It's been nearly 2 years since the tragedy, but Dr. Lorna Breen’s death still reverberates. A dedicated physician who ran the ED at New York-Presbyterian Allen Hospital in Upper Manhattan, Dr. Breen was in the thick of the pandemic’s dreadful early days, with intubated patients packing her hospital’s hallways and staffing scarce.
The experience proved to be too much. She took her own life in April 2020, becoming one among many tragic physician suicides prompted by the COVID-19 pandemic.
Breen’s story is a reminder of the humanity behind the statistics, underscoring the severity of Medscape’s Physician Suicide Report 2022. Undoing COVID-19’s psychological damage to clinicians will require concerted efforts that eliminate stigma and provide support for this generation of physicians and those that follow, experts say.
The Medscape survey, which included more than 13,000 physicians from 29 specialties, found that nearly one-fifth of doctors reported feeling depressed. Among that group, 24% said they had clinical depression, which constituted severe depression that didn’t stem from a “normal grief event.” Among the same cohort, 64% said they had colloquial depression, such as “feeling down, blue, sad.”
“I have little joy in performing the job that I believe I was born to do,” one EM physician wrote. “Now, not only am I tired of work—I’m tired of life.”
A peer-reviewed editorial, published in Cureus, offered this stark context: The authors noted suicidal ideation among doctors is nearly double that of the general population: 7.2% compared with 4%. Moreover, doctors have easier access to potentially fatal drugs, such as antipsychotics, barbiturates, and/or benzodiazepines.
The survey data also revealed that certain specialties may be at an increased risk of suicide. Those with the most reports of suicidal thoughts included pathology (13%), general surgery (12%), oncology (12%), infectious diseases (11%), and emergency medicine (11%).
Medscape asked respondents whether they had discussed their thoughts of suicide with anyone, and with whom. They were presented with options including a counselor, family, friends, or colleagues. A surprising number of doctors—34% of Millennials, 28% of Gen Xers, and 44% of Baby Boomers—said “none of the above,” indicating they spoke to someone other, or kept their feelings to themselves.
When asked why they elected to keep their experiences private, some doctors said they feared career implications.
“I’m afraid that if I spoke to a therapist, I’d have to report receiving psychiatric treatment to credentialing or licensing boards,” wrote one.
“Physicians cannot seek help for these issues because if we do that, these temporary issues will follow us for the rest of our careers,” wrote another.
Much of this reluctance also stems from stigma, according to Perry Lin, MD. Lin is an assistant clinical professor at Ohio University Heritage College of Osteopathic Medicine and national co-chair of the physician suicide awareness committee for the American Association of Suicidology.
“There is a longstanding expectation that physicians be perfect. That anything short of perfection makes for a worse doctor,” said Lin, in an interview with MDLinx. “Many in the medical community are pushing for a fundamental shift in this paradigm, instead viewing seeking mental health care as a sign of strength.”
That paradigm shift must also include a regulatory shift, Lin said, noting that “most states do not follow FSMB recommendations about physician mental health,” as indicated by a 2018 research letter published in JAMA.
“At local levels, many credentialing committees at hospitals ask even more archaic and in-depth questions about help-seeking behavior, making the barrier to help-seeking even higher,” Lin said.
Addressing the issue may require a comprehensive solution that includes policy and labor reform.
According to the AMA, much of the onus of physician suicide prevention falls on employing organizations, which must create “a supportive atmosphere in the workplace, which can be instrumental in addressing physician distress.” This includes confidential internal and external resources.
Authors of the editorial in Cureus also called for:
Lin said that doctors must also advocate for each other locally, ensuring that employers offer adequate support, including dedicated physician support systems, such as gatekeeper training—a peer-to-peer support system for mental health and suicide prevention. Lin also recommended advocacy for changes to local credentialing.
Doctors can also assist each other simply by talking, according to the Medscape report. While there is no uniform approach, it’s beneficial to thank a colleague for sharing their thoughts and feelings, which requires courage. Aim to keep the conversation going and ask how you can help. Leave the door open by saying that you’re available to talk again, and remind them that friends and family also likely will be supportive.
Doctors experiencing depression or thoughts of suicide also have the following support options:
Physician Support Line: A free, confidential psychiatrist-staffed support line for doctors and medical students. 1 (888) 409-0141.
National Suicide Prevention Lifeline: Open 24/7 and offering free, confidential support for all—doctors included—and their loved ones. 1 (800) 273-8255.
American Foundation for Suicide Prevention (AFSP): AFSP offers support for those having thoughts of suicide, people who have lost someone to suicide, those who have concerns about someone’s mental health, and people who have survived suicide attempts. 1 (800) 273-8255 or text TALK to 741741.
PeerRxMed: A free support service that partners doctors with peers to help navigate burnout, resignation, isolation, and distress.
While these resources and efforts may be beneficial in isolation, a concerted effort may be more potent.
In February 2022, the US Senate approved the Dr. Lorna Breen Health Care Provider Protection Act, sending it to the House for a vote. The bill establishes grants to develop evidence-based burnout-reduction strategies, creates a national mental health campaign for health professionals, and sets aside funds for education and peer support.
After Breen’s years of healing others in person as an MD, now her legacy may continue to do the same.