Update: licensing journey and Pamela Wible

[meow1985]

It's me again.

This is a very lonely, stressful process. No real updates yet.

This lady's post about MH friendly state licensing boards scared the s*** out of me, too. Physician-Friendly States for Mental Health: A Review of Medical Boards | Pamela Wible MD I get it, she's a bit fringy but holy s***, are the stories on there real? Also, if she fringey or is she right?

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[adaptation1]

Are you sure you want to post all this information on a public forum?

 

[meow1985]

Are you sure you want to post all this information on a public forum?

Yeah, on second thought no. I deleted most of it.

 

[meow1985]

Are you sure you want to post all this information on a public forum?

also, this is exactly what I mean when I say lonely. I can't talk to people I know because they're sick of hearing it. I can't talk to people I don't know because that info could be found by the wrong people.

 

[adaptation1]

Just watching out. I understand your situation is isolating and anxiety-provoking. I hope you find the support you're looking for and this licensing process goes smoothly the next couple months.

 

[Mass Effect]

also, this is exactly what mean when I say lonely. I can't talk to people I know because they're sick of hearing it. I can't talk to people I don't know because that info could be found by the wrong people.

Are these stories true? Yes, they are. Should that mean that we all go into hiding and refuse to talk about it to our own detriment? No. You should feel free to discuss your questions here (as long as you're not seeking medical advice, and you haven't been). The state boards aren't trolling SDN to figure out if you're in their state, which doc you are, and if the things you say could implicate you. Just don't post your name or identifiable information. But your posts, thus far, haven't given us any information that would identify you.

 

[downwithDTB]

It's me again.

I get it, she's a bit fringy but holy s***, are the stories on there real? Also, if she fringey or is she right?

Fringey. She hand picks data that suits her narritive and ignores data that doesn't and treats personal report as fact and case studies as evidence of systemic causation. She's a TED talk snake oil salesperson with a cause that people believe in because enough people can relate to her.

For example: "Doctors are reported to have the highest suicide rate of any profession—even higher than the military—according to findings presented at the 2018 American Psychiatric Association annual meeting. (3)"

She cites a poster to make her big argument and ignores Yaghmour 2017, which is the only study that's actually had a comprehensive enough database to address the question and been published, although the data is limited to residents and fellows.

Don't worry about her.

 

[wolfvgang22]

You'll be fine! You seem to be doing all the right things.

 

[meow1985]

treats personal report as fact

Yeah, my s/o likes to remind me of the fact that we don't know everything about these situations where someone allegedly got the book thrown at them simply for getting outpatient treatment for depression. Sort of like that woman at GWU who was allegedly fired for having cancer, when in reality she was in fact a poor performer who just happened to have cancer.

That's why I do in fact like to put a lot of details. I think it's important to know all the parts of a situation to get the most appropriate feedback.

 

[nexus73]

I wish there was more we could do to help. If it makes you feel any better, I know at least two doctors who have struggled with severe depression, one with borderline as well. One got ECT. They are both practicing full time currently.

 

[geri4lyfe]

Fringey. She hand picks data that suits her narritive and ignores data that doesn't and treats personal report as fact and case studies as evidence of systemic causation. She's a TED talk snake oil salesperson with a cause that people believe in because enough people can relate to her.

For example: "Doctors are reported to have the highest suicide rate of any profession—even higher than the military—according to findings presented at the 2018 American Psychiatric Association annual meeting. (3)"

She cites a poster to make her big argument and ignores Yaghmour 2017, which is the only study that's actually had a comprehensive enough database to address the question and been published, although the data is limited to residents and fellows.

Don't worry about her.

Deepika Tanwar, MD is the study investigator who presented that data at the conference.

Sounds like you’re trying to dismiss Wible’s important advocacy for doctors.

Why do so many doctors in New York City kill themselves? How many suicides among trainees have occurred in NY in the last decade? How many did you hear about?

Why is the suicide rate among physicians much higher than the general population?

We should all be concerned about physician suicide and well being.

Just as toxic masculinity hurts everyone, downplaying the stress on doctors and trainees, residents, med students and other people working in health care hurts everyone.

FWIW, I don’t think SDN is a good place to look for validation and support. Finding a good therapist (a psychologist or an experienced clinical social worker) has been helpful for me. Antidepressants and the support of family and friends have helped.

Physicians Experience Highest Suicide Rate of Any Profession

US physicians have the highest suicide rate of any profession. The number of physician suicides is more than twice that of the general population, new research shows.

www.medscape.com

The Vibrant Med

thevibrantmed.com

 

[calvnandhobbs68]

Fringey. She hand picks data that suits her narritive and ignores data that doesn't and treats personal report as fact and case studies as evidence of systemic causation. She's a TED talk snake oil salesperson with a cause that people believe in because enough people can relate to her.

