Beyond burnout: Talking about physician suicide in dermatology
Authors: Michelle S. Lee, Vinod E. Nambudiri
Journal: Journal of the American Academy of Dermatology (2021)

Physician suicide made headlines during the COVID-19 pandemic when emergency medicine physician Dr Lorna Breen committed suicide in April 2020. While this prompted discussions about burnout and physician suicide, especially among frontline workers, the conversation has remained limited in the dermatology community.1American Medical Association Now's the time to have a difficult talk about physician suicide.www.ama-assn.org/about/leadership/now-s-time-have-difficult-talk-about-physician-suicideDate: 2020Date accessed: April 25, 2021Google Scholar Although burnout rates in dermatology have traditionally been lower compared with other specialties, the rates have been rising more quickly.2Nagler A.R. Shinkai K. Kimball A.B. Burnout among all groups of physicians-mitigation strategies for dermatologists.JAMA Dermatol. 2020; 156: 1049-1050Crossref PubMed Scopus (3) Google Scholar With the increasing rates of physician burnout and suicide, we believe that it is time for the dermatology community to raise awareness and support efforts around physician suicide. Multiple factors that influence physician suicide have been impacted by higher levels of stress, burnout, and depression during the COVID-19 pandemic. Over 50% of physicians currently experience burnout, contributing to reduced productivity, worse patient outcomes, and poor physician mental health and suicidality.2Nagler A.R. Shinkai K. Kimball A.B. Burnout among all groups of physicians-mitigation strategies for dermatologists.JAMA Dermatol. 2020; 156: 1049-1050Crossref PubMed Scopus (3) Google Scholar Nearly 400 physicians die by suicide each year in the United States, with the rates especially high among female physicians, who die by suicide at rates 2-4 times higher than women in the general population.3Schernhammer E.S. Colditz G.A. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis).Am J Psychiatry. 2004; 161: 2295-2302Crossref PubMed Scopus (601) Google Scholar Physicians with histories of mental illness or substance use may also be at an increased risk. Within dermatology, it is imperative to encourage discourse around physician suicide for several reasons. First, burnout rates are rising among dermatologists; a recent survey found that nearly 50% of dermatologists reported burnout, similar to the national average across the specialties.2Nagler A.R. Shinkai K. Kimball A.B. Burnout among all groups of physicians-mitigation strategies for dermatologists.JAMA Dermatol. 2020; 156: 1049-1050Crossref PubMed Scopus (3) Google Scholar The contributors to burnout among dermatologists include excessive documentation and time spent on the electronic medical record, which have increased during the pandemic due to the transition to virtual care. Given the link between burnout, depression, and suicide, future studies must investigate the implications of these workplace shifts in dermatology. While suicide rates among dermatologists are unknown, an estimated 19% have experienced suicidal ideation—already a significant cause for concern.4Colon A. Gillihan R. Motaparthi K. Factors contributing to burnout in dermatologists.Clin Dermatol. 2020; 38: 321-327Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar Second, an increasing majority of the dermatologist workforce is female, a population at higher risk of suicide given stressors that may include increased household responsibilities, sex- or gender-based workplace harassment, and navigating through a historically male-dominated profession.5Sharp K.L. Whitaker-Worth D. Burnout of the female dermatologist: how traditional burnout reduction strategies have failed women.Int J Womens Dermatol. 2019; 6: 32-33Crossref PubMed Scopus (8) Google Scholar Third, the perceptions of high job satisfaction and low burnout rates may construct barriers to normalizing discussion around suicide in dermatology, leading to a stifling culture of silence and hesitancy to seek help. Therefore, we must increase the collective efforts to support each other as peers and dismantle the stigma around suicide in our specialty. Dermatologists can act against physician suicide in several meaningful ways (Table I). Organizations such as the American Academy of Dermatology can join and support nationwide efforts including National Physician Suicide Awareness Day. Individually and collectively, we can support policies including the Dr Lorna Breen Healthcare Provider Protection Act, which spearheads research and awareness around provider mental health. Perhaps most importantly, we must destigmatize physician suicide within dermatology by starting conversations about this difficult topic, encouraging support groups, increasing our vigilance of the signs of burnout and depression, and not hesitating to act when we recognize the suffering in our colleagues or ourselves.Table IResources for addressing physician suicideCategoryResourcesWellness and burnout resourcesAccreditation Council for Graduate Medical Education physician well-being resources: https://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/ResourcesAmerican Psychiatric Association: wellness education, self-assessment, and physician resources for burnout and depression: https://www.psychiatry.org/psychiatrists/practice/well-being-and-burnoutSuicide preventionNational Suicide Prevention Lifeline: 1-800-273-8255Crisis Text Line: Text TALK to 741-741American Foundation for Suicide Prevention suicide prevention resources: https://afsp.org/suicide-prevention-resourcesSuicide Prevention Resource Center: https://sprc.orgAmerican Hospital Association: Be well: preventing physician suicide: https://www.aha.org/advancing-health-podcast/be-well-preventing-physician-suicideTaking actionDr Lorna Breen Heroes' Foundation: https://drlornabreen.orgDr Lorna Breen Health Care Provider Protection Act: https://drlornabreen.org/about-the-legislation/Association of American Medical Colleges: "Time to talk about it: physician depression and suicide" video/discussion session for interns, residents, and fellows https://www.mededportal.org/doi/10.15766/mep_2374-8265.10508National Academies of Medicine: "Breaking the culture of silence of physician suicide" https://nam.edu/breaking-the-culture-of-silence-on-physician-suicide/American Medical Association: "Now's the time to have a difficult talk about physician suicide" https://www.ama-assn.org/about/leadership/now-s-time-have-difficult-talk-about-physician-suicideCoping with physician suicideAmerican Foundation for Suicide Prevention: After a suicide: a toolkit for physician residency/fellowship programs https://www.acgme.org/Portals/0/PDFs/13287_AFSP_After_Suicide_Clinician_Toolkit_Final_2.pdf Open table in a new tab It is time for us, as a specialty, to raise awareness, encourage dialogue, and support efforts around physician suicide to promote openness around the topic and ensure the well-being of all the dermatologists. None disclosed.