Physician Suicide

Updated: Jul 13, 2022
  • Author: Louise B Andrew, MD, JD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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It has been known for almost 150 years that physicians have an increased propensity to die by suicide compared with the general population. [1]  Exact numbers are not known. Although it is impossible to estimate with any precision because of inaccurate cause of death reporting and coding, an estimate often used is approximately 300–400 physicians/year, or perhaps loss of one doctor a day to suicide in the United States. A 2019 study  found that more than 300 doctors die by suicide each year across the nation. [1]  A more rigorous recent study [2]  puts the lower statistic at around 119 annually. These estimates may at any rate indicate that on average the United States loses between one small and one large medical school class to suicide each year. [3] Although none of these statistics can be proven conclusively, it is believed that the medical profession consistently hovers near the top of occupations with the highest risk of death by suicide. Considering the investment made in and by those who choose, and the motivations that young people have for entering the profession of medicine, any figure is too high.  

Sadly, although physicians globally have a lower mortality risk from other common causes such as cancer and heart disease relative to the general population (presumably related to knowledge of self care, awareness of symptoms, and acess to early diagnosis), it is believed they have a significantly higher risk of dying from suicide, the end stage of an eminently treatable disease process, depression. Perhaps even more alarming is that, after accidents, suicide is the most common cause of death among medical students and male resident physicians. It is the second most common cause of death in residents overall. [4, 5, 6, 7]

In every population, suicide is almost invariably the result of untreated or inadequately treated depression or other mental illness (that may or may not include substance or alcohol abuse), coupled with knowledge of and access to lethal means. [8] Depression is at least as common in the medical profession as in the general population, affecting an estimated 12% of males and up to 19.5% of females. [9, 10] Depression is even more common in medical students and residents, with 15–30% of them screening positive for depressive symptoms. [11, 12, 13, 14, 4]  This is a worldwide problem. Studies from Finland, Norway, Australia, Singapore, China, Taiwan, Sri Lanka, UK, Nigeria, and others have shown increased prevalence of anxiety, depression, and suicidality among students and practitioners of medicine. [15, 16, 17, 18, 19, 20]

However, because of the stigma associated with depression in almost all cultures (which seems to be greatly magnified among medical practitioners) [21] self reporting certainly underestimates the prevalence of the disease in medical populations. Indeed, although physicians seem to have generally heeded their own advice about avoiding smoking and other common risk factors for early mortality, they are decidedly reluctant to address the possibllity of depression, a significant cause of morbidity and mortality that disproportionately affects them. It may not be appreciated that depression is a leading risk factor for myocardial infarction in male physicians, and it may also play a role in immune suppression, thus increasing the risk of many infectious diseases and cancer. [22, 23, 24, 25, 26, 27, 28, 29]

Because of their greater knowledge of and better access to lethal means, physicians not suprisingly have a higher suicide completion rate than the general public. Estimates of successful completion of suicide by physicians range from 1.4 to 2.3 times the rate achieved in the general population. Although female physicians attempt suicide far less often than their counterparts in the general population, their completion rate equals that of male physicians; and thus, greatly exceeds that of females in the general population (2.5–4.1 times the rate by some estimates). [9, 10, 30]

A reasonable assumption is that underreporting of suicide as the cause of death by sympathetic colleagues certifying death may well skew these statistics. Most probably, the real incidence of physician suicide is somewhat higher than the prevailing estimate.

Prevalence of depression or suicidal ideation in physicians has not yet been scientifically studied across all medical specialties. However, a Medscape survey of more than 13K physicians over 2021 found that 24% of respondents felt that they had been clinically depressed. The survey found that pathology, surgery, oncology, infectious diseases, and emergency medicine top the list in the incidence of suicidal ideation. [31] Orthopedic surgeons recently surveyed 661 members more rigorously and found that of this group, 5% had experienced serious suicidal ideation (with a plan) during their lifetime compared with 1% of the general population. [32]

The most common psychiatric diagnoses among physicians who complete suicide are affective disorders (eg, depression and bipolar disease), alcoholism, and substance abuse. The most common means of suicide by physicians are lethal medication overdoses and firearms. [33, 34]


