Alarms go off so frequently in emergency rooms, doctors barely notice. But when a colleague is wheeled in on a gurney, clinging to life, that alarm becomes a deafening wake-up call.

For Dr. Kip Wenger, that colleague was a friend, a 33-year-old female physician.

Wenger is a regional medical director for TeamHealth, one of the country’s largest emergency room staffing companies, based in Knoxville, Tenn.

“It’s devastating,” he said. “This is a young, healthy person who has everything in the world ahead of them.” His friend had confided in a few co-workers about recent relationship struggles, but none of that had affected her work.

The medical profession treats doctors and medical staff like highly trained endurance athletes conditioned to clock long hours, and ignore the fatigue and emotional toll of their work.

But, for many in the profession, that day-in-day-out stress can lead to crippling depression. It’s one reason doctors are far more likely than the general population to die by suicide.

Doctors with suicidal urges also know exactly how to end their own lives.

Wenger remembered his friend as a confident professional he’d worked with in emergency rooms all over Knoxville—including the one where she died. That day three years ago still makes no sense to him.

“She was very strong-willed, strong-minded, an independent, young, female physician,” said emergency doctor Betsy Hull, a close friend. “I don’t think any of us had any idea that she was struggling as much personally as she was for those several months.”

That day she became part of a grim set of statistics.

A Harsh Reality

An estimated 300 to 400 doctors kill themselves each year, double the rate of the general population, according to a review of 10 years of literature presented at the American Psychiatry Association annual meeting in May.

For TeamHealth, the young woman’s death in 2015 sparked deep soul-searching.

TeamHealth held listening sessions and realized that burnout was rampant. They began encouraging doctors to work less. TeamHealth co-founder Dr. Lynn Massingale said the company average is now close to 40 hours a week—though there’s no avoiding nights and weekends in the ER.

The company also started a new protocol for one of the most stressful times in a physician’s career: when doctors are sued. The company pairs them with someone who has been there.

“We can’t change the facts. We’re not coaching you to change your memory,” Massingale said. “But we can help you deal with the stress of that.”

And TeamHealth is trying to reduce bureaucratic headaches, including hiring scribes who follow ER physicians and enter information into sometimes finicky electronic health records.

Dr. Jeffrey Zurosky, an ER director at Parkwest Medical Center in Knoxville, said he’s concerned for his youngest doctors who start out with a mountain of med school debt, eager to pick up as many shifts as possible.

“I tell them: Be balanced. Don’t overwork yourself. Spend time with your family. Stay married, if you can,” Zurosky said.

Yet to some in the medical community, the problem is far more fundamental than burnout. Pam Wible doesn’t even like the term since it suggests physicians just need to find ways to cope. The family practitioner from Eugene, Ore., said it starts in medical school. Entrenched ideas, like muscling through long hours on little sleep, are hard to break. Wible calls it abuse.

“These people who have been previously abused are now the teachers,” she said. “They’re teaching the next generation of doctors.”

Too Close to Call for Help

When physicians do want help, the industry makes it difficult. Wible said they can’t go see a psychiatrist without jeopardizing their medical license.

“I know a lot of them,” Wible said. “They’re having to sneak out of town, pay cash, and use a fake name to do it. Why are we putting these people in such a situation?”

Wible set up an anonymous helpline and has collected more than 900 stories of doctor suicides. She has inspired physicians to share their experiences, including an emergency doctor in Ohio.

“You don’t focus on the 99 you save,” that ER doctor said. “You end up focusing on the one that you lose.”

The doctor’s name is withheld to protect his career.

The one he lost was 19 years old and came in with the flu. Tests didn’t show anything unusual and he sent her home. She returned in cardiac arrest and died. The doctor fell into a dangerous depression.

“Like all doctors, you put that Superman cape on and you think you can get through it,” he said.

The family filed a complaint. Being told he might lose his job pushed him over the edge. He swallowed a lethal overdose but the police got him to a hospital in time.

This ER doc had treated many suicidal patients but never saw himself in their place.

“I didn’t know I was at higher risk of suicide than the average person,” he said.

Blake Farmer covers health care for Nashville Public Radio. This story is part of a partnership that includes Nashville Public RadioNPR and Kaiser Health News.

Categories: Treatment Health