For example: "Doctors are reported to have the highest suicide rate of any profession—even higher than the military—according to findings presented at the 2018 American Psychiatric Association annual meeting. (3)"

She cites a poster to make her big argument and ignores Yaghmour 2017, which is the only study that's actually had a comprehensive enough database to address the question and been published, although the data is limited to residents and fellows.

Don't worry about her.

Right.

the problem with these anecdotal stories is that there’s crazy selection bias. Who do you think are gonna be the people that want to go tell Pamela Wible their story of how unfair the board was to them? All the ones who had something to report but were approved by the medical board? Don’t think so.

She also tends to take their self reported stories as facts without considering any other side to the situation. Like you said yourself, the girl who said that her residency program got rid of her because of “cancer” but was actually just a terrible resident. The people who are trying to get sympathy from the public aren’t going to be inclined to post their own shortcomings.

 

[geri4lyfe]

Right.

the problem with these anecdotal stories is that there’s crazy selection bias. Who do you think are gonna be the people that want to go tell Pamela Wible their story of how unfair the board was to them? All the ones who had something to report but were approved by the medical board? Don’t think so.

She also tends to take their self reported stories as facts without considering any other side to the situation. Like you said yourself, the girl who said that her residency program got rid of her because of “cancer” but was actually just a terrible resident. The people who are trying to get sympathy from the public aren’t going to be inclined to post their own shortcomings.

This was more helpful than your calling Waggle a “terrible resident.”

Residency in any field is sometimes the first real adult job that people in medicine have. Do medical schools and residencies teach residents how to communicate? Or how to document when they need something from the institution? Or what our rights are? No.

Paper It: How Documented Decision-Making Can Help An Institution Avoid The Risk Of He Said/She Said Litigation

A recent case out of the District of Columbia underscores the importance of establishing policies and documenting performance-related issues.

www.mondaq.com

 

[geri4lyfe]

AADPRT is the association of directors of psychiatry residency training. Why is the current regional representative for AADPRT for the region of New York (Paul Rosenfield) from Mt Sinai, where several suicides have recently occurred?

AADPRT Member Representative | Regional Contacts

AADPRT member list for representative in each region across the US and Canada.

www.aadprt.org

 

[downwithDTB]

Deepika Tanwar, MD is the study investigator who presented that data at the conference.

I have no opinion on Dr. Tanwar. I hope that they publish their study so that I can review it critically. My point was not to diminish their important, yet preliminary work. It was that Wible selects studies that backs her view and ignores those that don't, even if they are published or methodologically superior.

Sounds like you’re trying to dismiss Wible’s important advocacy for doctors.

Why do so many doctors in New York City kill themselves? How many suicides among trainees have occurred in NY in the last decade? How many did you hear about?

Why is the suicide rate among physicians much higher than the general population?

We should all be concerned about physician suicide and well being.

Just as toxic masculinity hurts everyone, downplaying the stress on doctors and trainees, residents, med students and other people working in health care hurts everyone.

Part of the reason that so many physicians in NYC die by suicide is that there are so many physicians in NYC. The US crude suicide rate is 1.4/10k/year. There are health systems in NYC with 10k physicians/med students. That's an expected 1.4 suicides/year, and I hear about a lot of them thanks to phsyician groups and the NYPost.

I'm not convinced that physician suicide occurs at a particularly high rate. See Yaghmour 2017. I'm also not convinced that if it does, it's not partially attributable to higher risk factor burden independent of/predating med school / physicians with terminal illness. That's doesn't mean it's not important to advocate for better systems and better mental health care.

So what? It's advocacy! 1) The anecdotes allow identification. Publicity and identification are risk factors for chain suicide. 2) If (I'm not convinced either way based on the data I've seen) practicing medicine doesn't increase suicide risk when confounds are accounted for, this advocacy risks moving limited resources away from groups that need it AND include high risk phsyicians (i.e. bipolar do, borderline PD, AN, ect.) and towards the majority subset of phsyicians that are not at increased risk vs. the general public. That in fact is very serious and why people who advocate, especially MDs, need to be up front and present data that both agrees and refutes their hypotheses in a critical maner.

For example: OP reads Wible, flips out based on anecdotes. Doesn't actually bother to go look at objective data on licensing decisions that is publicaly available in many states that Wible also doesn't critically review or even mention.

I do agree with you, however, on the value of reassurance seeking in a public anonymous forum.

 

[calvnandhobbs68]

This was more helpful than your calling Waggle a “terrible resident.”

Residency in any field is sometimes the first real adult job that people in medicine have. Do medical schools and residencies teach residents how to communicate? Or how to document when they need something from the institution? Or what our rights are? No.