Depression in Physicians

Physicians are demonstrably poor at recognizing depression in patients, and perhaps even more so in themselves. Furthermore, they are notoriously reluctant to seek treatment for any personal illness. This may be especially true in the case of potential mental illness. A survey of American surgeons revealed that although 1 in 16 had experienced suicidal ideation in the past 12 months, only 26% had sought psychiatric or psychologic help. There is a strong correlation between depressive symptoms (as well as indicators of the distinct but related occupational stress syndrome of burnout) with the incidence of suicidal ideation. More than 60% of those with suicidal ideation indicated they were reluctant to seek help due to concern that it could affect their medical license. [35] Other studies [36] reveal that concern about regulatory intervention is a very common impediment to help-seeking for mental health issues, at least among women. A 2000 paper suggested that 1 in 3 physicians has no regular source of medical care. [37]  Although not systematically studied since, it seems likely that more women physicians do receive regular medical care because of reproductive needs. However, having a source of medical care does not necessarily mean that mental health concerns will be addressed. 

Reluctance to recognize depression in a colleague is probably common in physicians, who may be well intentioned, habitually emotionally distanced from colleague/competitors, and/or feeling temporarily vulnerable themselves. Even when they are healthy, it is well known that physicians find it difficult to ask for help of any kind.  Physicians identify as helpers, not "helpees." When depressed and feeling less than adequate, they find it even more difficult to reach out. When they can bring themselves to ask for help, they sometimes find that the help they need is remarkably difficult to obtain or may even be dangerous professionally.  

To some extent, physicians’ reluctance to reach out is self-imposed. They may feel an obligation to appear healthy, perhaps as evidence of their ability to heal others. Inquiring about another physician’s health can shatter an unspoken mutual myth of invulnerability, and volunteering support or assistance unasked may seem like an affront to a colleague’s self-sufficiency. Thus, the concerned colleague or partner may say nothing while wondering privately if the colleague is depressed or just having a bad day, week, or life. The impact of Covid on this phenomenon cannot be overstressed. When everyone in a population is suffering, mutual support is the normal human response. But when the population is composed of healers, most or all of whom are stressed or suffering, asking for personal support seems incredibly selfish. Offering such support should be and often is a natural impulse. However, due to depletion of energy from work overwhelm and the co-existence of moral injury when caregivers themselves are not feeling supported or are being targeted by their institutions for speaking out about institutional deficits such as lack of effective PPE during a pandemic, mutual support is likely considerably less available. 

Unconsciously defending against a painful vulnerability, physician partners or significant others may also fail to notice significant depression or withdrawal, attributing behavioral changes in physicians to stress or overwork, rather than to a very common and easily treatable mental illness like depression. Nearly every article about a physician’s suicide contains a quotation from some close contact, occasionally a spouse, saying something like, “I never had any idea that he/she was suffering.” [38, 39, 40, 41]  Of course, many physician obituaries omit the fact that the “sudden death” was a completed suicide.  

Depressed physicians who do manage to reach out may find that they receive only limited understanding or sympathy from colleagues. There is no specialized training for a physician's physician (as there is, for example, for the pope's confessor). Most physicians either shrink from this role or perform it poorly. [41]  Furthermore, state licensure boards are urging and in some cases mandating (on pain of licensure revocation) physicians to report other physicians whose behavior may suggest the potential for impairment. Most states that mandate such reporting have received minimal reporting, so some licensure boards such as Ohio are mandating courses and threatening penalties if it can be proven physicians are aware of colleague impairment yet have not reported. [42]  While any credible indication of direct patient safety threat is a legitimate reason for requiring such report, no physician is capable of determining whether a colleague is impaired, based solely on secondhand reports of others.  However, even if behavior suggesting potential impairment is personally observed, there is still a tendency to avoid reporting, based on fear of erroneous intrpretation or retribution, most especially if the individual whose behavior is being questioned is a supervisor. 

For many experiencing depression, the early symptoms are physical. A physician unable to diagnose his or her own symptoms commonly feels incompetent. To admit one’s inability to diagnose oneself to another colleague is to admit failure as a clinician. When this shameful admission is met with avoidance, disbelief, or derision by a reluctant physician colleague shrinking from the "doctor's doctor" role, it can only reinforce a depressed physician’s feelings of worthlessness and hopelessness.  

