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Medscape
20-05-2025
- Health
- Medscape
Medical Residents Still Most Likely to Die of Suicide: Study
Suicide rates among residents have remained steady since the turn of the century despite increased attention to physician mental health, a new study found. However, residents — like physicians in general — continue to be much less likely to kill themselves than nonphysicians. The suicide rate among medical residents was 4.89 per 100,000 person-years from 2015 to 2021 (47 people) vs 4.07 per 100,000 person-years from 2000 to 2014 (66 people), reported Nicholas A. Yaghmour, MPP, of the Accreditation Council for Graduate Medical Education (ACGME) in Chicago, and colleagues in JAMA Network Open . The difference was not statistically significant. In contrast, the rate of cancer deaths among residents declined by nearly 40% from 2000-2014 to 2015-2021 (incidence rate ratio [IRR], 0.59; 95% CI, 0.38-0.90; P < .05). Overall, suicides among medical residents remain very rare. According to the study, they're 70% less common in the 30- to 34-year-old age group than in the age-matched general population. Still, 'a resident or fellow death by suicide is a devastating event that harms patients, peers, attending physicians, and clinical staff,' Yaghmour told Medscape Medical News . Suicide Trends Are Difficult to Track The study updates a 2017 report by the same team that examined resident deaths from 2000 to 2014. For both reports, researchers tracked deaths in ACGME-accredited residency and fellowship programs, which are required to account for trainees who depart, and consulted a federal database and other sources for information about causes of death. During the 2015-2021 period, 161 residents and fellows died while in training (111 men and 50 women). Suicide was the most common cause, accounting for 29.2% of deaths (47 total: 35 men and 12 women). The researchers didn't find higher numbers of suicides during the COVID-19 pandemic period. The number of suicides tracked by the new report is small, making it difficult to detect trends, said Douglas Mata, MD, MPH, a Boston pathologist who studies physician mental health but was not involved in the research. Still, 'we can likely conclude that suicide rates have not meaningfully decreased, which is a concerning finding that warrants further study,' he told Medscape Medical News . The study noted that residents are much less likely than the rest of the population to die by suicide. For the entire period from 2000 to 2021, the rate of suicide among residents aged 30-34 years was less than a third of the rate among the comparable general population (IRR, 0.27; 95% CI, 0.20-0.35; P < .05). As for physicians overall, it's been widely reported that they're at twice the risk for suicide compared with their nonphysician peers. But a 2025 JAMA Psychiatry study reported that male physicians were less likely to die by suicide than men in their general population. Female physicians, however, had a higher suicide rate than their female peers. Residents Are Much Less Likely to Die of All Causes Than Peers From 2000 to 2021, residents aged 30-34 years were much less likely to die than the age-matched general population (IRR, 0.12; 95% CI, 0.11-0.14; P < .05), the report found. Cancer was the second most common cause of death among residents at 17.4% (28 total: 14 men and 14 women), followed by accidental poisoning at 13.0% (21 total: 19 men and 2 women) and accidents at 13.7% (22 total: 16 men and 6 women). The dip in cancer rates could reflect improvements in healthcare services for residents and better overall cancer outcomes, Yaghmour said. By comparison, in 2021, accidents were the top cause of death in the United States for people aged 25-44 years based on age-adjusted mortality rates, followed by COVID-19, heart disease, suicide, and cancer, according to the Centers for Disease Control and Prevention. Rising Stress, Heavy Workloads Among the suicides of 43 residents (excluding fellows), nine occurred during the first 3 months of the first year of residency. Another six happened during the final quarter of the second year. Mata said the findings about suicide timing make sense. 'The first quarter of the intern year brings isolation, exhaustion, anxiety, and the shock of entering clinical practice — often while moving to a new city with no friends or family support,' Mata said. 'The fourth quarter of PGY-2 brings new stressors: Rising clinical responsibility, career planning pressures, and, in some cases, worsening burnout.' Sen, who experienced depression himself and lost a close friend to suicide during residency, said workload is 'far and away' the biggest contributor to depression during training. 'If we can create a healthier system, we could reduce the number of people who get depressed.' Mata agreed, pointing to predictable stressors in residency, including long work hours, sleep deprivation, lack of control over schedules, and the high-stakes nature of patient care. 'As a resident, you are continually being thrown onto new clinical services, trying to meet the expectations of new attendings, and encountering unfamiliar diseases,' Mata said. Intervening for Well-Being Mata emphasized that suicide rates alone may not be the best metric for measuring well-being interventions. More sensitive indicators, like rates of screening positive for depression or job satisfaction surveys, would better detect improvements, he said. However, suicide rates remaining stable worries Mata. 'This finding suggests that surface-level wellness efforts alone aren't enough and that continued structural reforms could be considered,' he said. 'These things often cost money, so there's resistance in medicine to doing that,' he noted. Mata recommended a back-to-basics approach: 'Enforce reasonable work hours, protect time for sleep, provide easy access to confidential mental healthcare, foster supportive program cultures, and normalize seeking help.' He highlighted a 2016 study that estimated only 16% of medical students who screen positive for depression seek help. 'Residency demands are inherently stressful because becoming a doctor carries enormous responsibility,' he said. 'Real change will require creating cultures where vulnerability is not treated as a liability, and where seeking help is seen as a sign of strength, not weakness.'