Paper It: How Documented Decision-Making Can Help An Institution Avoid The Risk Of He Said/She Said Litigation

A recent case out of the District of Columbia underscores the importance of establishing policies and documenting performance-related issues.

www.mondaq.com

What? Who's Waggle? And where did I call Waggle a terrible resident?

 

[hallowmann]

What? Who's Waggle? And where did I call Waggle a terrible resident?

Might need to work on a little reading comprehension there.

Waggle was the resident in one of Wibble's many articles that had cancer, said that was the reason they were fired, but really they had a well documented history of poor performance as a resident, who just happened to develop cancer. I think your statement of the resident with cancer that was also just bad in residency is what they're referring to.

The documentation is pretty impressive. She somehow made such a bad impression as an intern on an IM rotation that in less than a couple days they had to restructure the coverage of that rotation because of the complaints they were getting from multiple attendings, other residents, and even patients. There are emails back and forth between the faculty at that rotation site, the PD, and the chiefs that were all provided as evidence.

 

[meow1985]

I have no opinion on Dr. Tanwar. I hope that they publish their study so that I can review it critically. My point was not to diminish their important, yet preliminary work. It was that Wible selects studies that backs her view and ignores those that don't, even if they are published or methodologically superior.



Part of the reason that so many physicians in NYC die by suicide is that there are so many physicians in NYC. The US crude suicide rate is 1.4/10k/year. There are health systems in NYC with 10k physicians/med students. That's an expected 1.4 suicides/year, and I hear about a lot of them thanks to phsyician groups and the NYPost.

I'm not convinced that physician suicide occurs at a particularly high rate. See Yaghmour 2017. I'm also not convinced that if it does, it's not partially attributable to higher risk factor burden independent of/predating med school / physicians with terminal illness. That's doesn't mean it's not important to advocate for better systems and better mental health care.

So what? It's advocacy! 1) The anecdotes allow identification. Publicity and identification are risk factors for chain suicide. 2) If (I'm not convinced either way based on the data I've seen) practicing medicine doesn't increase suicide risk when confounds are accounted for, this advocacy risks moving limited resources away from groups that need it AND include high risk phsyicians (i.e. bipolar do, borderline PD, AN, ect.) and towards the majority subset of phsyicians that are not at increased risk vs. the general public. That in fact is very serious and why people who advocate, especially MDs, need to be up front and present data that both agrees and refutes their hypotheses in a critical maner.

For example: OP reads Wible, flips out based on anecdotes. Doesn't actually bother to go look at objective data on licensing decisions that is publicaly available in many states that Wible also doesn't critically review or even mention.

I do agree with you, however, on the value of reassurance seeking in a public anonymous forum.

State boards have data on disciplinary actions, which I’ve looked at before. FWIW in my destination state nobody seems to disciplined *just* for having an illness when they already have a license. There have to be other concerns or complaints. When it comes to my specific situation, though, namely who disclosed what and what it meant for their license at the initial point of application, that data is NOT something I was able to find. All I had were anecdotes and generalities from people who process the paperwork.

Also, imperfect though the forum venue may be, it provides a wider range of unbiased perspectives, because the people here don’t really know me. Plus, the people in my life have said what they were able to say and my therapist says the same CBT based things over and over again. I may want to get another more psychodynamically oriented one but now is not a good time when I am already under so much stress. And the forum is available when the parties above are not.

 

[hallowmann]

State boards have data on disciplinary actions, which I’ve looked at before. FWIW in my destination state nobody seems to disciplined *just* for having an illness when they already have a license. There have to be other concerns or complaints. When it comes to my specific situation, though, namely who disclosed what and what it meant for their license at the initial point of application, that data is NOT something I was able to find. All I had were anecdotes and generalities from people who process the paperwork.

Also, imperfect though the forum venue may be, it provides a wider range of unbiased perspectives, because the people here don’t really know me. Plus, the people in my life have said what they were able to say and my therapist says the same CBT based things over and over again. I may want to get another more psychodynamically oriented one but now is not a good time when I am already under so much stress. And the forum is available when the parties above are not.

You'll be OK. The anecdotes by Wibble are usually associated with people with other interpersonal problems. If you are nice, honest, and responsible, there are usually ways around even bigger issues than you've presented. Its a serious thing, which is why I get your anxiety, but just take it one step at a time, and much more likely than not, you'll be fine and wonder why you stressed out about it so much. Lots of physicians struggle with depression and anxiety. We're human after all.

 

[calvnandhobbs68]

Waggle was the resident in one of Wibble's many articles that had cancer, said that was the reason they were fired, but really they had a well documented history of poor performance as a resident, who just happened to develop cancer. I think your statement of the resident with cancer that was also just bad in residency is what they're referring to.

