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Psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article “Physician suicide prevention: a call to action.” Muhamad opens with the tragic losses of Dr. Nolan R. Williams and Dr. Charles Szyman to illustrate the devastating toll of the profession on even its most accomplished members. He examines the alarming data showing suicide as a leading cause of death among medical residents and outlines specific, actionable steps for trainees, program directors, and hospital executives to build safety nets rather than barriers. The conversation emphasizes the importance of using neutral language like “died by suicide,” removing intrusive credentialing questions, and creating a culture where seeking help is viewed as an asset rather than a liability. Join us to learn how we can protect the people who dedicate their lives to healing others.

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Transcript:

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Muhamad Aly Rifai, psychiatrist, internist, and addiction medicine specialist. Today’s KevinMD article is “Physician suicide prevention: a call to action.” Muhamad, welcome back to the show.

Muhamad Aly Rifai: Thank you very much for having me to talk about this important and ever-timely topic about physician suicide prevention and how we can help our colleagues during tough times.

Kevin Pho: All right, so for those who did not get a chance to read your recent article, what is this one about?

Muhamad Aly Rifai: Last year, I called attention to this phenomenon of physician suicide, which is a silent epidemic. I discussed how suicide was affecting a large number of vulnerable physicians and the fact that we were losing the equivalent of one medical school class every year. That is close to 500 physician suicides a year. This was last year in December 2024.

We are here again in December 2025. In October, we lost a pillar of the psychiatric community: psychiatrist Nolan Williams, who was a major researcher on depression, anxiety, and transcranial magnetic stimulation.

We lost him. His life ended with suicide. It is quite unfortunate, and he was missed by a lot of his colleagues. That actually highlighted how this silent epidemic is affecting our fellow physicians. It prompted me to write about this again because it does not seem that the epidemic is remitting in any way. I wanted to call attention to that because depression and anxiety are affecting our colleagues out there. We are not seeing that this thing is backing away, and we are losing more and more physicians.

Kevin Pho: Is the rate of physician suicide higher as compared to other professions? Talk about the contrast. How much higher is it, and what is it specifically about the medical profession that may contribute to that higher rate in relation to other professions?

Muhamad Aly Rifai: It is definitely higher than other professions. We are a little bit ahead of lawyers and a little bit ahead of dentists. A recent paper just early on this year in May 2025 in JAMA Network reviewed the cause of death among U.S. medical residents and looked at data between 2015 to 2021. Suicide was the single leading cause of death for medical residents.

It is very interesting that in this young population who is going through residency or who just finished medical school, suicide was the single leading cause of death. It was not accidents, illness, or cancer. It was suicide. The highest rates were actually in the first couple of months when they started their residency.

That highlights the intensity of the feelings of depression, anxiety, and stress that medical residents are facing. That also goes on and translates into stress, anxiety, and depression that they face later on in their professional career. This puts us at a high risk for depression, anxiety, and ultimately completed suicide. I am just calling attention to that, especially for residents, the new classes starting, as well as other physicians. It is still ongoing, and we are at a higher rate as physicians.

Kevin Pho: From your perspective as a psychiatrist, can you speculate on some of the reasons why medical residents, especially those who just graduated medical school, are more prone to anxiety and depression? What are some specific facets of the medical profession that can lead to anxiety and depression among physicians?

Muhamad Aly Rifai: It is the high pressure that we face on a regular basis. We are seeing a higher incidence of preexisting depression in a lot of new classes of medical students. We are also seeing the demands of the profession significantly accelerating. We are seeing students graduating with a high level of debt, and that is affecting them.

We are seeing the intensity of graduate medical education significantly increasing compared to our time in terms of residency training. The number of hours has significantly decreased. We never had the 60- or 80-hour rule in our residency days, but we are seeing that even that has contributed to more residents facing more difficulties. They are not able to adjust and acclimate to residency training, which is leading to symptoms of depression, despair, and suicide that are reflected in the JAMA paper.

I wrote this paper to bring attention to program directors and other clinicians that this is a real phenomenon. We need to be cognizant of that and help fellow residents as well as other fellow physicians.

Kevin Pho: Physician burnout, moral injury, and suicide have been common themes on my site and on this podcast for years now. Do you feel that those in charge of medical school and training and our health care entities take this phenomenon seriously? If so, what are some of the things that you are seeing that they are doing to help mitigate physician suicide?

Muhamad Aly Rifai: I think they are hearing about it. They are trying their best. We are seeing that some programs have started in large health systems where physicians, especially those that are thought to be affected with burnout or depression, are paired with a peer where they do have a peer check-in. They are asked to be aware and audit their sleep so that they are able to talk to the employee assistance program.

We know that people feel that the licensure language is sometimes punitive if they come forward with symptoms of depression. Program directors are placing a special focus on the period where the residents are mostly vulnerable, which is that period of month one and month two of residency training. They are trying to map out the interns or the residents that they feel are at the highest risk.

We are even seeing that sometimes they put attendings on “wellness call” at night where interns and residents could call that attending. They are holding protected time or wellness time where people are commiserating or talking about the difficulty of residency training. We are seeing a lot of residency program directors acknowledging that this is a significant issue that they need to address in their classes of interns and among residents just because they are seeing it happening more often, and the statistics are reflecting it.

