Physicians face unique circumstances during their careers that may lead to depression; these include bullying, hazing, sleep deprivation, overwork, and medical board investigations—plus the repeated near-daily exposure to suffering and death. However, doctors also experience depression for the same reasons the general public does, says Pamela Wible, MD, Ideal Medical Care, Eugene, Oregon.
Dr Wible has been running a physician suicide hotline since 2012 and has had the opportunity to help hundreds of depressed and suicidal doctors. She also interviewed 200 physicians who have experienced depression during their careers. She asked what treatment they pursued and found that 33% chose professional help, 27% pursued self-care, 14% engaged in self-destructive behaviors, 10% did nothing, 6% changed jobs, 5% self-prescribed medication, and 5% chose other activities.
“Most physicians tried multiple treatments. Sadly, the majority of doctors I spoke with did nothing for months to years until they finally decided to take action—sometimes self-harm. Professional help was not generally first-line therapy,” said Dr Wible.
In a recent Medscape article on physicians and depression (Doctors and Depression: Suffering in Silence), Dr Wible described her findings. Her article sparked about 100 emotional responses from physicians, many of whom talked about their own struggles.
“Owing to the punitive nature of physician treatment programs, such as physician health programs (PHPs), and the prevalence of intrusive mental health questions on physician licensing, hospital privilege, and insurance credentialing applications, many doctors avoid seeking needed care,” says Dr Wible.
Sadly, many doctors continue to suffer with untreated or poorly treated depression.
A family physician pointed out that doctors are punished when they seek help for depression, saying, “It is sad how doctors with depression are treated by their own and by the public! The PHP encourages doctors with difficulties to self-refer but punishes them for doing so. Changes need to be made!”
One neurologist described the problem:
No other profession has the degree of intrusion with regard to healthcare that doctors have to suffer from. In residency, a resident friend of mine became depressed. She made the mistake of doing the correct thing and asking for medical care. This almost destroyed her future. I was the one who had to take random blood samples from her. It was humiliating and wrong. We both learned our lesson. The boards, licensing, and privilege questions are wrong. We are human and should be able to ask for medical care if needed. We doctors instead are subjected to a witch hunt with a 200-year-old attitude. Any other profession would be up in arms screaming discrimination; we take it.
Another clinician noted:
I believe that doctors and all healthcare professionals should be able to get the care that they need without censure. It appears heartless to me that a physician can recommend to a client the care needed, but that the way the system is set up, deny that same physician the care he/she requires. There is no health without mental health.
A psychiatrist advised, “I recommend psychotherapy, at least once a week. Eventually, I recommend time-limited antidepressant medication if it enhances psychotherapy; otherwise, avoid psychotropics.”
An ophthalmologist who sought treatment for addiction said:
I am 7 months from completing a 5-year contract with my state’s PHP. I am a bipolar recovering alcoholic. I am unable to recredential with health plans owing to a board order suspending my license. I have a stay of suspension, provided that I am compliant with the dictates of my monitoring contract. I couldn’t be where I am mentally or physically without their help. Onerous, yes, but a lifesaver in my case.
One psychiatrist described why so many physicians are having a hard time:
The number-one cause of burnout in physicians in my opinion is the loss of autonomy and the host of abuses foisted upon them by the system. Take the incredible burden, the responsibility, and the stress of being in charge of other people’s lives, and combine that with the utter disrespect and contempt with which doctors are treated, and what do you get?
Combine the conflict between the professional and ethical duty to do your best for your patient and being forced to do otherwise by businessmen so that they can profit, and the outcome is inevitable. The EMR is not only crazy-making but also offensive to a professional. Add to that work conditions that are intolerable and are forced upon the doctor by others. Many physicians experience an utter lack of control over their work….
“Most of the depression in medicine is caused by a lack of control,” noted a cardiothoracic surgeon, who continued:
You can’t control your schedule, your income, or your hours; you can’t pick your patients, and patients can’t pick you; and the people who designed this hell have given themselves a 35-fold pay increase while doctors’ pay has barely doubled (since 1970). Imagine how many of the stressors that currently plague physicians might be relieved if they had received a 35-fold pay increase? As a physician, you could have a truly private practice, determining who to see, and even who to charge. You could hire your own staff, operating room assistants, nurses, etc. How much less stressful would your life be if you could pick the material, drugs, sutures, gloves, and other equipment your practice requires to meet your specific requirements?
Still, respondents noted that there are still ways to be happy as a physician. “[T]here are plenty of physicians who have lives filled with joy,” said an internist, who noted further:
Happiness is fleeting, as the etymology of the word ascribes (happen). Depending on the field you decide to specialize in, there will be varying constraints on your scope of practice. But being an internal medicine guy with a Navy flight background and some tough times therein, I found that a fellowship in wilderness medicine helped to rejuvenate me, and that international and disaster/humanitarian medicine fulfilled me. And teaching, my old profession before med school, was something I needed to incorporate into my career again to bring back that joy of work.