The documentation is pretty impressive. She somehow made such a bad impression as an intern on an IM rotation that in less than a couple days they had to restructure the coverage of that rotation because of the complaints they were getting from multiple attendings, other residents, and even patients. There are emails back and forth between the faculty at that rotation site, the PD, and the chiefs that were all provided as evidence.

got it.

yeah I remember reading those court documents. She was just a terrible resident based on that extensive documentation so yeah I still think she was a terrible resident who tried to blame all her problems on the program.

 

[downwithDTB]

AADPRT is the association of directors of psychiatry residency training. Why is the current regional representative for AADPRT for the region of New York (Paul Rosenfield) from Mt Sinai, where several suicides have recently occurred?

Can you quantify "several" and how that compares to the expected rate? To appropriately know if a given system is an outlier, you'd have to assume random distribution of suicides and model the likelihood that a given rate is not randomly distributed. This is *very serious* business and should be addressed with numbers and complex stats, not agendas and opinions.

Finally, if a given program/state is particularly proactive about taking phsyicians with psychiatric or other risk factors for suicide to begin with, they may be the ones with the highest physician suicide rate, given the dearth of evidence based preventative interventions available.

 

[meow1985]

You'll be OK. The anecdotes by Wibble are usually associated with people with other interpersonal problems. If you are nice, honest, and responsible, there are usually ways around even bigger issues than you've presented. Its a serious thing, which is why I get your anxiety, but just take it one step at a time, and much more likely than not, you'll be fine and wonder why you stressed out about it so much. Lots of physicians struggle with depression and anxiety. We're human after all.

Yeah.

 

[Mass Effect]

Fringey. She hand picks data that suits her narritive and ignores data that doesn't and treats personal report as fact and case studies as evidence of systemic causation. She's a TED talk snake oil salesperson with a cause that people believe in because enough people can relate to her.

For example: "Doctors are reported to have the highest suicide rate of any profession—even higher than the military—according to findings presented at the 2018 American Psychiatric Association annual meeting. (3)"

She cites a poster to make her big argument and ignores Yaghmour 2017, which is the only study that's actually had a comprehensive enough database to address the question and been published, although the data is limited to residents and fellows.

Don't worry about her.

You forgot to mention that during that very APA meeting in 2018, a psychiatry resident in NY jumped to her death. That same weekend. The week before, a med student in NY jumped to her death.

I didn't find Yaghmour's study to be particularly helpful in comparing suicide rates. Perhaps I'm misremembering, but the comparison was residents versus general population with no word on what the general population consisted of and what predispositions there were in that population. Meanwhile, we're watching trainees and physicians commit suicide in real time every few months, so I'm not even much interested in the comparisons on the superficial level as I am what triggered the suicides among our colleagues, most of whom presumably don't have factors that put them at elevated risk (substance abuse would be detected on drug tests, most -- if not all -- are not homeless, most don't have hx of weak coping and/or self-injurious behavior, most presumably don't have hx of suicide attempts, most don't have hx of chronic mental illness, etc, etc, etc).

 

[meow1985]

You forgot to mention that during that very APA meeting in 2018, a psychiatry resident in NY jumped to her death. That same weekend. The week before, a med student in NY jumped to her death.

I didn't find Yaghmour's study to be particularly helpful in comparing suicide rates. Perhaps I'm misremembering, but the comparison was residents versus general population with no word on what the general population consisted of and what predispositions there were in that population. Meanwhile, we're watching trainees and physicians commit suicide in real time every few months, so I'm not even much interested in the comparisons on the superficial level as I am what triggered the suicides among our colleagues, most of whom presumably don't have factors that put them at elevated risk (substance abuse would be detected on drug tests, most -- if not all -- are not homeless, most don't have hx of weak coping and/or self-injurious behavior, most presumably don't have hx of suicide attempts, most don't have hx of chronic mental illness, etc, etc, etc).

I think Igor Galynker's framework of acute suicide crisis syndrome may be a helpful one for understanding this. Dr. Galynker, ironically, is affiliated with Mount Sinai.

His work suggests that risk factors for imminent suicide are different and can occur independently from long term risk factors for suicide. Many people who do in fact end their lives also do not disclose suicidal ideation, but other behavioral clues act as a warning sign.

