132. Breaking The Silence: The Truth About Suicide In The Medical Field

You will never make someone feel worse or feed their suicidal thoughts by asking them. It's quite the opposite. So don't be afraid of having the conversations. Know the warning signs.

Are you a woman in medicine feeling overwhelmed and disconnected from the personal fulfillment that you desire? You're in the right place. Join doctors Joanne and Erin as they rewrite the rules for women in medicine.

Let's begin during our recording of this session. It will be released in September. And today I'm going to be interviewing my Amazing Co host, Dr. Joanne Sotelo. And we're going to be talking about a very serious issue today, that of physician suicide. And we have talked about this before. In episodes 27, we talked about mental health and physicians. Episode 28, we talked about physician suicide awareness. And during September the whole month is dedicated to suicide awareness. And we want to specifically talk about that related to physicians. Joanne, I'm so appreciative that you are such an expert at talking about this and really want to know why does this conversation matter so much?

Thank you, Erin. And we love bringing topics that are inspiring and personal development and motivating inspiring. And it is very important for us to also talk about this more serious topics that we don't always talk about. And as physicians we spent years learning how to save lives, but somewhere along the way we forget to protect our own. And it this is so, so important. And we talk about self care so much and these numbers kind of vary but if you think about it, every year we lose more than a medical school's worth of physicians to suicide in the United States. Imagine the ripple effect not only in our hospitals, but in our families, communities and the patients lives. And I have a little bit of data to share. I've tried to do a little bit of research to see if there was anything new. So these are the numbers that we've heard a lot that it's an estimation of about 300 to 400 US physicians die by suicide each year. And it's roughly double the rate of the general population to give some perspective. And it's just a horrible number. And there was a study published at the JAMA Psychiatry Study and it was released this year, February 2025. And it analyzed data from 2017 to 2021. And this was a good distinction, kind of sad, but important for us to know that female physicians face a 53% higher suicide rate than female non physicians. And those numbers were not as bad for male physicians. But again, this is the awareness that we need to have another that it touches my heart especially Knowing that my kid will be going to medical school and eventually to residency. There was a two reports that I could find, one in Medscape and another one in JAMA as well, both published just a couple of months ago in 2025, in May. And it showed again another story study from 2015 to 2021. And it said that suicide was the leading cause of death among U.S. medical residents. And that's just, I don't know, my heart hurts hearing that. And another report that I was able to see, also published this year, talked about how I think it was published in Medscape, if I'm remembering correctly, that 15% of U.S. physicians reported having contemplated suicide. That number is higher than the last time they looked at it in 2023 where it was 9%. That's a 66% increase. So again, these are facts. This is not just things that we want to talk about. This is serious and we can't ignore it or we can just assume, oh, those people must have had problems or depression, anxiety. And, and of course, even though that might be part of it, we cannot see it as an as isolated event. We have to look at the big picture. And it's why Erin and I are here talking about this topic.

And I just want to also point out, you know, your own son is looking into going into medical or medical school. And many of my college friends, I see them posting their child is going into medical school or has entered residency. And I wonder what is their knowledge about these numbers? And as I've been mentoring medical pre med students and one is just starting medical school this past week and it's very exciting and yet I'm already hearing about there's stressors going on and I think there's also numbers that say it only takes about six months for medical students to join the ranks of depression and other mental health concerns. Just like attending physicians, it's only six months. And I think, okay, what are we doing in their training as medical students and residents in order to make an impact? And I'm actually going to be reaching out to my medical school to say, hey, what are you doing for your wellness program? And is there something that can be bolstered so we can mitigate those numbers that aren't in our kids in the next generation's favor? And Joanne, why are physicians uniquely vulnerable to this risk of suicide?

