Throughout your career, you may hear some people refer to you and your colleagues as "invincible heroes." If you’re like a lot of physicians, you may find yourself reveling in this recognition—and rightly so.

But the truth is that physicians aren’t invincible. In fact, many physicians may be at a higher risk of mortality due to factors like suicidal ideation, job strain, and, of course, unforeseen pandemics. In 2020, MDLinx investigated a list of top causes of death among doctors.

 

Top cause of death: Suicide

 

Despite their responsibility to do no harm to others, physicians are at an increased risk of suicide and suicidal ideation when compared with the general population.

According to a 2023 article published by the AMA, suicidal ideation among doctors is largely associated with medical errors and a large workload, while suicide itself is linked to depression, emotional exhaustion, impaired relationships, and other factors.

Preventing physician suicide. American Medical Association. May 10, 2023.

 

 

A 2021 study published in Mayo Clinic Proceedings examined suicidal ideation among physicians and their attitudes toward seeking help.

Shanafelt TD, Dyrbye LN, West CP, et al. Suicidal ideation and attitudes regarding help seeking in US physicians relative to the US working population. Mayo Clinic Proceedings. 2021;96(8):2067–2080.

 

Researchers used data from a secondary analysis of a cross-sectional survey of US physicians conducted between October 2017 and March 2018. A total of 5,197 physicians (17.1%) completed the survey.

 

Finally, for workers between the ages of 29 to 65 years, suicidal ideation was more common among physicians (7.1%) than for individuals in other fields of work (4.3%).

The impacts of suicidal ideation and suicide on physicians is more clearly seen in the number of doctors who die by suicide each year. According to the American College of Emergency Physicians, that number is between 300 and 400 in the United States—an approximate average of 1 death each day.

Matheson J. Physician Suicide. American College of Emergency Physicians. 2023.

 

Given these statistics, how can physicians reduce their risk of suicidal ideation and suicide-related mortality?

 

Suicide prevention methods

According to the 2023 AMA article, suicide prevention among doctors rests on physicians and the organizations they work for.

For example, it’s crucial for doctors to recognize the value of implementing self-care habits. 

 

Healthcare organizations, on the other hand, can encourage mental health maintenance among physicians by creating a supportive atmosphere. This is especially important for doctors who are in distress. By providing them with physician advocates, healthcare organizations can point those in need to proper support services.

 

Number 2: COVID-19 (2020-2021)

 

The next top cause of death among physicians is related to COVID-19. A 2023 article published by JAMA Internal Medicine looked at excess mortality among doctors due to COVID-19.

Kiang MV, Carlasare LE, Israni ST, et al. Excess mortality among US physicians during the COVID-19 pandemic. JAMA Internal Medicine. 2023;183(4):374–376.

 

Researchers used the AMA Masterfile and corresponding Deceased Physician File to estimate monthly mortality among doctors between the ages of 45 and 84 years from January 2016 through February 2020. Based on these statistics, they were able to calculate the differences in expected and observed physician mortality between March 2020 and December 2021.

During that year and a half, a total of 4,511 physicians died, amounting to 622 more deaths than expected. Older physicians experienced a higher rate of excess mortality when compared with younger, active doctors.

Furthermore, there were zero excess deaths after April 2021, when COVID-19 vaccines became widely available.

Lindsey Carlasare, MBA, research and policy manager for the AMA and co-author of the JAMA article, explained the clinical significance of these findings in response to the AMA news report. “Beyond the deaths directly attributable to the virus, we see the extended impact by quantifying the number of physicians deceased beyond what would have been expected under normal circumstances,” she wrote.

Berg S. New study tallies excess physician deaths during early pandemic. American Medical Association. February 7, 2023.

 

 

Highly effective protocols

 

The good news is that experts are more confident than ever in COVID-19 prevention protocols.

The JAMA Internal Medicine article states that because active physicians had lower excess mortality than their non-active counterparts (despite being more likely to contract SARS-CoV-2), workplace-based protective measures such as PPE use, vaccine requirements, adequate staffing, and infection prevention protocols proved highly effective in preventing the spread of COVID-19.

“Our findings demonstrate not only the tragedy that is the hundreds of physicians deceased due to COVID-19, but it also adds to the body of evidence showing that reasonable measures, such as providing adequate access to PPE, infection-prevention protocols and better staffing are integral in preventing excess mortality,” Carlasare said.

 

Number 3: Peripheral artery disease

 

Lastly, research shows that doctors in the US may be at higher risk of another disease that is seemingly linked to job strain, which some doctors are all too familiar with.

A study published by the Journal of the American Heart Association examined the role of job strain as a risk factor for peripheral artery disease (PAD).

Heikkilä K, Pentti J, Madsen IEH, et al. Job strain as a risk factor for peripheral artery disease: a multi‐cohort study. JAHA. 2020;9(9):e013538.

 

Of the 139,132 participants who weren’t previously hospitalized with PAD, researchers found that 23.4% reported job strain at baseline. 

They also found that job strain was linked with a 1.41‐fold (95% CI, 1.11–1.80) increased average risk of PAD requiring hospitalization.

The authors elaborated on the significance of this study: “Physicians in occupational health and primary care need to recognize work‐related stress as a risk factor for many cardiovascular disease outcomes, including peripheral artery disease.”

 

Mitigating symptoms of burnout

 

 

According to an article published by the Agency for Healthcare Research and Quality, a range of interventions designed to improve communication, adjust workflow, and address clinician concerns are available for physicians to employ.

Physician Burnout. Agency for Healthcare Research and Quality. February 2023.

 

For example, healthcare organizations could schedule monthly provider meetings focused on work-life issues and clinical topics, and survey physician staff members to determine what issues they’d like to see covered at those meetings. 

In addition, physicians may benefit from increased technological support, a reduction in required activities, and time in the work day dedicated to completing documentation tasks. 

Finally, flexible scheduling and support for striking a sustainable work-life balance may also aid physicians in their efforts to minimize burnout and associated life-threatening diseases like PAD.