Physicians find it difficult l to share their experience of mental illness with others and know that doing so is somewhat risky; therefore, published accounts of physician depression have traditionally been difficult to find. [43]  However, recent highly publicized cases of resident and physician suicides and subsequent sharing of experiences of depression and suicide attempts by physicians [44]  suggest that either the incidence of depression and suicidality is rising in the profession or we are beginning to be more able to admit and to address the immensity of the problem. [45]  Such revelations have unfortunately not occurred without consequences [46, 47, 48, 49, 50, 51]

Covid has magnified all aspects of both burnout and depression throughout the medical profession [52, 53, 54]  and has contributed to suicides. The death by suicide of Dr. Lorna Breen in particular, at the start of pandemic, garnered worldwide attention both because of the circumstances of her death (after suffering Covid and experiencing a not uncommon cognitive effect of the infection that made it impossible for her to continue her high standards of service), and because the fear she harbored (which her family revealed after her death) that to admit to psychiatric hospitalization would end her medical career.  This fear was not unfounded (see preceeding paragraph and Licensure and Employment Considerations section below). For decades, medical boards used admission of having ever experienced any type of mental illness as an indication for further examination and discipline, and questions regarding such conditions actually increased during the decade following a New Jersey decision pointing out the ADA problems inherent in pursuing them. [55]  Sadly, many boards still do so, despite a 2018 Federation of State Medical Board (FSMB) policy [56]  that inquiry about any medical condition that does not impair CURRENT ability to practice is discouraged. Such questions are violative of the ADA; yet there were at last analysis, only two state boards that avoid such questions altogether. [57]  

Marriage is in most populations considered to be an effective buffer to emotional distress. This does not seem to be true for women physicians. [34, 32]  It is believed that physician divorces are less frequent compared to the general population, but marital problems are common, perhaps in part because of the tendency of physicians to postpone addressing marital problems and to avoid conflict in general. [39] Marital problems, separation, or divorce can certainly contribute to depressive symptoms, which can increase the likelihood of suicidality if unaddressed.

Physicians are a "high control" population (along with law enforcement, lawyers, and clergy), and situations that decrease physicians' ability to control their environment, workplace, or employment conditions predictably play a greater role in physician suicide than they do in lower control populations. [34]  The massive changes that have taken place in medicine in the past several decades, leading to increased workloads and regulatory requirements coupled with decreased ability to control income and address patient and provider safety (especially during Covid), as well as liability concerns, also predictably lead to higher levels of stress, job dissatisfaction, burnout, and depression in physicians. 

Litigation-related or regulatorily imposed stress can precipitate depression and, occasionally, suicide. [58, 59, 60] The suicide note of a Texas emergency physician, written the day after he settled a malpractice case, read, “I hope that my death will shed light on the problem of dishonest expert testimony.” [61] Some physicians have completed suicide upon first receipt of malpractice claims, after judgments against them in court, or after financially motivated settlements foisted upon them by a malpractice insurer solely in order to cut the insurer’s losses. Almost any settlement in a malpractice case is by law reported to the National Practitioner Data Bank. The existence of such reports is yet another source of distress and stigma that can contribute to depression in members of the profession, especially when settlement was imposed upon them by insurers in situations of no actual negligence. 

Physicians have attempted or completed suicide in response to employment discrimination relating to judgments or settlements or upon the realization that they are no longer able to practice because of discrimination by liability insurers who refuse to insure them because of past judgments or settlements or because of licensure investigations or limitations or National Practitioner Databank reporting, [62, 63]  or in the setting of forced institutionalization for multidisciplinary evaluation [51]  or treatment for mental illness and/or substance use (even when such a dual diagnosis has not been justified under medically accepted standards). [64, 65]


Problems with Treating Physician Depression

Many clinicians are uncomfortable treating fellow physicians, especially in the realm of mental health. [66] The “VIP syndrome,” characterized by well-intentioned but superficial or inadequate treatment based on collegiality and concerns about confidentiality, can detract from the effectiveness of therapy.

Mental health experts who have studied physician depression and suicide stress the fact that immediate treatment and often confidential hospitalization of suicidal physicians can be lifesaving—even more so than in other populations—because of restriction of access to lethal means coupled with supportive interventions. [67] Yet, the specters raised by this approach—the fear of temporary withdrawal from practice, of lack of confidentiality and privacy in treatment, or of loss of respect in the community—are often major impediments that hinder physicians from reaching out in a time of crisis and seeking effective treatment. [62, 68, 69, 70]

