It struck Pamela Wible at the funeral on Oct. 28, 2012, during an overcast afternoon in Eugene, Oregon. Her colleague from the hospital had shot himself in the head on Mount Pisgah, in the middle of the day. He was the third doctor from Eugene to die of suicide within that year. Yet nobody at the funeral spoke openly about suicide. In fact, they seemed to want to avoid the topic altogether. “These were doctors at the prime of their careers, who were all well loved but somehow dead. People did know why they died,” Wible says. “But they only whispered in the bathroom about it.”
Wible zoned out as the service continued, staring at her fingers as she tallied up every story of a doctor suicide she could remember. Within a few minutes, all ten of her fingers were extended. The lightbulb moment — of realizing how strange and significant this trend was — came when she considered that two of those 10 deaths were of former boyfriends from medical school. “Their families called it accidental overdoses, but we knew,” she explains. “And they were married with little kids when they killed themselves. It was hard to fathom.”
Since 2012, Wible has made it her task to keep track of doctor suicides around the country, and the numbers are bleak. By late 2017, her database had the details of 550 deaths — a number that’s ballooned to more than 1,100 today. Generally speaking, Wible and others who have researched this trend say somewhere between 300 to 400 doctors die of suicide each year, though it’s hard to pinpoint because many deaths are reported only as accidents. This means that doctors are dying of suicide at more than double the rate of general population and at a higher rate than even military veterans.
The stories come from all corners of the U.S. A medical student at New York University jumped to his death from his dorm room. Three young women at the prestigious Mount Sinai St. Luke’s, also in NYC, took their lives within a two-year span. Another young doctor, the son of two successful physicians, chugged vodka before laying in a warm bath and cutting the arteries in his wrist. “Earth wasn’t a particularly great place for me. We’ll see what else is out there,” he wrote in a note he left at the edge of the tub. “Will miss you all! Am sorry, for what it’s worth.”
The mothers, fathers and loved ones who discover these suicides routinely tell Wible about the pressure to keep such incidents quiet, noting the stigma around the idea that a successful doctor would choose to die. “The hospital and everyone is so silent. They cover it up. No one talks about it. Someone dies and everyone puts their heads down and ignores it and are told by the hospital to keep quiet — especially to reporters,” one woman wrote to Wible.
The loss of a doctor in this way affects their patients, too. Considering the annual caseload of most family doctors is about 2,300 patients, the death of more than 400 physicians each year means nearly a million Americans lose their caregivers annually. Heartbroken patients gather on forums and Facebook pages, mourning their loss while wondering how to transition to someone new. “It is so hard to find someone you have a deep connection with. I was with him for 15 yrs. The loss I feel is devastating,” one woman wrote on a tribute page to Houston psychiatrist Dr. David Love, who died of suicide in March. “How will I ever find another one who will be as compassionate and caring as Dr. Love? His name fit him perfectly. God be with his family.”
Male and female physicians die of suicide at similar rates, despite the suicide gap between men and women in the general population, and the darkness of depression and anxiety appears to touch doctors in all medical fields. Further research has shown that this isn’t a uniquely American problem either, with physicians in Europe and Asia also showing similar mental health struggles. All in all, doctors have the highest suicide rate of any profession in the world. At the core of the issue is the sheer number of doctors who feel that they’re not allowed to confront their own pain when they’re trying to help patients, says Reef Karim, a psychiatrist and counselor based in L.A. That “Superman” effect, coupled with the very real emotional and economic drama physicians suffer through, can send a person over the edge, Karim notes.
“Think about the amount of schooling we do, and the cost of that training. People are in debt for $300k, $400k coming out of medical school. And being a doctor used to be more glamorous, but right now, it’s not a safe, secure career anymore. You desperately need to want it,” he says. “The money doctors earn has been decreasing. The number of patients they must cycle through keeps growing. And there’s a societal belief that, well, you went into medicine to be noble — that it’s valuable to not really think about yourself.”
Kyle Jones, a family medicine physician at the University of Utah, experienced his first panic attack as a pre-med student while working the night shift at a home for mentally ill patients. The tightening in his chest and the cold sweat on his body felt like the start of a heart attack. A few days later, a doctor told him that it was caused by anxiety.