The first criterion for suicide crisis syndrome is "frantic hopelessness or state of entrapment defined as being stuck in a life situation that is painful and intolerable, and a feeling that all routes of escape are blocked." Residency and medicine in general can very easily create an environment where one feels that way. You're the bottom of the totem pole and if you're ousted from residency, you're essentially done in medicine. Many people have six figure debt that hangs over their heads, and they can't pay it off by working in any other field because their skills have limited translatability. Then there's criterion B - among other things affective and cognitive dysregulation, which sleep deprivation, social isolation and constant pressure to perform can make worse. Medicine is of course not unique in creating the perfect storm of factors for acute suicidality, but it's pretty darn good at it.

Here's a link to a podcast: Dr. Igor Galynker on identifying suicide crisis syndrome (Part 1)

 

[Mass Effect]

Can you quantify "several" and how that compares to the expected rate? To appropriately know if a given system is an outlier, you'd have to assume random distribution of suicides and model the likelihood that a given rate is not randomly distributed. This is *very serious* business and should be addressed with numbers and complex stats, not agendas and opinions.

Are you serious?

I think Igor Galynker's framework of acute suicide crisis syndrome may be a helpful one for understanding this. Dr. Galynker, ironically, is affiliated with Mount Sinai.

His work suggests that risk factors for imminent suicide are different and can occur independently from long term risk factors for suicide. Many people who do in fact end their lives also do not disclose suicidal ideation, but other behavioral clues act as a warning sign.

The first criterion for suicide crisis syndrome is "frantic hopelessness or state of entrapment defined as being stuck in a life situation that is painful and intolerable, and a feeling that all routes of escape are blocked." Residency and medicine in general can very easily create an environment where one feels that way. You're the bottom of the totem pole and if you're ousted from residency, you're essentially done in medicine. Many people have six figure debt that hangs over their heads, and they can't pay it off by working in any other field because their skills have limited translatability. Then there's criterion B - among other things affective and cognitive dysregulation, which sleep deprivation, social isolation and constant pressure to perform can make worse. Medicine is of course not unique in creating the perfect storm of factors for acute suicidality, but it's pretty darn good at it.

Here's a link to a podcast: Dr. Igor Galynker on identifying suicide crisis syndrome (Part 1)

Don't get me wrong, I'm aware of the risk factors unique to doctors and doctors in training. That's why I'm saying it's not an even comparison with the general public. That's why I don't get into the weeds on whether or not the suicide rate is higher (though I 100% think the rate is higher), but rather focus on the fact that suicide occurs at all and the risk is exacerbated by the problems unique to medical education and medical practice.

 

[Orgone]

Wible is a vile person.

I have personal experience of her knowingly and blatantly disregarding grieving family member's wishes when publicly airing the personal details of the life and death of a suicide victim. It is hard to calculate the additional suffering and pain she caused to many, many people in just this one case. She pretends to be a righteous crusader for the downtrodden but is only really interested in promoting herself.

Vile.

 

[downwithDTB]

You forgot to mention that during that very APA meeting in 2018, a psychiatry resident in NY jumped to her death. That same weekend. The week before, a med student in NY jumped to her death.

...most -- if not all -- are not homeless, most don't have hx of weak coping and/or self-injurious behavior, most presumably don't have hx of suicide attempts, most don't have hx of chronic mental illness, etc, etc, etc).

I am not minimizing physician suicides. These are very tragic events. It is not fair to say that physicians are uniformly healthy. On one hand, the mantra is that we have high rates of depression. On the other, we are too healthy to suicide? I personally have known plenty of physicians/trainees with diagnoses that significantly impact suicide risk, anorexia nervosa, schizophrenia, bipolar disorder 1, severe MDD, cutting, heroin use d/o, ect.. I imagine that personality traits associated by some with suicide, such as perfectionism, may be enriched in physicians as well.

Remember, med school starts for most at 22 and we are by no means out of the risk window at that point. Further, the selection process is basically a sliding mix of intelligence and study ethic with a single day interview thrown in the mix. Not exactly a comprehensive psych eca Also, lots of other professions are hard. Finance is dog eat dog and abusive. Most lawyers and scientists end up with working their faces off much harder than many phsyicians (some surg excepted) to make it or make about half a resident salary for life. Being a small business owner can be profitable, but you're literally living day to day with no long term income or weath security for many years and probably an even larger business startup loan.

Finally, I get the question of what is an appropriate control suicide rate to use for phsyicians. I would argue that zero suicides in any group is about as realistic a goal as zero automobile fatalities. I would further argue that if you can't convincingly make the argument that suicides are more common among phsyicians than other groups, that may not be where we should be specifically directing our efforts.

 

[geri4lyfe]

This video on burnout really resonates with me and the current toxic climate at SIUH:

 

[Mass Effect]

I am not minimizing physician suicides. These are very tragic events. It is not fair to say that physicians are uniformly healthy

No one said they were uniformly healthy. Saying they don't have some of the traditional risk factors is not the same as saying they're uniformly healthy.

