Another look at physician suicide

By Michael D. Shaw May 22, 2017 @ Health News Digest

We first covered this topic back in 2014. The linked article went through the basics…

1. The annual toll is estimated at 300–400 per year, but many believe that this figure is low. Unless the circumstances of death are quite obvious, owing to its negative connotations, “suicide” is not a readily ascribed cause of death. Yet, how many “accidental overdoses” among drug-savvy physicians can one countenance?
2. Authorities speak of untreated depression among doctors, but also acknowledge that few physicians want mental health issues on their record.
3. The threat of malpractice litigation is cited, along with the frequently dicey outcomes of such cases.
4. The specter of crushing student debt; highly regimented clinical protocols–all geared to maximum coding (aka revenue enhancement); and the sad realization that they are little more than pawns of the insurance industry.

Outspoken physician Elizabeth Lee Vliet, suggests that the suicide rates have risen since the passage of Obamacare, with its added regulatory and financial pressures. As she puts it…

"Most doctors go into medicine truly committed to helping people who are ill and in pain. Today, doctors are under siege with outside forces preventing them from doing the very thing that means the most: taking care of patients. The sensitive and compassionate ones have an even harder time dealing with denials of care they know their patients need.” 

“The toll on doctors–and then patients–is getting worse daily. Insurance and government bureaucrats had best remember: at some point, we ALL will be a patient–that includes YOU. Dead doctors cannot save yourlife.”

In January, 2016, Forbes posted an article by healthcare visionary and entrepreneur Dave Chase entitled “The Story Behind Epidemic Doctor Burnout And Suicide Statistics.” In this ambitious 3400-word piece, Chase relates the story of Dr. X, who escaped a broken hospital system…

Under the hospital system, compared to his experiences in residency, physicians like Dr. X are not rewarded for their good intentions. “It was made clear to us by the administration that if we didn’t reach a certain quota of patients, it would affect our compensation.”

As such, the manner in which cases were coded on electronic health record systems was crucial. In fact, most of his time was spent interacting with a computer screen. Matters that probably could have been handled at the primary care level were referred out to save time–so that they could see more patients:

“I eventually started to realize that the monetary value of primary care physicians in the hospital system came through referrals. The more patients we saw, the more we would refer to specialists and order tests, both of which could get higher rates of reimbursement through insurance."

Even worse, Dr. X claims that aggressive coding, to achieve the maximum number of diagnoses, was especially applied to patients who had–according to administrators–more generous insurance plans. The docs were incentivized to set up medically unnecessary visits to secure this end.

Finally, Dr. X and two colleagues decided to leave the hospital system and start their own private practice using the direct primary care model. They were threatened with a non-compete lawsuit, which never occurred–ironically because the physicians were determined to use the direct primary care model, and this suddenly made everything cool with the hospital system.

Well-reviewed author and physician Michael F. Myers is Professor of Clinical Psychiatry at SUNY-Downstate Medical Center in Brooklyn, NY. Myers has specialized in physician health his entire career, and has lost a few doctors under his care to suicide.

His latest book, Why Physicians Die by Suicide: Lessons Learned from Their Families and Others Who Cared, is based on interviews of those close to doctors who killed themselves; as well docs who tried, but did not quite succeed in their attempts.

Myers notes that doctors will readily admit to burnout–since it is not in the Diagnostic and Statistical Manual of Mental Disorders, but will rarely admit that they have been diagnosed with depression, as it could affect their careers. Still, he encourages them to seek treatment, and notes that virtually all of them feel much better when they do, and wonder why they delayed it for so long.