Physicians who have reported depression (even long in remission or for which they are receiving effective treatment) to their licensing boards, potential employers, hospitals, and other credentialing agencies have experienced a range of negative consequences, including loss of their legally protected medical privacy or clinical autonomy, abusive, repetitive, or intrusive examinations, [71]  including expensive inpatient evaluations [72] at out-of-state institutions that seem predisposed to linking psychiatric symptomatology to substance use [49] , licensure denial or restrictions, discriminatory employment decisions, practice restrictions, hospital privilege limitations, substance use monitoring (even absent a substance use disorder), and increased practice supervision. [46, 73, 74, 68, 69, 75, 36, 76, 45] . Individuals with longstanding and stable conditions such as bipolar disorder or ADD/ADHD with established treatment teams and longstanding individualized care plans have been required to change their regimens or discontinue treatment altogether, on the justification that previously prescribed medications might interfere with the random drug monitoring that is typically required under participant contingent contracts for licensees. [71]   

In addition to disrupting life and care plans, such discrimination can immediately and severely limit a physicians’ livelihood as well as the financial stability of their family. Most physicians have heard or read details of unfair treatment experienced by other physicians at the hands of regulatory bodies or their agents, and in most cases neither physicians nor their families have any prior knowledge of their civil rights or legal constraints on employers' or agencies' actions. They may fear harms to reputation or adverse employment actions as a result of disclosure. For these reasons, well-meaning colleagues or family members who are concerned about or aware of the existence of depression sometimes discourage physicians from seeking help. Many physicians are privately advised by colleagues (with the best of intentions) that if they do seek help, they should do so anonymously, outside of their own health system and health insurance network, and to pay in cash, both to avoid breaches in confidentiality and possible reporting. [77]  

Licensure and employment considerations

Many medical licensure applications (both MD and DO) and renewal applications still require answers to impermissibly broad-based, time-unlimited questions regarding the physician’s mental health history without regard to current impairment, despite the fact that courts and the Department of Justice, Civil Rights Division have determined that such questions are problematic, specifically because resultant examinations and restrictions constitute discrimination under Title II of the Americans with Disabilities Act (ADA) based on stereotypes. [55, 78, 79, 80, 74, 81, 82, 83, 84, 85, 82, 57, 45, 86, 69]

There is as yet only minimal indication of awareness from either the Federation of State Medical Boards (FSMB) or from individual state licensure boards or their associated physician health programs that they, as Title II entities and/or their agents, are NOT exempt from federal laws that prohibit discrimination based on forced disclosure of or the presumption of disability (legally called the "regarded as" prong of ADA definition of disability) that is conferred by their application of the label "potentially impaired." Even quite recently, approved policies evince no consideration of the applicability of such laws as the ADA to their recommended procedures [87]  or any awareness of the fact that an ADA-covered entity such as a medical licensure board cannot legally outsource its federal anti-discrimination obligations to an entity such as a physician health program or preferred rehabilitation evaluation center that does not comply with the ADA because the law prohibits delegation of such duty to a noncompliant entity. The trade association of PHPs, the Federation of State Physican Health Programs (FSPHP), seems unaware of their compliance obligations to ADA requirements or even the fact that physicians are protected by this statute. Legally, physicians are protected from discrimination under the ADA when they are merely treated or "regarded as" beng disabled by being wrongly labeled as having a condition that is "potentially impairing," and NOT solely when they meet a colloquial or medical definition of having a disability, a distinction that is widely misunderstood. [88, 89, 90]  An interesting fact is that even the threat of reporting of an ADA-protected physician "participant" deemed "noncompliant" with their contingent contract with a PHP to a regulatory agency for possible licensure action actually constitutes a form of retaliation, which is also prohibited by the ADA. [91]   Contrary to what may be believed by physicians who are being contracted into such programs, settled law also prohibits giving consent (through, for example, a contract) to violation of federal civil rights to protection from discrimination.  

Most states have physician health programs typically under contract with the medical licensing authority. Many states, if not most, have for years maintained regulations that allow a physician voluntarily enrolled in a physician health program who is compliant with treatment to check “no” on mental health treatment questions on licensure applications.  However, physicians who are contemplating or in need of treatment are mostly unaware of such provisions. Dr. Breen's reported lack of awareness is typical. The Lorna Breen Act [92] (described in more detail below) allows for federal funding for programs addressing the problems of physician burnout, mental health, and suicide; and many organizations are in the process of applying for such funding. Unfortunately, this act has seemingly ushered in a spate of new state legislation heralding (now renamed) "safe haven" non-reporting provisions that purport to newly protect voluntary participants in physician health programs. However, such legislation typically also contains unrelated "riders" (and sometimes are even titled revealing the intent of) guaranteeing legal nondiscoverability by courts of program actions and minutes, and concomitant civil immunity to those managing, working in, or consulting with physician health programs.  However, it is unappreciated that when state legislation hinders discovery of violations of federal law, it cannot legally be enforced.  