On one hand, the mantra is that we have high rates of depression. On the other, we are too healthy to suicide?

That isn't the mantra at all. No one said they were too healthy.

I personally have known plenty of physicians/trainees with diagnoses that significantly impact suicide risk, anorexia nervosa, schizophrenia, bipolar disorder 1, severe MDD, cutting, heroin use d/o, ect

Yes, mental illness/substance use exists among trainees. That isn't big news. But the unique factor in training is that everyone is under a microscope. In most cases, the schizophrenic intern is not going to fly under the radar during a psychotic break like, say, the guy who quits or gets fired from his job as a mechanic. In most cases, the heroin user is not going to overdose and have no one at work find out.

Remember, med school starts for most at 22 and we are by no means out of the risk window at that point. Further, the selection process is basically a sliding mix of intelligence and study ethic with a single day interview thrown in the mix. Not exactly a comprehensive psych eca Also, lots of other professions are hard

I can't tell what point you're trying to make.

Finance is dog eat dog and abusive. Most lawyers and scientists end up with working their faces off much harder than many phsyicians (some surg excepted) to make it or make about half a resident salary for life. Being a small business owner can be profitable, but you're literally living day to day with no long term income or weath security for many years and probably an even larger business startup loan

The difference in all of those professions is that you can quit. An intern can't just quit his job. He doesn't even get much of a choice in his job, besides ranking it -- he matches there, even if it's number 15 on his list, and hopes for the best for the next 5 years.

Finally, I get the question of what is an appropriate control suicide rate to use for phsyicians. I would argue that zero suicides in any group is about as realistic a goal as zero automobile fatalities. I would further argue that if you can't convincingly make the argument that suicides are more common among phsyicians than other groups, that may not be where we should be specifically directing our efforts.

Why shouldn't we specifically direct our efforts there? We know that physicians have a high rate of suicide. We know that the medical culture and training exposes them to numerous risk factors that we note with other patients in our risk assessments -- stress, financial burden, sleep deprivation, abuse/mistreatment, in some cases public humiliation, in some cases guilt, demoralization, learned helplessness, etc, etc, etc. It isn't a bad think to try to combat some of these things and/or help trainees through the process.

 

[downwithDTB]

The difference in all of those professions is that you can quit.

Why shouldn't we specifically direct our efforts there? We know that physicians have a high rate of suicide.

Interns can quit, actually, and some do.

More importantly, you keep insisting that physicians have a high rate of suicide. I am not convinced that real evidence beyond stories that *some* physicians die by suicide, which is true. However, at least for residents, the ones subjected to the worst abuse, the rate appears lower than age matched controls.

I will throw back at you: what is your evidence that physicians die by suicide at a high rate and how are you defining "high" if not compared to general population matched for age and sex? And if so, why not spend resources on a group that is higher than the gen pop like homeless or SMI instead of a group like resident phsyicians with a OR of suicide under 0.3.

I totally agree that the match and residency system is abusive and can be demoralizing; I was actually shocked when I saw the data; however, I simply don't agree with associating anything with suicide without a ton of high quality evidence and the best publicaly available evidence points against your conclusion.

I hypothesize that we may have to agree to disagree here.

 

[wolfvgang22]

Interns can quit, actually, and some do.

To me, this is a really insensitive and out of touch comment. A lot of trainees have over $250,000 in student loan debt. They can't quit without their lives being essentially ruined by crushing debt. If they quit or if they are dismissed for any reason, they are effectively black balled from ever being a physician, something they have worked hard for and dreamed about for years. They face demoralization and shame having to face family and society who knew they failed. This is a recipe for suicide. Just quitting is not nearly as easy as you make it sound.

Also, I have family who are entrepreneurs and attorneys, and friends who switched careers from being these careers to being a physician. One of my physician friends worked on Wallstreet for a number of years. Another is a CEO of a technology firm with a large state contract. Each one tells me that while challenging, those professions were not equivalent to the stress of medical training. All anecdotal, I know, and maybe they are invested in looking tough, but I personally believe them. They tell me they did not face the professional and legal consequences physicians face for making a mistake.

I agree more studies need to be done, but I'm offended by what I view as insensitivity masquerading as intellectualism. My opinion is that you are absolutely minimizing suicide. This, a psychiatry student forum, is the last place to minimize suicide.

Edit: I have edited the above to try to avoid making personal attacks. Clearly, I'm incensed.

