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3 leading health organizations aim to reduce suicides by physicians, medical trainees

As increasing rates of stress, depression and fatigue fuel concern about physician well-being, the Accreditation Council for Graduate Medical Education (ACGME), the American Foundation for Suicide Prevention (AFSP) and Mayo Clinic recently launched an initiative to prevent physician and medical trainee suicides.

“We want to be part of a national dialogue that addresses physician well-being and leads to transformational change— to a more humane learning environment for all medical education and a healthier culture for all physicians,” says Thomas J. Nasca, M.D., MACP, chief executive officer of the Accreditation Council for Graduate Medical Education.

At the ACGME’s Second Symposium on Physician Well-Being, the three organizations introduced a library of educational resources on the ACGME website. The research into physician well-being has been growing over recent years, and there have been many efforts at medical schools and residency programs. The resources, intended to help physicians and medical trainees, include:

A four-minute video that advises medical students, residents and fellows on how to support each other, express concern to peers, and encourage help-seeking behavior

A comprehensive guide to help graduate training programs respond to a resident death by suicide

Additional information and access to support

“Taking care of your mental health is the strong and smart thing to do,” says Christine Moutier, M.D., chief medical officer, American Foundation for Suicide Prevention. “Consider it a best practice for physicians and medical trainees. Addressing our own risk in the physician community is an important step toward addressing suicide at the public health level. If physicians begin modeling proactive mental health behaviors, it will send a strong message to all of society.”

A primary risk factor for suicide is unaddressed mental health conditions, including depression, bipolar disorder, substance use disorders, post-traumatic stress disorder, and personality disorders. Suicide risk is mitigated when mental illness is addressed and managed well, Moutier says.

Physician well-being has a direct impact on patient care. Extensive evidence indicates that burnout and depressive symptoms undermine quality of care and may contribute to medical errors. Physicians with burnout are also more likely to leave medicine and reduce their clinical hours―both of which impact patient access to care.

“Physician well-being is crucial to the health of our entire system of medical care,” says Fredric Meyer, M.D., executive dean of education, Mayo Clinic. “For the welfare of patients and the next generation of physicians, the nation’s providers of medical education must strive to cultivate an environment that promotes both stress management and resilience.”

Meyer oversees Mayo Clinic College of Medicine and Science, whose enrollment includes 200 medical students and nearly 2,400 residents and fellows on three campuses in Arizona, Florida and Minnesota.

At Mayo Clinic School of Medicine, a transformative education model includes specialized training on physician wellness and resiliency to prevent burnout and prepare future physicians for the rigors of clinical practice. Wellness training now has extended into Mayo Clinic School of Graduate Medical Education. And Mayo Clinic Department of Medicine created the Program on Physician Well-Being in 2007 to evaluate personal, professional and organizational factors that contribute to burnout and foster physician well-being, satisfaction and productivity.

About 87,000 medical students are enrolled in U.S. medical schools, according to the Association of American Medical Colleges. Approximately 125,000 graduates from medical school currently are training in about 150 specialties and subspecialties as residents and fellows in ACGME-accredited programs at about 800 sponsoring institutions, including universities, medical schools and hospitals.

10 facts about physician suicide and mental health

  1. Suicide generally is caused by the convergence of multiple risk factors—the most common being untreated or inadequately managed mental health conditions.
  1. An estimated 300 physicians die by suicide in the U.S. per year.
  1. Physicians who took their lives were less likely to be receiving mental health treatment compared with nonphysicians who took their lives even though depression was found to be a significant risk factor at approximately the same rate in both groups.
  1. The suicide rate among male physicians is 1.41 times higher than the general male population. And among female physicians, the relative risk is even more pronounced—2.27 times greater than the general female population.
  1. Suicide is the second-leading cause of death in the 24-34 age range (Accidents are the first.).
  1. Twenty-eight percent of residents experience a major depressive episode during training versus 7 to 8 percent of similarly aged individuals in the U.S. general population.
  1. Among physicians, risk for suicide increases when mental health conditions go unaddressed and self-medication occurs as a way to address anxiety, insomnia or other distressing symptoms. Although self-medicating, mainly with prescription medications, may reduce some symptoms, the underlying health problem is not effectively treated. This can lead to a tragic outcome.
  1. In one study, 23 percent of interns had suicidal thoughts. However, among those interns who completed four sessions of web-based cognitive behavior therapy, suicidal ideation decreased by nearly 50 percent.
  1. Drivers of burnout include workload, work inefficiency, lack of autonomy and meaning in work, and work-home conflict.
  1. Unaddressed mental health conditions, in the long run, are more likely to have a negative impact on a physician’s professional reputation and practice than reaching out for help early.

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