DOCTOR

By Paul Bremmer

Vincent was a jubilant elementary-school boy, the kind who played pranks and made people laugh. When he reached high school, he maintained his outgoing nature but also matured into a kindhearted and sensitive young man. As a student, athlete and artist, he always strove for perfection. He was an all-around good kid, according to his mother.

But then Vincent went off to medical school. Forced to work or study more than 80 hours a week, he had trouble sleeping. He lost a lot of weight. He stopped joking and laughing.

As a surgical resident, Vincent had qualms about saving a rapist who was injured while trying to escape from the scene of his crime. Another day, Vincent was shaken when two car accident victims brought to the ER looked like his mom and aunt, who often rode together without seat belts.

Vincent became disillusioned. The stress of the medical profession was too much for him to handle. Two months after starting his surgical residency in New York City, at the age of 25, Vincent hanged himself with a belt in his closet.

Dr. Pamela Wible told Vincent’s story at the 2014 American Academy of Family Physicians Assembly in Washington, D.C., to highlight the problem of physician suicide.

About 300 to 400 physicians kill themselves in the U.S. each year, according to the American Foundation for Suicide Prevention. Physicians have the highest suicide rate of any profession and are more than twice as likely as the average American to kill themselves.

Experts note common diagnoses among doctors who commit suicide are depression, bipolar disorder, alcoholism and substance abuse – the same factors that generally lead to suicide in the population at large. But what is the impetus that drives so many doctors to take their own lives?

Three University of Oxford researchers performed a psychological autopsy study of 38 physicians who died by suicide in England and Wales from 1991 to 1993. The researchers found that 25 of the 38 doctors had significant problems at work before they died. Of the 25, eight felt overburdened by their volume of work, six suffered from long work hours and six felt unable to cope with the responsibilities of their jobs.

Some physicians and medical students have offered anecdotal explanations for the high suicide rate in their profession. Pranay Sinha, a physician in his first year of residency at Yale-New Haven Hospital, wrote in the New York Times that he and other medical students experienced “fatigue, emotional exhaustion, and crippling self-doubt” at the beginning of their residencies.

Sinha said that once medical students become real doctors, their workload suddenly increases.

“Most fourth-year medical students are expected to take care of four patients at a time,” he said. “But within a month of graduation, without any additional training or practice, we are required to have a comprehensive understanding of up to 10 patients on any given day.”

Sinha wrote that his first two months were filled with “severe fatigue, numerous clinical errors (that were promptly caught by my supervisors), a constant and haunting fear of hurting my patients and an inescapable sense of inadequacy.”

A 2008 study published in the Annals of Internal Medicine examined the relationship between suicidal ideation and burnout, defined as emotional exhaustion, depersonalization and a lowered sense of personal accomplishment.

The study of more than 4,000 medical students at seven schools found that half of all students experience burnout while in medical school. Approximately one of every nine students reported having suicidal thoughts while in school. The researchers found a correlation between student burnout and subsequent thoughts of suicide.

Wible echoed the study in a post on KevinMD.com.

“Most doctors are burned out, overworked, or exhausted,” she wrote.

But that’s only the beginning of their problems.

“For a physician, a cry for help is weakness,” Wible wrote. “Doctors can feel severe psychological pain. Doctors can feel powerless. Doctors can feel trapped. Some see no alternative to their suffering.”

Wible herself once considered suicide as a young doctor. She wrote in the Washington Post that she felt “trapped in an assembly-line clinic, forced to rush through 45 patients a day.” Upon opening her own clinic, she became much happier, she says.

Unfortunately, being a doctor is not all about practicing medicine. Some physicians get bogged down in other aspects of the job. Daniela Drake, an internist in Los Angeles, wrote in the Daily Beast that being a doctor is now “the most miserable profession.”

“Just processing the insurance forms costs $58 for every patient encounter,” she wrote. “To make ends meet, physicians have had to increase the number of patients they see. The end result is that the average face-to-face clinic visit lasts about 12 minutes.”

The Affordable Care Act has made the situation worse by forcing everyone to have health insurance, according to Drake. Many doctors have closed their practices because of the sheer difficulty of dealing with insurance companies.

The Heritage Foundation has written about how Obamacare will increase doctors’ workloads, adding to the stress in their lives. In addition to the millions of new patients, ACA regulations will impose enormous new paperwork requirements. Heritage estimated Obamacare will add 190 million hours of paperwork to the health-care industry per year. The workload will greatly increase costs and decrease a physician’s time available to spend with patients.

The medical profession is challenging enough as it is. Doctors must work and study long hours in medical school, keep up on all the latest developments in medicine and, above all, never make mistakes. It’s a stressful job. But Obamacare, by flooding the system with millions of new patients, increasing tedious paperwork and regulations and incentivizing doctors to leave the profession, promises to increase the stress of the job even more, critics have noted.

WB276Dr. Lee Hieb, past president of the Association of American Physicians and Surgeons, anticipates Obamacare will cause a full-scale collapse of the American health care system. Her how-to guide, “Surviving the Medical Meltdown,” will be published in January.

In the book, Hieb tells the story of her own troubled experience with government-run health care, in the form of Medicare. As more and more elderly Medicare patients moved to her city, and as the government dropped physician reimbursement levels, doctors began to leave town for cities with more private-pay patients. This put added stress on the doctors who remained.

“In general medicine and other areas, hospital on-call nights were so brutal – keeping doctors up all night in spite of working all the next day – that all the doctors who could function outside the hospital chose to leave the hospital staff for purely outpatient practices,” Hieb writes. “Those who could afford to retire did so. And in orthopedics, we were left with four surgeons doing the work that was being done elsewhere by 10 or more.”

As the American population ages, more doctors will need to work more hours to provide patient care. Unfortunately, many doctors are already crumbling under increased workloads, and Hieb believes it’s one of the factors that drives so many doctors to suicide.

“In areas where fewer and fewer physicians remain, it is very difficult to recruit new physicians to the job – since the new docs do not want to be forced to cover impossible patient loads,” Hieb writes. “Around the country, there are already these medical ‘black holes’ – areas without coverage for certain specialties.”

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