 

[futuredo32]

Michigan is a very friendly state for physicians with mental health issues. I have seen a psychiatrist for years for analysis. I got special accomodations to take the board exam due to GAD, although I applied for the accomodations for my ADHD. I am open about my analysis and at a new position I am starting out of state, they had to change my start time so I could do teletherapy with my psychiatrist and they are well aware of why they changed my start time. I took a leave of absence during med school to take care of my Grandma because she was amazing and didn't want to live in a nursing home. I hope things get worked out for you. It's ridiculous that physicians are supposed to be immune from any mental disorder considering the stress it takes to have peoples lives in your hands. I wish you the best.

 

[Merovinge]

Interns can quit, actually, and some do.

More importantly, you keep insisting that physicians have a high rate of suicide. I am not convinced that real evidence beyond stories that *some* physicians die by suicide, which is true. However, at least for residents, the ones subjected to the worst abuse, the rate appears lower than age matched controls.

I will throw back at you: what is your evidence that physicians die by suicide at a high rate and how are you defining "high" if not compared to general population matched for age and sex? And if so, why not spend resources on a group that is higher than the gen pop like homeless or SMI instead of a group like resident phsyicians with a OR of suicide under 0.3.

I totally agree that the match and residency system is abusive and can be demoralizing; I was actually shocked when I saw the data; however, I simply don't agree with associating anything with suicide without a ton of high quality evidence and the best publicaly available evidence points against your conclusion.

I hypothesize that we may have to agree to disagree here.

Physicians have: lower divorce rates, higher incomes, and lower death rates by some physiologic death pathways, but repeatedly have higher suicide rates to the best of our ability to measure despite several factors that lower suicide risk. There have been several studies looking at this, and while systemically the death reporting system in american makes this information impossible to be fully accurately known, does not mean that the null hypothesis is sided with when a preponderance of data from many different cohorts suggest otherwise. Your argument sounds a lot like tobacco manufacturers that we can't be 100% sure smoking actually causes strokes, MI, cancer, etc so lets focus on air pollution instead! This "ton of high quality evidence" mythic standard makes no sense when generations of people have observed this effect and there is compelling hypothesis to support why this would be. If you have more evidence to the contrary, I am very interested in reading it.

This has several links, I'm sure the APA has more for you if you'd like to reach out to them.

Physician Suicide: Overview, Depression in Physicians, Problems with Treating Physician Depression

It has been reliably estimated that on average the United States loses as many as 400 physicians to suicide each year (the equivalent of at least one entire medical school). Sadly, although physicians globally have a lower mortality risk from cancer and heart disease relative to the general...

emedicine.medscape.com

 

[Mass Effect]

Interns can quit, actually, and some do

I ask, once again on this thread, are you serious?

More importantly, you keep insisting that physicians have a high rate of suicide. I am not convinced that real evidence beyond stories that *some* physicians die by suicide, which is true. However, at least for residents, the ones subjected to the worst abuse, the rate appears lower than age matched controls

Based on ONE study that didn't even tell us who the age-matched controls were.

I will throw back at you: what is your evidence that physicians die by suicide at a high rate and how are you defining "high" if not compared to general population matched for age and sex?

https://www.researchgate.net/profile/Eva_Schernhammer/publication/7784092_Taking_Their_Own_Lives_-_The_High_Rate_of_Physician_Suicide/links/0a85e530bd7ee22555000000/Taking-Their-Own-Lives-The-High-Rate-of-Physician-Suicide.pdf

Experts Address Risk of Physician Suicide

Studies over the past 4 decades have shown that physicians die by suicide more frequently than nonphysicians. Because of this striking finding, experts with knowledge and experience in areas including medicine, health insurance, and physician licensing recently convened to address factors in the...

jamanetwork.com

https://www.researchgate.net/profile/Sam_Shamyar/publication/332798267_Physician_Suicidepdf/data/5cca064a92851c8d2213f438/Physician-Suicide.pdf

The suicide mortality of working physicians and dentists

Abstract. Background Some studies have shown that physicians and dentists have elevated risks of suicide, while other studies have not.Aims Using all death

academic.oup.com

Physician Suicide: A Fleeting Moment of Despair - PMC

This ongoing column is dedicated to the challenging clinical interface between psychiatry and primary care–two fields that are inexorably linked. In this article, we examine the somber issue of suicide among physicians. While there is some variation ...

www.ncbi.nlm.nih.gov

And if so, why not spend resources on a group that is higher than the gen pop like homeless or SMI instead of a group like resident phsyicians with a OR of suicide under 0.3.

Because my passion and advocacy is geared toward physicians and medical trainees. Why? Because that's what I choose.

I totally agree that the match and residency system is abusive and can be demoralizing; I was actually shocked when I saw the data; however, I simply don't agree with associating anything with suicide without a ton of high quality evidence and the best publicaly available evidence points against your conclusion.

But you do agree with stating it isn't higher than the general population without a ton of high quality evidence? All the above articles I cited should be read and the references should be looked up if you have any doubt about this problem.