There are a few things that are particular to us as physicians. So there's a stigma, of course, a stigma in psychiatry that's in the general population. But for us, and we talked about that in this podcast, it's the fears because of our licensing, because it's changing hopefully. But a lot of states you still have to report if you not only are struggling right now, but if you've struggled in the past and then it's a completely set of evaluations and that you have afterwards. So there's a real fear that something might happen to your medical license if you report seeking help. So of course this is gets in the way of access and then another one is that for a lot of specialties it's easy to have access to lethal means and we have the medical knowledge. One of the higher numbers is in anesthesiologist and it's, you know, it's been reported that it's because of that like you have access to all this medications, you know, the dosing, you know how to inject them and horrible. There's also chronic exposure to trauma. And when we look at numbers reported throughout the years and especially for depression and burnout, physicians are up there with first responders and with the military and we see we're daily encountering suffering, death, moral injury. This is right, like we don't have a, you know, just to sit in front of a computer kind of work. So it takes a toll on us, it's part of our calling, it's in our hearts, but it, it also drains us mentally and emotionally. There's also other things that we've talked about in this podcast, right? Like it's a culture of perfectionism. So there's this such high internal and external expectations, self criticism, fear of failure, right. Like we're always strong and like I like to say that four letter word that starts with an F that gets us in trouble because or like we believe it, that we're fine, we're resilient, we're strong, I'm not supposed to seek help. And then of course our workload and burnout, the long hours, the administrative burdens, the emotional exhaustion. So in these things by themselves could be enough to put you at risk. But a lot of physicians have multiple risk factors to get into that range of depression, anxiety, burnout and start feeling hopeless and having the suicidal ideation and one thing fits the other and it's exponential and then we know that it impacts patients and systems, right? Like it's horrible that losing clinicians this way and how it affects the ripple effects in colleagues and patients, it's just tragic.

Well, a couple follow up things. We heard the impact from a patient's perspective when we interviewed Kim Downey and that was episode number 1 19, when she talked about her book, White Coats, Courageous Hearts, and many stories of physician struggles and overcoming those struggles. So get infusing some hope in here. Also in our next episode, episode 133, we're going to be interviewing Corey Feist, who has been doing something about physician suicide and is part of the Dr. Laura Breen Heroes Foundation. And one of the areas, again, about hope is I live in Oregon, and we actually got the mental health questions changed on our licensing. Many of the states are starting to have those changes. The foundation that Corey is a part of is working hard to get legislature changed. And it's not just the licensing credentialing, though, because you can get that change, but also then the insurance credentialing is a completely different set of questions. And so really going to the legislature, really trying to take action. And I've seen a trend since I started hosting retreats back in 2020 where providers were like, there's no way I would seek mental health services because of that worry about the licensing. And now it's so much more common for not only healthcare providers to be seeking some mental health support, but being vulnerable enough to talk about it. And that's something where, you know, when we can maybe normalize it and can talk about it, that's when we can do more about it. So I just wanted to infuse a little bit of hopeful information in there because I have seen some changes. And that, to me is inspiring that people are willing to ask for help. And so, Joanne, why else is it so important for us to talk about this topic?

We need to stop the suffering in silence. We've talked about that. Silence costs life. That's why we need to keep this open dialogue and because if not, we will continue to suffer in isolation. And I, I've been an advocate my whole career in terms of mental health. And even when I've struggled, I have to remind myself, this is what you talk about. You have to ask for, for help and say things out loud. So it's easier sometimes for us to say these things. But in your practicing what, what we preach and this stigmatization, if I'm pronouncing that word correctly, starts with visibility. It starts again with talking about these conversations like we just did right now, of sharing data and talking about changes and connecting with that hope in the future, like you just shared, Aaron. Right. Because we have to infuse these conversations with hope. I love that there are things that we can prevent, not a hundred percent, but suicide can be treatable. This is hard for me to talk about as a psychiatrist because I want to get so detailed about this, but because we've talking about risk factors, that's where we have room to grow. That's where we have room to do something about it. And. And especially if we can identify symptoms of depression or overt anxiety, PTSD burnout, we can tackle that ahead of time so that we don't cross that line where it starts to feel very hopeless. And then we start having not just the thoughts of suicide, but an intent and a plan. And we talked about it. It's not just an individual issue. I think that sometimes it's easier to think about it that way so that we kind of separate from it. We have to think about it in terms of how it is systemic and cultural and how we can address it as well.

And one of the areas I wanted to share is, you know, I worked in child abuse medicine for 10 years, and, you know, if you can't talk about those things, you can't do anything about it. Back in the day, I remember reading the beginnings of the Susan G. Komen foundation, and, you know, 30, 40 years ago, you couldn't even talk about having cancer, especially not one about reproductive organs. And you can't do anything about it if you're not talking about it. And then also that sense of community. And one of the beautiful things I love about Joanne and my coaching programs is we offer group programs and that sense of belonging when there's another person right next to you sharing so many similar struggles that you are, and you're like, oh, I'm not alone. I know when I started coaching other women, and I was like, oh, these aren't just Aaron issues. I'm not the only one that dealt with these issues. These women that I'm coaching, they're dealing with them too. And how can we better pivot what's going on? Not on our own, but doing it in community and in a safe space. And if you've reached out for help and it wasn't a great fit, then keep looking until you find that. And so the next thing I want to ask Joanne is, what can we do about it?