Jones figured that being newly married, broke and worried about getting into medical school had caused the symptoms. But even after he got into the Medical College of Wisconsin, the anxiety persisted. He was used to being “the smartest student, with the best grades” — but now he was surrounded by overachievers, each with an impressive resumé. “You look at that very competitive atmosphere, and you assume no one else is struggling. I felt like I was the only one with mental health problems. It was extremely lonely,” Jones recalls. “It was only later that I spoke with my peers about this that I realized how many were showing symptoms of mental health trauma. Roughly half of my fellow residents were struggling with emotional problems.”
It’s the back stretch of the schooling process that wears most physician recruits down to the bone. In the third and fourth years of school, and then the three to five years of residency training in a hospital that follow, you’re worked so hard that there isn’t time to think about self-care, Jones says. In particular, the 30-hour shifts make it unwieldy to schedule therapy or experiment with a new cocktail of psychiatric medications that could potentially slow you down. And the high-pressure environment breeds a style of teaching that’s abrasive and bullying — almost as if it’s designed to weed out people who don’t fit a certain model of intensity. “The medical industry relies on the cheap labor of students and residents. There’s a constant rush of patients, so you’re thrown into chaos and stress,” he adds. “It’s just easier to cope with that bullying mentality of, ‘Look, we need to get this done, we don’t have time for your bullshit.’”
That mentality can get complicated fast when coupled with the earnest compassion that so many doctors feel toward their patients. A good physician is able to empathize and share in the journey of a patient, often shouldering a portion of the hurt and worry that person holds, Karim says. If a doctor has 20 patients, that can mean feeling the burden of 20 distinct people who need you, he notes. It’s a big reason why physicians have higher rates of substance abuse and addiction than the general population, with research showing that “protecting workplace performance and image” is a primary cause of why so many doctors let their personal problems get so bad in the dark.
“We had very little training about self-care in school, and while things are supposed to have changed since then, I don’t know that we’ve seen real improvement,” Karim says. “But if a doctor doesn’t have a good self-care plan, you’re gonna see them drink, seek out drugs or just be less emotionally available in their relationships. That happened to me. I was so focused on my patients’ pain that I didn’t have energy or emotion to show to my friends or family. I was just spent.”
The toll of caring for ailing patients has been well documented over the course of the 20th century, and many historical reports affirm a physician culture of toughing it out, and staying silent in the face of stress. Yet in Wible’s view, the new pressures of 21st-century medicine are also responsible for pushing physicians to suicide. She recalls how her own doctor parents spent generous amounts of time talking with patients and taking notes, making sure that they felt satisfied about the care they were receiving. The “therapeutic relationship” between the two parties was essential, she says — but finding that today as a physician is harder than ever.
When Wible wrapped up her residency at the University of Arizona’s family medicine department in 1993, she moved to Eugene, Oregon in search of a small-town lifestyle in the Pacific Northwest. She landed a job at a large specialty medicine facility, and for the first week, she spent about 30 minutes to an hour with each of her patients. So far, so great, she thought. Then her appointments began crowding together, with more and more patients filling her daily schedule. A month in, the duration of each appointment was barely 10 minutes. This wasn’t the kind of medicine Wible had signed up to practice. But six more jobs over the next 10 years, in a variety of Pacific Northwest hospitals, showed her that it didn’t matter — medical institutions needed to hit a certain pace to turn profits, and Wible was expected to be a well-greased cog in that machine.
“You take on all this debt with the idea that it’s all worth it, because you get to make a living of caring for people. Then you realize you’ve signed up to be an assembly-line physician, seeing patients every seven minutes, and you feel completely duped,” Wible says. “On top of thinking you’re not giving patients enough time, you’re also being pushed by people above you to upcharge at every turn. So you feel like you’re guilty in taking part in insurance fraud and malpractice, too.”
Her disillusionment peaked in a six-week period starting in October 2004, when Wible laid on her bed for hours, unable to even get up for a glass of water despite the cracking of her dry lips. She slept through her 36th birthday, trying not to think about the energy needed to lay there for another day. “I didn’t have a gun or pills, or the energy to go through with that. I just wanted so badly to die in my sleep, as if I could will myself to do that,” Wible says. “Waking up and realizing I was still alive was a horror story.”
