent suicide of another successful orthopedic surgeon highlights the issue of high suicide rates among physicians. Thomas Fishler, M.D. of Sonoran Orthopaedic Trauma Surgeons in Scottsdale, Arizona, was like many other doctors who have completed suicide in that he showed no warning signs to his medical colleagues. A fellow orthopedic doctor commented upon hearing of his death, “I would never have guessed in a million years that Tom would take his life.”

Orthopedic trauma surgeon and physician coach Jeffrey Smith, M.D. blogged about his colleague, “Tom and I did not talk much about emotions. We had talked more about the challenges of practice and integrating efficiencies in practice, and his strengths in this area were why I had reached out to Tom to be on the panel for the annual meeting breakout session. I will share those with others next week. Tom was a great guy and a great surgeon. He was very caring, and I don’t think he would have intended this to hurt his patients, colleagues, mother or daughter.”

Breaking the Silence

Mental health issues remain stigmatized in a professional community where objectivity is expected and fears of losing licensure often prevent seeking help. Doctors may feel that taking time off or revealing depressive symptoms are not options.

Edward M. Ellison, M.D., executive medical director/chairman of the board of Southern California Permanente Medical Group and chairman of the board and CEO of The Southeast Permanente Medical Group, wrote in a recent editorial that “beyond the anxiety, depression, insomnia, emotional and physical exhaustion, and loss of cognitive focus associated with physical burnout, an estimated 300-400 U.S. physicians take their lives every year.” Dr. Ellison referenced suicide rates among doctors is 40% higher for men and 130% higher for women than the suicide rates among the general population.

Another advocate around this issue, Pamela Wible, M.D., gave a keynote at the 19th Annual Chicago Orthopaedic Symposium. She presented research “discovered from investigating more than 1000 doctor suicides—and specifically the suicides of 33 orthopedic surgeons.” Dr. Wible also discussed the lack of warning signs due to physician fears of professional ramifications.

A Case for Burnout Prevention

The World Health Organization’s (WHO) recently classified workplace burnout as an International Classification of Diseases diagnostic code. WHO is currently developing evidence-based practices to promote mental wellness in the workplace.

In a recent piece in OTW, “Physician Burnout: Its Costs and Treatment,” we explored a research study on the costs of physician burnout. “Estimating the Attributable Cost of Physician Burnout in the United States” was published in the Annals of Internal Medicine. In the study, researchers from the National University of Singapore, Stanford University School of Medicine, American Medical Association, Atrius Health, Mayo Clinic, University of North Carolina Physicians Network, and Harvard Business School estimated that physician burnout costs the United States healthcare industry roughly $4.6 billion annually.

The researchers suggested benefits to physician health, patient care outcomes as well as the fiscal impact on the healthcare industry through implementing wellness programs to reduce burnout.

Lead author Shasha Han, M.S., of the National University of Singapore and co-authors referenced a 2018 study in which 10 U.S. CEOs of prominent healthcare organization called physician burnout a public health crisis and called for a larger discussion on solutions. Han and colleagues suggest that highlighting the financial impacts of physician burnout may lead healthcare organizations to be more willing to invest in wellness policies aimed at burnout prevention.

Interview With James Robert Ficke, M.D.

OTW spoke with Colonel James Ficke, M.D., Professor of Orthopaedic Surgery at the Johns Hopkins School of Medicine, Director of the Department of Orthopaedic Surgery and orthopaedist-in-chief of The Johns Hopkins Hospital. Dr. Ficke is a renowned expert on complex foot and ankle treatment, lower extremity trauma and amputee treatment. He has also taken a special interest in the growing trend toward physician suicide.

When asked about physician burnout, Dr. Ficke emphasized, “It is less successfully treated but it can be prevented.” For the past several years, Ficke has lectured young and developing physicians on avoiding physician burnout.

He said, “We have a great profession. We love to take care of patients. We can see the impact of our profession. We can relate to and connect with our patients. And so, there is a tremendous reward in the field. We are well compensated. We generally can control our destinies. These are all job satisfiers.”

Ficke also explained that, simultaneously, “It is stressful to think about the changing world of medicine, especially in orthopedics. Electronic health records, higher volumes, things that we do not always have control of. Those impact us.”

Ficke was formerly chairman of the Department of Orthopaedics and Rehabilitation at the San Antonio Military Medical Center and also served the U.S. Army Surgeon General as the senior advisor on policy and personnel for orthopaedics and extremity injuries. Additionally, during deployment as deputy commander of clinical services he was the senior orthopedic surgeon, treating more than 600 U.S. soldiers and Iraqi patients.

Ficke reported that in the last 20 years, 33 orthopedic surgeons have committed suicide. The majority of suicides were completed in the past 10 years.

Ficke noted that red flags may include partners, either surgical or life partners, noticing behavioral changes. In addition, data collection research has indicated that increased patient complaints are an indicator of burnout risk. A marked increase in patient complaints is correlated with likelihood that burnout is occurring for the treating physician.

National Suicide Prevention Awareness

A dialogue around the reality of physician burnout and suicide is timely. September was National Suicide Prevention Month. Mental health organizations, survivors and suicide prevention advocates worldwide unite to educate and raise awareness all month.

The National Alliance on Mental Illness (NAMI) has suggested promoting awareness by using #SuicidePrevention or #StigmaFree.

NAMI stated, “September is National Suicide Prevention Awareness Month—a time to share resources and stories in an effort to shed light on this highly taboo and stigmatized topic. We use this month to reach out to those affected by suicide, raise awareness and connect individuals with suicidal ideation to treatment services. It is also important to ensure that individuals, friends and families have access to the resources they need to discuss suicide prevention. NAMI is here to help.”

Dr. Ficke agreed that the idea that an open dialogue is critical. “At a grassroots level, the prevention is something that we all engage in and I think it starts by talking about it.”

Crisis Resources

The National Alliance on Mental Illness also suggests the following crisis tools:

• If you or someone you know is in an emergency, call 911 immediately.
• If you are in crisis or are experiencing difficult or suicidal thoughts, call the National Suicide Hotline at 1-800-273 TALK (8255)
• If you’re uncomfortable talking on the phone, you can also text NAMI to 741-741 to be connected to a free, trained crisis counselor on the Crisis Text Line.