In order to avail themselves of "Safe Haven" non-reporting protections being reintroduced in these state laws, physicians must typically agree to a contingent contractual agreement following guidelines to Physician Health programs issued by the FSPHP. Conditions of participation require strict compliance with all incorporated terms, including monitoring and strict abstinence (even without any diagnosis of, or when lacking medically recognized criteria for, a diagnosis of subtance use). [89] Failure to strictly comply with each and every contingent contractual term impliedly and contractually constitutes consent to reporting of such "noncompliance" to the associated licensure board, which can then mandate restriction of practice or loss of license, if protections that are federally afforded by the ADA are disregarded. The FSPHP/FSMB definitions of "noncompliance" are remarkably broad. [89]  The Federation of State Medical Boards in its revised 2021 Impairment Policy [87]  incorporates by reference these FSPHP guidelines, despite ample evidence of their lack of ADA compliance.  Neither document evinces any awareness of ADA, section 504 of the Rehab Act, or 42 CFR Part 2. Even the nondiscrimination statements in these policies noticeably omit the clause "discrimination against persons with disabilities." 

Most physicians are led to believe that any state agency or treating physician has the right to, and they therefore assume correctly that such entities will, share confidential information about them to the licensing authority with impunity. Largely, this mistake results from their signing, without benefit of ADA-informed legal review, contingent contracts as a standard requirement of physician health program "participation." [93] This is a powerful inducement to unquestioning compliance with all terms by participants. However, such sharing may well be violative of physicians' federal civil antidiscrimination as well as privacy rights.  

With respect to employment, abrogation of terms regarding any lack of disclosure on an employment or credentialing application of mental health or substance use treatment could be used as grounds for non-hiring, termination, practice limitation, or de-credentialing of a physician. Furthermore, disclosure of such conditions or treatment could also result in reflex referral to a physician health program. Referral by an employer of more than 50 employees to an entity whose policies are discriminatory is in itself a violoation of federal anti-discrimination law such as ADA. If the entities involved receive any federal financial assistance (eg, any employer that accepts governmental payment for medical services), such discrimination is prohibited by Section 504 of the Rehab Act and can result in loss of all such funding. Furthermore, costs for any medical fitness for duty examination required by an employer is under ADA Title I interpretive guidance and case law legally the obligation of the employer. [94]  

Insurance concerns

Discrimination in obtaining insurance coverage is a common but little publicized problem for physicians with mental illness [1] . Health, disability, life, and liability insurance may all be denied to a physician who admits ever having experienced a mental health condition such as depression or treatment. Since these are private entities, this type of discrimination is probably not covered by anti-discrimination laws. Inability to procure liability insurance effectively precludes medical practice in most states.  

Even if disability insurance has previously been procured, its use may subject physicians to repeated humiliating and invasive examinations by  “independent medical examiners” for the insurer, whose motivation is to cut company losses. Many physicians affected by mental illness feel that insurers expect them to adhere to the standard prescription “physician, heal thyself.” When they attempt to do so, or refuse help-seeking because of such policies based on liability avoidance by insurers, they may be risking everything.  Suicide may seem to be a reasonable alternative.  


Despite the protections afforded by law to citizens and equally to professionals with disabilities, the potentially devastating effects triggered by a physician’s self reporting of depression may delay or, in effect, preclude seeking appropriate treatment.  

Although everyone knows that a doctor who treats themself "has a fool for a patient,” we also know that most physicians treat themselves anyway, at least on occasion. This is especially likely when the physician believes that the consequences of seeking treatment may subject them to stigmatization, shame, illegal inquiry, and evaluation or treatment by entities that are not aware that they are discriminating in contravention of law.  Investigative reporting and personal and family sharing has shown that physicians can be impoverished, [49] forced to leave practice [95] or change profession [50] , or even driven to suicide [51]  by policies and patterns of practice that have been allowed to govern continuing licensure, often with in disregard of applicable federal laws.  