The horror story came to an end with a fever dream of sorts. Wible remembers being awake for a vision — that of a “hospital revolution,” with flashing images of grassroots volunteers re-building a medical institution brick by brick. She bolted up and sprinted around the house in her underwear, channeling a manic flash of energy. She realized she needed to build her own practice and start advocating for fundamental changes in how medicine is conducted. “It sounds crazy, but it showed me the alternative to what I’d been doing,” Wible says. The revelation at the funeral in 2012 brought the issue of physician suicides to the forefront of her advocacy, and she’s traveled the country to present her findings on why so many doctors — young and old — meet a tragic end.
To their credit, more medical institutions are now offering mental health assistance to students and residents, and Jones notes that he’s seen helpful practices like meditation, mindfulness and yoga appear in hospitals as amenities for physicians. His family medicine program had mandatory six-month group counseling for new interns, and the University of Utah provided counseling and employee assistance for faculty. He also acknowledges, however, that such resources only amount to “lip service” when physicians aren’t given any time in practice to pursue counseling and self-care activities. “A lot of places almost seem to assume that, well, we’ve done our part in hiring a therapist or two — so if you’re still struggling, it’s your own fault,” Jones observes. “There may be a desire to provide resources, but it’s not made practical or accessible.” (The American Medical Association didn’t respond to multiple requests for comment on physician suicides.)
Karim, as a mental health expert, has a lot of different ideas about how to fix the physician suicide crisis: Better education in school, regular sessions that emphasize why self-care makes you a better doctor, access to physician counselors that are independent of hospitals or a medical board to reduce the threat of reprisal, etc. But awareness and honest conversation around these suicides need to improve first and foremost, he says. For example, a 2016 survey of female physicians found that a stunning 50 percent of respondents believed they had signs of mental illness, but refused to get treatment out of fear of being alienated at work and being investigated by a medical board.
“There’s truth to the idea that mental illness can endanger your livelihood. There’s a system whereby you’re monitored on your performance at your job. And if things go well, you’re fine. But if things don’t, you might be facing some very tough questions,” Karim says. “So the pressure there is that you spent 16 years of your life to train for a single job. What are you gonna do if you can’t do that job?”
As such, some physicians drive out of town and set up appointments with fake names in order to get help. Others even try to cover up for their colleagues, as with the tale of Christopher Stanley, a young doctor who died of suicide on Nov. 11, 2011. It followed a suicide attempt that summer in which his fellow residents at St. Bernards Hospital in Jonesboro, Arkansas, found him in his apartment. They checked him into a psych ward under an assumed name, hoping to keep it off his professional record and perhaps keep their hands clean of the incident, too. After 72 hours, Stanley was released and expected back at his residency program without meds or a formal plan for a follow-up, according to his mother Vicki Stanley — resources that may have saved his life. She reached out to Wible after her son’s death, hoping to push the conversation on physician suicide forward.
“We’re often lying on behalf of our peers, to protect life-insurance payouts and benefits and just their reputation,” Wible adds. “A lot of death certificates are forged. There are a lot of ‘accidents’ — was it a suicide, or was there ice on the bridge at night when they drove off? A lot of times it’s friends and colleagues filling out these certificates, and we just don’t want to talk about suicide.”
To that end, Wible’s not pleased with how she continues to get uninvited from speaking events or banned from some medical schools for her blunt, often fiery talking points on why physicians die of suicide. All the while, the letters and phone calls reporting new deaths continue to pour in. One wall of her house in Eugene, where she lives with her partner and a cat, is covered in photos of smiling doctors who decided to end their lives. Each image is a reminder of why she bothers to work on her database, or why she has run a hotline for suicidal doctors — “I’m a night owl, so I can talk to someone in New York City who’s crying at four in the morning,” she says. “These doctors don’t want to call some general national hotline. They’re too smart for that.”
It seems like a heavy burden for a doctor, who was once suicidal herself, to have to shoulder. But Wible views it as her life’s work now, in addition to caring for her pool of family medicine patients. As she sees it, the suicides somehow found her, not the other way around. “Suicide brings me to life now. There’s a mission here,” she says. “I just don’t want to stop talking about it.”