 

[Mass Effect]

I'm not sure what point you were making here but if anything mental illness and substance use disorders are covered up during training and in practice. There is more secrecy in medical training and practice than in most other fields. Physicians are good at hiding illness, and there is a conspiracy of silence around mental illness and addiction. When several colleagues raised concerns about the mental state of a resident, they were dismissed and serious issues brushed aside by program leadership. I know a physician who while a resident was literally sending out job applications from a psych unit while recovering from psychosis. When I was a resident, a resident died on call of a drug overdose. The hospital covered it up and most people had no idea what happened. I know of a resident who carried a bottle of vodka to work everyday and was drinking at work and no one said anything. They had to beg the program director to let them stop working. Physicians cover for alcoholic and drug addicted colleagues all the time. Sometimes with tragic consequences.

Sure, we all have anecdotal stories, but I think the rates of veiled substance abuse/misuse and veiled mental illness among physicians, as a whole, is likely less than the general public. That psychotic guy on the inpatient unit looking for another job? He was on an inpatient unit, so someone noticed.

 

[downwithDTB]

To me, this is a really insensitive and out of touch comment. A lot of trainees have over $250,000 in student loan debt. They can't quit without their lives being essentially ruined by crushing debt. If they quit or if they are dismissed for any reason, they are effectively black balled from ever being a physician, something they have worked hard for and dreamed about for years. They face demoralization and shame having to face family and society who knew they failed. This is a recipe for suicide. Just quitting is not nearly as easy as you make it sound.

Also, I have family who are entrepreneurs and attorneys, and friends who switched careers from being these careers to being a physician. One of my physician friends worked on Wallstreet for a number of years. Another is a CEO of a technology firm with a large state contract. Each one tells me that while challenging, those professions were not equivalent to the stress of medical training. All anecdotal, I know, and maybe they are invested in looking tough, but I personally believe them. They tell me they did not face the professional and legal consequences physicians face for making a mistake.

I agree more studies need to be done, but I'm offended by what I view as your insensitivity and insecurity about the topic masquerading as intellectualism. My opinion is that you are absolutely minimizing physician suicide, I suspect because you are uncomfortable with the topic. This, a psychiatry student forum, is the last place to minimize suicide.

I asked for evidence that the assertion that physicians suicide as a "high" rate and what you're defining high in relation to. I have not in any way defended organized medicine or the current system as a whole; I'm just not sure that there is a link, which honestly, I thought there would be when I started looking into it. This doesn't mean that we can't advocate to right the wrongs in the system that exist.

Blaming people/systems/things for suicide is not something that should be done lightly, so I react strongly to it. Blame without evidence can lead to harmful interventions. If this is intellectualizing, fine. I personally think that discussing causes and prevention of suicide, from a scientific lens, is one of the most important things that could be discussed in a psychiatry forum.

Edit: will read everything posted above re: evidence once I'm able and respond. I hope you two can't convince me, but if you do, then you do.

 

[Mass Effect]

No one noticed.

Did he voluntary check himself into the inpatient psych unit? And why was he looking for another job?

And my point is I disagree. In general even if people notice they pretend they don’t, especially for addiction and sex pests.

That has not been my experience.

 

[meow1985]

You all have not mentioned that physicians perform a unique and valuable public service, and it costs the state - among other parties - a lot of money to train a physician. If there is something inherently about the work and training that is an independent risk factor for suicide, then it's important to isolate that factor and address it. How to do that, though, is a different question. One way could be to compare physicians in training to others in similarly grueling, high-sacrifice-high-reward careers. Any comparison to the general population, even if controlled for SES and prior mental health factors, is likely to be limited.

To the point of "interns quit" just like junior financiers and early career lawyers - yes, they do, but the difference is that there are few careers outside of medicine where it's so hard to translate your skills to another area, or to find an on-ramp again once you get off.

 

[clausewitz2]

You all have not mentioned that physicians perform a unique and valuable public service, and it costs the state - among other parties - a lot of money to train a physician. If there is something inherently about the work and training that is an independent risk factor for suicide, then it's important to isolate that factor and address it. How to do that, though, is a different question. One way could be to compare physicians in training to others in similarly grueling, high-sacrifice-high-reward careers. Any comparison to the general population, even if controlled for SES and prior mental health factors, is likely to be limited.

To the point of "interns quit" just like junior financiers and early career lawyers - yes, they do, but the difference is that there are few careers outside of medicine where it's so hard to translate your skills to another area, or to find an on-ramp again once you get off.

Also need to control for familiarity with and access to relatively lethal means on a regular basis. Cf. the research suggesting there is no gender gap in completion rates between male and female combat veterans and police officers.