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Sep 23 2020

Situation critical: 1 in 4 depressed physicians admit they have considered suicide

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It is widely understood that medical professionals are at increased risk for suicide relative to other professions due to the unique stressors of working in healthcare. The Medscape Physician Burnout & Suicide Report 2020 found that nearly one in four physicians with depression surveyed said they had thought about ending their lives, and a little more than one percent had attempted it. About 16 percent of all physicians surveyed reported that they are depressed and more than 40 percent said they have symptoms of burnout, which overlaps with depression in many respects. Still more sobering: More than 60 percent of those who contemplated suicide indicated that they had no plans to seek help and had not sought professional care in the past.

The reasons for this reluctance to get mental health care are varied. According to the Medscape report, about half of respondents either felt their situation was not serious enough to need outside help, or thought they could handle their problems without professional help. Many also indicated they are just too busy to take care of their own mental health issues. Tellingly, more than 20 percent of those who did not seek help said they did not want to risk disclosure of their problems with burnout and/or depression to an employer, medical regulatory board or other authority.

The North Carolina Medical Board recognizes that it is essential for licensees to have the freedom to seek mental health care without fear. For this reason NCMB made changes, starting in January 2017, that eliminate the need to disclose physical or mental health issues or current treatment status to the Board. This is no longer asked as part of the annual license renewal (effective January 2017) or on the initial application for licensure (effective September 2018). Instead, NCMB includes a statement in both the license application and renewal questionnaires communicating its expectation that medical professionals address any personal physical or mental health problems. NCMB hopes that removing this potential barrier to treatment will empower more licensees who need help to pursue any needed mental health treatment without concern for their licensure.

 Comments on this article:

This announcement caught my attention so I reviewed the survey! I understood it to say that 1 in 4 of the DEPRESSED physicians (not all physicians) have considered suicide. Still very disturbing and we must ask for help.

By Amanda Austin on Sep 23, 2020 at 10:07pm

Note the high frustration quotient with second time trying to submit this comment. Perhaps there is another explanation for why there are no comments posted so far?

The obvious explanation for why 60 percent of the 1 in 4 physicians who have considered suicide do not seek mental health treatment is that our training and experience have taught us the futility of such effort. We suffer moral despair from the conflicted positions we are placed in daily. Exercising our judgement and advocating for patients in this cockeyed, greed-driven medical system puts us and our families in peril of losing our livelihood. We have given up
leisure time, learning activities, and family time to carry the burdens of making profits for commercial and non-profit enterprises. Suggesting that we lack self-care adds insult to injury. We recognize there is no medication and no wise counselor on earth who can save us. Many of us can’t even find adequate mental health treatment beyond our own expertise for our patients. Ask the millionaire who got NC Medicaid in the black by taking back payments from non-profit hospices for real care delivered to real people suffering terminal diseases why doctors might feel like they would rather be dead.

By Rebecca J Love, MD on Sep 23, 2020 at 11:41pm

Thanks very much to Dr. Austin - the headline and article have been amended to clarify this important point. It does appear that things are worsening for clinicians struggling with depression. Notably, the 2019 Medscape report found that 14 percent of depressed physicians indicated they had contemplated suicide; As noted in the article, in 2020 that had climbed to nearly 25 percent. A 10-point jump in a year’s time is very concerning, although perhaps not surprising given the unprecedented challenges presented by the ongoing coronavirus pandemic.

By Jean Fisher Brinkley on Sep 24, 2020 at 9:08am

My apologies for the frustration Dr. Love - comments are moderated and have to be approved by an administrator. That’s why they do not show up immediately. Thank you very much for taking the time to comment, and for sharing your perspective.

By Jean Fisher Brinkley on Sep 24, 2020 at 9:10am

If the NCMB is concerned about the mental health of physicians in the state, there are some concrete steps they could take to make a physician’s life easier.
1.  Change the application/renewal questions.
It seems apparent when I renew my license every year, that the process was created by a prosecuting attorney. 
a.  It is a valuable first step that the NCMB does not demand self-reporting when one seeks mental healthcare but the renewal process still demands that a licensee report excessive use of alcohol, controlled substances, and drugs.  The NCMB should eliminate this question.  Does one lose their right not to self-incriminate when they apply for a medical license?
b.  The renewal app asks if the physician is aware of any complaints, investigations, etc.  It should be the burden of the accuser to report these items to the board, not the physician.
c.  Denial or refusal of a malpractice company to cover a physician is a matter between the physician and the insurance company.  It is not the business of the NCMB.  This is a very curious question because the NCMB does not require that physicians have malpractice insurance.
d.  Four times in the renewal process the renewal app uses the phrase “have you ever”.  I think that everyone can agree this is an overly broad starting point.  Why not ask, “In the last 3 (or 5 or 7 or 10) years.  At what point are we willing to forgive and forget past issues.  Next the application goes on to ask about 22 different possible “actions” taken by a possible 15 Boards, Courts or Agencies.  REALLY.
Again, the physician should not have to self-incriminate.  If the issues are worrisome enough it should be the Board’s job to seek out, i.e. a criminal background check, or that Board/Agencies duty to report to the NCMB.
e. Malpractice reporting.  How long must a physician wear a “Scarlet M” on themselves for prior acts of malpractice.  I submit that after a few years the record of prior acts should be cleared.  I have been involved in 2 lawsuits in my almost 30 years.  Do I really need to be reminded when I renew every year of my failings from 1993?  Forgiveness is a big part of mental health.

2.  Eliminate the requirement by the NC insurance regulators, that health insurers credential doctors in their networks.  The sole authority on whether a physician is qualified to practice medicine in the state of NC should be the NCMB.  As the system currently exists, a physician could be licensed by the state to practice medicine but not be “good enough” to work for BCBS patients.  This seems to establish a double standard of care.  This dual credentialling has also given rise to a whole credentialling industry, CAQH.  CAQH demands a re-attestation every 3 month.  This requirement weighs heavy on the mental health of a practitioner.
I have been licensed in North Carolina since 1991 and I am getting ready for my 2021 renewal.  I am licensed in 3 other states and I feel the renewal process in NC is the hardest.  The NCMB can fulfill its job of protecting patients and also help make the life of the physician less a burden.

By Clyde Price M.D. on Sep 26, 2020 at 2:01pm

Dr. Price - Thank you for reading the article and for taking the time to share your perspective.

By Jean Fisher Brinkley on Sep 28, 2020 at 2:34pm
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