Suicide is the act of an individual ending their life. It is generally caused by the convergence of multiple factors, the most significant of which is untreated or end-stage psychiatric illness. As a practicing psychiatrist who has been involved in the Pennsylvania Physicians Health Program for more than a decade, I believe we need to do better to stem the increasing numbers of physician suicides. A better understanding of and effort to dispel the stigma associated with psychiatric illness can go a long way toward this goal.
In 2023, more than 50,000 individuals were lost to suicide in the United States. An estimated 1.7 million people attempted suicide in the same year, and according to the Centers for Disease Control and Prevention (CDC), the life of one individual is lost to suicide every 11 minutes in the United States. It is estimated that close to 500 physicians die by suicide every year—that’s more than one physician per day, based on 2023 estimates. This statistic from the American Medical Association includes practicing physicians, resident physicians, and medical students. Alarmingly, in 2023, suicide may have been the leading cause of death for physicians ages 24–34, equaling or surpassing accidents in this young age group. The suicide rates among male physicians in the United States are more than two times higher than those of the general male population. Among female physicians, the rates are even more pronounced—three times greater than the general female population. By these estimates, the U.S. loses the equivalent of one large medical school class to suicide every year. This is a worldwide phenomenon, as studies from many countries show an increased prevalence of suicide and suicidal ideation among physicians. A recent study from Korea, validated by research from other countries, shows an increased risk for suicide on New Year’s Day around the world.
Physicians and medical professionals are apprehensive about discussing the topic of physician suicide because of the stigma associated with suicide and psychiatric illnesses. This stigma is intensely magnified among physicians. Nonetheless, the physician community, in general, seems to have heeded the advice it offers patients about preventable causes of morbidity and mortality, such as smoking, diet, and drug use. However, physicians have shied away from accepting that psychiatric illness may play a role in their lives, placing them at significant risk for morbidity and mortality. Furthermore, because of their greater knowledge and better access to lethal means, physicians have higher rates of suicide completion than the general population. Physicians successfully complete suicide three to four times more often than the general U.S. population. Similarly, male and female physicians’ suicide completion rates are equal, making female physicians’ rates significantly higher than those of the general U.S. female population.
Suicide and suicidal ideation are closely associated with psychiatric illness, most notably mood disorders, anxiety, and substance use disorders. The Suicide Prevention Resource Center at the American Psychiatric Association has defined warning signs, risk factors, and protective factors for suicide. Unfortunately, for physicians, warning signs are often muted. Because of the stigma, medical professionals rarely talk about their own death or dying. Medical schools have initiated surveys among their students asking about suicidal ideation. It is seen as a sign of weakness for a medical professional to make comments about being hopeless, helpless, or worthless, or to express reasons for not wanting to live. Increased alcohol and drug use are usually hidden, and workload demands can mask withdrawal from friends, family, and the community. Physicians have been increasingly voicing concerns about their situation in health care systems, feeling trapped and experiencing burnout. These are all warning signs, and we have not been listening. If we don’t act soon, things will escalate further.
As with the general population, physicians need to recognize their elevated risk factors for suicide, including access to lethal means, frequent losses, bullying by health care administrators, and ongoing symptoms of psychiatric illness that they attempt to mask or hide. Fortunately, physicians possess significant protective factors, which they often fail to mobilize. These include increased access to health care systems and effective psychiatric treatment. Their strong connections to family, community, and patients propel their motivation to continue caring for others. Physicians also have a tenacity for problem-solving, which may protect them from completing suicide.
Tackling the problem of physician suicide requires interventions such as screening, early identification, outreach, and the implementation of effective treatments. All of these interventions must be delivered in a physician-friendly, non-punitive fashion to address the concerns of the physician community about the stigma associated with psychiatric illness and suicide. Simple screening interventions in medical schools and residency programs have increased the identification of depressive symptoms and suicidal thoughts, which surveys indicate are present in as many as 30 percent of participants. Studies show that simple interventions, such as web-based cognitive behavioral therapy, can decrease suicidal ideation in the physician community by nearly 50 percent. Additionally, addressing drivers of burnout—such as high workload, work inefficiency, lack of autonomy and meaning in work, and work-home conflicts—can significantly reduce the rate of psychiatric illness exacerbation and the evolution of suicidal ideation.
It is also important to address psychiatric conditions among physicians in an open, non-punitive way. Stigma and fear of professional repercussions often deter physicians from seeking help. There are many resources available for physicians, such as physician health programs through the American Medical Association and state medical societies. Most recently, the Suicide and Crisis Lifeline can be reached by calling or texting 988 or chatting online at 988lifeline.org. As someone involved in the Suicide Prevention Resource Center for the American Psychiatric Association, I encourage physicians experiencing psychiatric illness or fear of escalation to suicidal ideation to reach out. Resources are available in a nonjudgmental and non-punitive manner through the American Psychiatric Association, the American Medical Association, and state medical societies. Help is available.
Muhamad Aly Rifai is a practicing internist and psychiatrist in the Greater Lehigh Valley, Pennsylvania. He is the CEO, chief psychiatrist and internist of Blue Mountain Psychiatry. He holds the Lehigh Valley Endowed Chair of Addiction Medicine. Dr. Rifai is board-certified in internal medicine, psychiatry, addiction medicine, and psychosomatic medicine. He is a fellow of the American College of Physicians, the Academy of Psychosomatic Medicine, and the American Psychiatric Association. He is the former president of the Lehigh Valley Psychiatric Society.
He can be reached on LinkedIn, Facebook, X @muhamadalyrifai, YouTube, and his website. You can also read his Wikipedia entry and publications.