Kevin Pho: It sounds like some of these approaches are more reactive in nature. Is there anything that we could do with the profession itself? I know that there has to be some baseline stress in medicine, but do you feel like there could be some improvements in the profession itself to help mitigate some of the potential causes that may lead to suicide?

Muhamad Aly Rifai: I think normalizing the fact that we are humans is key. We always portray physicians as superhumans. We think we can do it no matter what. Whether we are surgeons, psychiatrists, internists, or ICU doctors, we think we are superhumans. We are there to do it anytime you can call us 24/7. We would jump into being able to help and facilitate the wellness of our patients, but then we forget our own wellness.

That portrayal of physicians significantly accelerated with the COVID-19 pandemic. We were asked to jump in and save this nation, which was experiencing this pandemic. We were asked to work long hours with difficult circumstances in a condition that was unknown. We were asked to make death and life decisions, and that really accelerated the burnout. I think that increased what we are seeing right now with increased rates of depression, burnout, and suicide in residents as well as in physicians.

Kevin Pho: In your article, you write that sometimes hospital executives ask for resilience rather than trying to fix the system itself. One option that is suggested is to maybe tie their leadership bonuses to the behavioral wellness of the clinician staff. Is that right?

Muhamad Aly Rifai: Yes, absolutely. I think talking about the problem is very important. We should be measuring the wellness like RVUs. Publish the numbers. Are physicians happy? Are they not happy? What is their wellness? What is the retention rate? What is the burnout rate? What is their access to care?

I know that in my area at local hospitals, physicians have very little access to care. They have to go out of their way to be able to access a psychiatrist or a therapist because they also fear that they are going to be reported to the medical staff services. They fear they are going to be reported to the medical board. So they go out of their way, and they are secretive. Nobody knows that they are experiencing symptoms of depression and anxiety.

For example, with our colleague Nolan Williams, nobody knows what happened. Nobody knows what he was experiencing. It is very unfortunate that he was secretive and did not talk about it, and nobody knew about it. Then all of a sudden, his life ended with suicide.

We must push the executives to acknowledge that this is a problem and that they need to be aware of it. They need to be measuring it. They need to talk about physician wellness because we are seeing physicians exiting medicine. That is something that you have talked about in your blog also. Physicians prefer to exit medicine rather than end their life in response to what they are experiencing.

Kevin Pho: You wrote in your article that the cost of prevention is modest, but the loss of life is infinite. I am going to ask you to put yourself in a position of both a program director and a hospital executive. If we want to value residents and physician survival and prevent physician burnout, I want you to tell me one thing that you would do from the perspective of a program director as well as from the perspective of a hospital leader.

Muhamad Aly Rifai: From a program director’s perspective, I think talking openly about it is essential. On day one, July 1, sit with the interns and tell them that the program director’s door is open. He is available no matter how bad things are. No matter how much despair and depression you are feeling, or whether you are feeling that you want to end your life because things are so bad, talk about it from day one.

Just putting it out there is very important. Not a lot of people have the courage to do that because there is the myth that if you talk about it, maybe you will put it in somebody’s mind. Actually, that has been proven not true. So talk about it on day one as a program director. Sit down with your interns and say: “I am here for you. No matter how depressed and desperate you are or how you feel, I am here for you. Your life is valuable to us. We want you to go through your residency and complete your residency. The country needs you as a physician to help your patients, and you are not good at helping your patients if you are not helping yourself.”

That is the number one thing that I tell program directors: July 1, talk to your interns and residents and tell them that help is available and they should not despair.

In terms of hospital executives, I think that they only understand the numbers. Hospital boards and physicians should pressure hospital executives to be measured like RVUs. They need to be measured by physician wellness. If physicians are not happy, if physicians are in despair, or if physicians are not happy with the system, the system needs to hear it. The system needs to measure it and need to be able to publish those results. The executives need to be accountable to the hospital board about the fact that physicians are not happy.

We see that sometimes in hospitals where there is an exodus of physicians because they are not happy. Invariably, sometimes it leads to the ouster of the executive of the hospital. Sometimes the hospital does not blink and they just keep going on and go through another round of physician exodus. I think hospital boards are hearing about it. Communities are hearing about it because they want physicians to be able to continue to work in their community. This phenomenon of burnout and suicide is affecting our physician community.

Kevin Pho: We are talking to Muhamad Aly Rifai, psychiatrist, internist, and addiction medicine specialist. Today’s KevinMD article is “Physician suicide prevention: a call to action.” Muhamad, let us end with some take-home messages that you want to leave with the KevinMD audience.

Muhamad Aly Rifai: To my fellow physicians, I think you need to hold onto each other tight. Ask a colleague to be your sounding board and to be your call-in if you need any support. Support is out there. We want our physicians to return back to wellness. We want our physicians to be safe. We want to be able to reduce this phenomenon of physician suicide. We lost Dr. Nolan Williams, and we have lost too many other physicians. Always speak up. Always seek help.

To the physician executives and to hospital executives: Build systems that protect physicians. Protect people, refuse to normalize preventable death, and refuse to let the next obituary be someone that you know.

Kevin Pho: Muhamad, as always, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.

Muhamad Aly Rifai: My pleasure. Thank you.