So there's. We can think about it in three ways. For yourself, if you're part of a bigger institution or a leader, and then also for a colleague. So for ourselves, and this is so good, no matter what, we have to normalize, check ins, asking ourselves from a very vulnerable place, how am I really? What do I need? All those things over and over. If you're struggling you can find confidential help. I know that we want to say that it shouldn't matter and that, you know, there's no stigma, but we also have to face reality. But there are resources that can be very confidential, and that's something that's also getting more like. We're. We're doing more for that, to provide confidential help for healthcare workers. And it could be peer support, it could be psychotherapy, it could be a psychiatrist. You can, you know, do hotlines, and we'll share some resources. In thinking about our own mindset, we have to challenge our ver. Like our own kind of invincibility myth and actually get in touch with our vulnerability as a strength and not a liability. And we had our episode with Dr. Michael Hirsch, and it was so beautiful the way he talked about vulnerability. And that was the last episode. Aaron is the guard of the numbers.

1:31 with Dr. For Michael Hirsch.

Thank you, Erin. And then I love talking about this because it's, I think, in our big brains, we sometimes think of the big plans, which are great, but then also connecting with mini micro recoveries, like short breaks, connection moments, sleep, hygiene, all those things that you've heard us talk about. So that's it for yourself, right? For physicians in general or, you know, of course, any professional. But so important, if you're an institution or a leader, that's almost like a whole episode on its own. But we can, like Erin said, challenge this licensing language. And I know that that's something that we're going to be talking some more in our next episode with Corey Feist, if I'm pronouncing his name correctly again, create confidential mental health services. I know that when physicians in the institutions I work with, they come to me. I always offer it. I said, I can see you in the institution. And I also have some psychiatrists and psychotherapists outside of the system if you wanted to see it a little bit more private. So we need to foster that also, you know, again, bigger conversations, but we have to address workload and kind of the this is how we've always done it mentality and more breaks and all those things, and also foster a culture of openness where you can share how you're feeling, ask for resources without fear that it's going to be used against you somehow, and then for colleagues. And this is one of my favorite things to talk about because I always say, and I say this also to my patients and the families of patients, you will never make someone feel worse or feed their suicidal thoughts by asking them Never. It's quite the opposite. So don't be afraid of having the conversations. So know the warning signs, especially if you see a colleague that's usually a little bit more social and they have their doors open regularly and, you know, you sometimes go to coffee and then all of a sudden they're are more isolated or they seem more serious, their head is down. You hear them complaining more than kind of that cynical voice or talking sounding very hopeless. Ask them directly, hey, what's going on? Or even if you don't want to talk about it, say, would you like to have. Go have some coffee at the end of the day? Or you bring them a plate of food and then you say like, I'm here. Do you want to sit down and talk? Some always open access to those conversations.

We had the episode with Don Vesalka about card writing. Right. And it can. A simple text, simple card, a simple, you know, just reaching out might be the one thing they needed that day to lift them out of hard circumstances. So it doesn't have to be complicated. You don't have to start a nonprofit like Corey Feist to do something big. A simple text once a week to a colleague can be a good start.

I love that. Yeah. So that's it for, for the. For colleagues, right? Like, know the warning signs, have the conversation and stay connected, even if it's by a small gesture. It's all important. It can make the biggest difference.

And I would love for us to share some resources with our listener. Joanne.

Yes. And we'll add this to our show notes. So this is the important one because this was something that a lot of us fought for. It's 988. So we have 911. 988 is a suicide and crisis lifeline. So this is very important. This is something that we should have in all of our clinics. Access. Easy. Memorize it because it's very helpful. There's a physician support line and the number, it's 1-888-409-0141. And it's free and confidential and it's staffed by volunteer psychiatrists. There's also more general things like NAMI, NAMI.org and it, it's full of resources and you can find resources local to you. And we are also going to Talk about the Dr. Lorna Breen Heroes Foundation. That's going to be our next episode. And it's doctorlornabreen.org and they talk a lot about advocacy and education and policy change and all those good things. I'm really looking forward to that next episode.

Thank you so much, Joanne. You have done an amazing job at sharing so many things to be aware of as a physician, as a healthcare provider, warning signs. And also, what can we do when we have concerns for ourselves or others? Be sure to check the show notes for all of those resources. And if you're in need of support, please reach out and take action. And with that, we'd love for you to stay tuned for our next episode with Corey Feist with the doctor Lorna Breen Heroes Foundation. Stay tuned.

Do you want exclusive resources and the opportunity to connect with us? Then visit createmeaninginmedicine.com now, where you'll dive deeper into how you can create meaning in medicine. And if you're serious about optimizing your results, take two quick steps now. Number one, connect with us on the website. And number two, tune in to the next episode.