Because many states require reporting by other licensed physicians of a physician who may be suffering from a potentially impairing condition, physicians can be reluctant to seek treatment from known colleagues, or from utilizing their insurance coverage, or even from using their own names when seeking treatment. A physician whose thought processes are clouded by depression and the anticipated consequences of seeking treatment for it could not be blamed for honestly believing that self-treatment is the only "safe" option (although self treatment except in emergency situations is proscribed by most state Medical Practice Acts). One analysis of physician suicide data relative to nonphysician victims revealed a much lower prevalence of antidepressant medication in the blood of physician victims, which is an objective indication of the truth that physicians do not receive mental health care in proportion to their need. [34] Too often, attempts at self-treatment even by specialists knowledgeable about the area of medicine being treated are unsuccessful. Failure to obtain consultation and treatment for depression both needlessly and significantly increases the risk of physician suicide.


Depression in Medical Trainees

Prospective medical students and residents are extremely unlikely to report a history of depression during highly competitive selection interviews or application essays because of antiicipated stigma. [21]  Those who have sometimes report immediate negative repercussions. The prevalence of depression in these populations and in medical student and postgraduate trainees is unknown, but it is estimated to to be in the range of 15%–30%. [11, 12, 13, 14, 4, 96, 5, 7, 97, 98, 99]  After accidents, suicide is the most common cause of death among medical students. In one study, 9.4% of fourth-year medical students and interns reported having suicidal thoughts in the previous two weeks. [12]  

One report has suggested that depression is not uncommon in pediatric residents (up to 20% self-reported in 3 programs). This preliminary study found that residents who experienced depression may be as much as 6 times more likely than nonaffected controls to make medication errors. [100] Other studies have confirmed the association of depression with self-perceived medication and other errors. [101] Recently, skyrocketing rates of burnout being reported among physician trainees and physicians have garnered attention. [102]  Although burnout does not necessarily lead to depression, some of the symptoms are similar. Severe burnout has been associated with suicidal ideation, and burnout probably coexists with or contributes to the development or onset of depression in some of those who are predisposed. 

Stressful aspects of physician training—such as long hours, having to make difficult decisions while being at risk for errors due to inexperience, learning to deal with death and dying, frequent shifts in workplace, and estrangement from supportive networks such as family—predictably add to the tendency toward depressive symptoms in trainees. Each and every one of these factors has been greatly exacerbated by Covid.  

Harassment and belittlement by professors, higher-level trainees, and nurses contribute to mental distress of students and development of depression in some. [103]  Reports of such treatment, including even assaults by patients (especially of minority trainees) have increased during Covid. [104]  Conversely, even positive workplace changes, such as translocations to secure desired training or job advancement, can contribute to job-related stress. Suicide in medical trainees is most likely to occur just prior to beginning clinical rotations or prior to or at the beginning of residency. 

Suicide awareness can have a dichotomous effect on students. Those with no experience may harbor negative attitudes towards suicidal patients. Those with knowledge or experience (eg, familial) may view it as a more normal phenomena. There may be a correlation between better education of and care for students and physicians regarding depression and suicidality and their care for depressed or suicidal patients. Some schools are implementing programs to recognize and deal with depression and other stresses in medical trainees. [83, 105, 13, 106, 107, 4, 98] The American Foundation for Suicide Prevention has created a video on the topic for physicians and other medical trainees and much additional information and reference to resources. [40, 108]  The Office of the Surgeon General, [109]  National Academy of Sciences, Engineering and Medicine (NASEM) aka NAM, [110, 111]  AAMC, [97]  ACGME, [112]  and AMA [113] , among others, have made safety and wellbeing (including burnout prevention) for medical providers and trainees and mental health key organizational priorities in the wake of Covid.  


Education, Resources, and Recent Developments

Depression, like substance abuse, is at least as common in physicians as in the general public but also more readily treatable, as a rule. This is because of physicians’ strong self-motivation to continue successful pursuit of a professional calling, which is an important source of their self-esteem, and well-founded concerns about continuing licensure. There is no reason to believe that physicians would not welcome treatment for depression and other common mental health conditions, if they felt safe in doing so. The notion that physicians are more resistant to treatment, especially for substance use, is patently false and predicated on financial considerations, according to a co-founder of what is now the American Society of Addictions Medicine. [114]  There is also no justification for the contention that physicians require more intensive evaluation or treatment than normal citizens. In fact, extensive evaluations beyond what is required to determine the existence of an impairment whose negative effects are job-related or consistent with business necessity, or that constitutes a direct threat to self or others, are prohibited by various sections of the ADA. Contrary to a commonly repeated but false meme, unless they are employed in several designated federal agencies or are so designated by state law or employment contract, physicians are not "safety-sensitive" workers as legally defined. They are not exempt from the protections of anti-discrimination law.  Physicians may have a "higher calling," but we deserve no less stringent protection from discrimination based upon this calling.

