Why Would a Promising Young Physician Take His Own Life?

—
The loss of William West Jr. forces us to consider the role of health systems in staff well-being

by
N. Adam Brown, MD, MBA, Contributing Writer, MedPage Today
October 15, 2024

Medicine is a calling — a career filled with purpose. Why, then, would a promising young physician, one on track to be an ophthalmologist, take his own life?

The Washington Post asked essentially that question in a recent investigative report surrounding the suicide of William Ballantyne West Jr., MD, an ophthalmology resident at George Washington University (GWU) Hospital. For those of us who know the system, the answer to that question has never been opaque: for doctors, clinicians, and nurses, there is a stigma to admitting mental health struggles. Indeed, there is outright fear of losing licenses, reputation, and trust. Add to that limited access to behavioral health resources, long hours, and high-stress jobs, and the mix is, all too often, deadly. West’s suicide letter plunges the depths of provider despair, shedding light on the pressures and hopelessness too many like him have felt.

Suicide rates among many types of healthcare professionals are higher than that of the general population. For female physicians, rates of suicide are 250-400% higher than women in other professions. Nearly 30% of medical students are depressed and over 50% of residents across all specialties are burned out. (In my specialty of emergency medicine, over 60% of physicians are burned out.) Data from the American Foundation for Suicide Prevention estimate that about one doctor dies by suicide every day in the U.S. Residents and fellows, like West, are among the most vulnerable. Forced to work 80 hours a week, they must juggle demanding study schedules outside of clinical hours, all while having limited time to seek care for themselves. This exhausting routine leaves little room for anything other than survival.

The system is broken.

Much attention has been paid to the need to address the stigma that providers face. But I also believe hospitals must take some of the blame for the 50-year rise in provider depression and suicide.

Hospital Culture and Business of Healthcare Drive Burnout

In a statement after West’s death, the administration at GWU Hospital said, “The safety and well-being of GW students, faculty, and staff — including our residents — is the university’s highest priority,” adding that the institution offers “resources to support the physical, emotional/mental health, and overall well-being of residents — including confidential counseling at no cost.” The hospital has since offered counseling sessions via Employee Assistance Programs (EAP) and platforms like Talkspace.

But let’s be clear: these words ring hollow to me.

The culture in medicine demands perfection, perpetuates a fear of disclosure, and often stigmatizes those who admit they need help. Requiring clinicians to go through an EAP to get behavioral healthcare is part of the problem. It is the “employee” part that’s most telling — when physicians and nurses fear that disclosing their mental health condition could result in being flagged as a problem or even fired, they hesitate to seek help.

The unfortunate truth is that the business of healthcare often drives significant burnout. Hospitals leverage residents and fellows as low-cost units of production, receiving substantial funding from CMS to cover these training positions, only to pay the residents less than the reimbursement they receive.

This setup is not just financially advantageous for the institution; it is exploitative.

Some system stakeholders try to justify the long hours and low pay. “On one hand, residents work long hours and contribute significantly to the care of patients. For this they receive a stipend,” Janis Orlowski, MD, chief healthcare officer at the Association of American Medical Colleges (AAMC) has explained. “On the other hand, they’re apprentices who are receiving very valuable training that is expensive for institutions to provide.”

The training is valuable, but outside of medicine, how many “apprentices” or trainees work more than 80 hours a week? (To be sure, clinicians do require more training than other professions, but the opportunity to train should not demand a person sacrifice sleep.)

Instead of nurturing the next generation of healthcare providers, the current system often sets them up for years of abusive behavior. “Here is why this is so frustrating for prospective doctors: To practice medicine, trainees are required to complete a 3-to-7-year residency at an accredited hospital program,” a 2019 Slate article explained. “Unlike the traditional labor market, medical students don’t choose where they work; they are assigned and locked into multiyear employment contracts with a single hospital.”

We drive doctors and nurses into the ground, leaving them to struggle with the weight of unrealistic expectations, fear of reprisal for seeking help, and little to no time to heal.

Changing the Conversation: We Must Do Better

The current system does not harm only providers. As Kaley Kinnamon, MD, a resident at the University of Vermont Medical Center, told the AAMC, “In order to take good care of others, we need to be able to care for ourselves … We love being residents and caring for patients. But we can’t do that well if we neglect ourselves.”

Hospitals can debate fair pay versus the value of training, but they cannot deny the system is not helping the patients they serve.

Healthcare executives, administrators, and policymakers need to ask themselves tough questions. How can we claim to prioritize the well-being of our clinicians when the very structure of our system discourages them from seeking help? In the memory of West, Lorna Breen, and the 300 to 400 other physicians who will die by suicide in 2024, and in support of every physician and nurse silently battling anxiety, depression, and burnout, we need to create meaningful change.

Drawing from guidelines by the Dr. Lorna Breen Foundation, hospital administrators, policymakers, and professional organizations must:

• Normalize Mental Health in Medicine: Stigma thrives in silence. Mental health diagnosis and treatment should be as openly discussed as physical ailments like diabetes and hypertension.
• Acknowledge Doctors and Nurses Are Human Too: It is time to remind doctors, nurses, and administrators that clinicians are not immune to mental health issues. They are not superheroes; they are people who need compassion, understanding, and support.
• Remove Mental Health Barriers in Credentialing: Intrusive questions about mental health history during the hospital credentialing process must be eliminated. These questions create unnecessary barriers to care and perpetuate the stigma surrounding mental health treatment.
• Empower Residents with Knowledge and Resources: Residents must fully understand their healthcare benefits, where they can receive care, and that they have paid time off to seek the help they need without fear of repercussions.
• Fix Job-Related Stressors: Providers deal with death and dying every day. We need to build a community of support around our healers, and we need to fairly compensate them for their work. Policymakers who are not fighting for fair reimbursement rates are part of the problem. It is also time to address workplace violence.

The tragedy of West’s death should not be in vain. It should serve as a wake-up call to all stakeholders that our current efforts are insufficient. It is time to move beyond hollow statements and shallow offers of support. We must build a healthcare culture that genuinely prioritizes the mental health and well-being of its workforce, without fear of stigma or career consequences.