A retrospective analysis of 141 Tennessee physicians evaluated for fitness-for-duty assessment by the Vanderbilt Comprehensive Assessment Program (V-CAP) found an “astoundingly” high rate of suicide among the physicians who were evaluated if they: were found unfit to practice; were in solo practice; or if they were taking benzodiazepine (anti-anxiety) drugs.
The analysis, available online in General Hospital Psychiatry, found seven of the 141 physicians (average age 51) attempted suicide and five died — a rate that is 175 times higher than the comparable rate of .02 percent in the general population of Tennessee.
“Being found unfit for practice means a loss of income, loss of social contact and loss of social status. It’s very distressing,” said Reid Finlayson, M.D., associate professor of Clinical Psychiatry and medical director of the Vanderbilt Comprehensive Assessment Program.
Finlayson said that being in solo practice can make physicians feel isolated. “It stands to reason. Doctors who are in large practices or who work at a hospital have colleagues who can see what’s going on with them. They’re observed and they can be pointed toward getting help.”
And Finlayson said that it appears that the physicians in the analysis who were taking benzodiazepines like Valium and Xanax had denied the treatment that was suggested and continued to take the medication prior to their suicide.
The intense stress associated with medical practice and the relatively high rates of suicidal behavior among physicians make it important to be able to identify physicians who are at risk so that appropriate preventive actions can be taken, he said.
V-CAP is designed to assist medical professionals, business executives and others with emotional and behavioral concerns that affect the quality of their work and life including addictions and disruptive conduct. The physicians who were analyzed were referred by the Tennessee Medical Foundation due to concerns about a variety of behavioral health issues that affected their ability to safely practice medicine. V-CAP has evaluated more than 500 physicians from 39 states and four Canadian provinces since 2001.
Another interesting finding from the analysis was of the five physicians who committed suicide, three were being investigated for their prescribing habits.
“That suggests that doctors who are taking benzodiazepines may self-prescribe, and may be more likely to be prescribing them too often for their patients, and contributing to the epidemic drug abuse in this country.”
Finlayson said that a close look at the interviews and extensive battery of testing done with the physicians who were evaluated at V-CAP and committed suicide revealed little indication of eventual suicidal behavior.
“Our next steps are to try and find some way to predict which physicians will try to commit suicide,” he said. “This may be a bit premature, but the next time I evaluate a physician taking benzodiazepines, I will try harder to have them detoxify. Benzodiazepine use appears to be a risk factor for suicide.”
Other authors include first author Richard Iannelli, Ph.D., senior associate director of the Vanderbilt Institutional Research Group, Kimberly Brown, Ph.D., Ron Neufeld, Mary Dietrich, Ph.D., and Peter Martin, M.D., of Vanderbilt, and Roland Gray, M.D., medical director of the Tennessee Medical Foundation.