More education is needed regarding physician suicide and its disproportionate and needless toll on the medical profession, beginning in the earliest stages of physician training. [115] In addition, there is an urgent need to change the attitudes of those in health care (including those in the regulatory system), as well as the attitudes of the general public, toward common mental illnesses such as various forms of depression and anxiety. Such changes might encourage physicians to be more receptive to a mental health diagnosis and enable them to feel free to seek treatment privately, without fear of stigma or potentially profound financial and regulatory repercussions.

Physicians do need to be aware of the existence of physician health programs in nearly every state and province. But they also need to be circumspect in dealing with these agencies and to proceed with caution and full knowledge of the PHP process and their civil rights before entering into participation contractually because of the risk of being entailed into substance abuse programs, even if no concomitant substance use disorder exists. [116, 81, 95] If mandated into such a program while suffering from a legal disability such as depression and/or substance use in treatment or remission, or when incorrectly regarded as having one of these conditions, or before volunteering to participate in such a program, obtaining legal advice from an attorney with demonstrated knowledge and experience in employment law (and especially the ADA) is highly adviseable. Unfortunately, many lawyers who specialize in licensure defense are former counsel for licensure boards, and some may have insufficient knowledge of or inclination to learn about the applicability of anti-discrimination laws to licensure situations. [117]  

The American Medical Association has had numerous directives from its House of Delegates to work with the FSMB and FSPHP to study barriers to effective utilization of physician health programs, including education, and was directed in June 2021 to survey these programs and licensure boards on their use without penalty or licensure restriction if they choose standard-of-care medication for opioid use disorders (MOUDs). The survey, however, is not yet organized, and it is unclear as yet what if any effect these efforts may have on physician willingness to seek help for mental illnesses and/or substance use disorders that may predispose them to suicide. A December 2021 FSPHP position statement [118] still illustrates lack of understanding of ADA applicability to physicians with opioid use disorder in treatment, and conflicts dramatically with the recent drive announced by the DOJ [119]  to assure that ALL those who are in publicly administered programs are entitled to the full spectrum of standard of care MOUD.  Several medical professional organizations have voiced strong support for MOUDs in clinicians, but there is clearly still great resistance to the full spectrum of standard-of-care treatment by both FSMB and FSPHP, despite strong indications from the DOJ that denial constitutes discrimination against (legally defined) disabled individuals, including individuals with substance use disorders in treatment or remission. The Indiana State Nursing Board has recently been fined, including compensatory damages, for denying such treatment to licensees. Medical professionals, including physicians, are equally protected by the ADA. 

Promisingly, all medical professional and related organizations have acknowledged that there is an emerging crisis of burnout in physicians and medical trainees, as well as other health professionals, and are taking concrete steps to address the burnout component that can contribute to suicidality, even absent depression. 

In 2022, President Joe Biden signed the Dr. Lorna Breen Health Care Provider Protection Act (H.R. 1667). The bill, supported by many such organizations, establishes grants and supports other activities to improve mental and behavioral health among healthcare providers, health profession students, and residents. It is named for Lorna Breen, MD, who led the emergency department at New York-Presbyterian Allen Hospital before she died by suicide in 2020 during the early phase of the Coronavirus pandemic. The Act stipulates that the Department of Health and Human Services (HHS) must award grants to hospitals, medical professional associations, and other healthcare entities for programs to promote mental health and resiliency among healthcare providers. The bill also directs HHS to study and develop policy and education programs for improving mental and behavioral health among healthcare providers, removing barriers to care and encouraging professionals to seek support and treatment, and determining best practices for preventing suicide and promoting resiliency. [92]  HHS will be mindful of federal antidiscrimination laws as it considers and evaluates the implementation of grants to existing and future policies and programs. As previously mentioned, under Section 504 of the Rehab Act, [120, 121]  any program receiving federal financial assistance must abide by all applicable federal laws and regulations, including those protecting ALL persons from civil rights discrimination.  

For further information and resources related to physician depression and suicide, see the full reference list and especially the American Foundation for Suicide Prevention (at