The Guardian
09-04-2025
- Health
- The Guardian
‘A skill you need to save a life': the US doctors traveling to Mexico for abortion training
On paper, it should not be difficult for Dr Sebastian Ramos to learn to perform abortions. As a family medicine doctor, Ramos works in a specialty that frequently provides the procedure. He lives in deep-blue California, where it is still allowed. And the administrators running Ramos's residency program – a kind of apprenticeship that US doctors must undergo to become full-fledged physicians – support Ramos's desire to learn how to do it. But over the course of his three-year-long residency, Ramos is guaranteed just three days' worth of training at Planned Parenthood. Residents get to participate in only a handful of abortions. 'That's just not enough if you want to practice abortion care,' said Ramos, who asked to go by a shortened version of his last name to protect his privacy. 'I knew that if I wanted to do this, I needed more experience.' That's why, earlier this month, Ramos traveled to a clinic in Mexico City for two weeks' worth of training in abortion provision. During his first week at the clinic, which is run by the global organization MSI Reproductive Choices and its Mexican arm Fundación MSI, Ramos performed roughly 60 abortions. In the years since the US supreme court overturned Roe v Wade, paving the way for more than a dozen states to ban virtually all abortions, a small but growing number of would-be abortion providers have begun to leave the country in search of an education. In 2023, MSI trained nine American doctors to perform abortions at clinics in Mexico. In 2024, it trained 27. So far this year, it is on track to double that number. 'On one hand, it's a tremendous relief to know that medical students and residents aren't going to have to forego this very important part of their training in their education,' said Pamela Merritt, executive director of Medical Students for Choice. Last year, Merritt's organization helped eight medical students and residents receive abortion training in Mexico and the UK. Merritt continued: 'It's also incredibly sad that in the United States, we are failing to train people even to the standard of care indicated by abortion bans.' Every abortion ban in the US permits abortions to save a patient's life. But without adequate training, doctors may not be skilled enough to perform abortions even in those dire circumstances. Medical schools and residency programs are run by massive hospitals that are heavily dependent on public funding; such institutions tend to be, by nature, leery of anything as controversial as abortion. The Accreditation Council for Graduate Medical Education (ACGME) has required OB-GYN residencies to teach doctors how to perform abortions since the 1990s, but rather than offer training in-house, hospitals have often farmed their residents out to freestanding abortion clinics for training. Even before Roe fell, this system was faulty: a 2019 study found that, despite the ACGME requirement, just 64% of OB-GYN residency programs offered 'routine training with dedicated time' for abortions. Family medicine residents who want to learn to perform abortions face a greater disadvantage, since the ACGME does not require their residency programs to offer any kind of abortion training. Even most OB-GYN residents, program directors reported in the 2019 study, did not achieve what doctors call 'competency' when it came to abortion. Without competency – a qualification that's measured through a melange of doctors' knowledge, skills and attitudes – doctors may not be able to safely perform abortions on their own. Abortion training and competency is now even harder to come by. Since Roe's collapse, more than 100 abortion clinics have shuttered. Those that are left are often besieged by patients fleeing abortion bans, leaving them without the time and space to teach everybody who wants to learn. If an OB-GYN residency program is located in a state that bans abortion, ACGME rules currently dictate that the residency 'must provide access to this clinical experience in a different jurisdiction where it is lawful'. The ACGME declined to respond to a request for information about how many residency programs are currently compliant with its abortion-training requirement, although records show that no OB-GYN programs have lost their accreditation status in the last year. Patricia Lohr serves as the director of research and innovation for the British Pregnancy Advisory Service (Bpas), a UK nonprofit that provides abortions up until about 24 weeks of pregnancy. Lohr trained to become an OB-GYN in the US. 'Having been a resident and a medical student in the United States, I could really see the importance of having access to abortion education that wasn't entirely reliant on what was being delivered within academic training programs,' Lohr said. 'Because often, abortions weren't being provided in those academic hospitals.' When Lohr moved to the UK, she quickly moved to create a two-week training program at Bpas where medical students could learn about abortions and observe – but not perform – the procedure. In the years since Roe fell, that training program has received a surge of applications from American medical students and residents. 'It's a shame that people would have to travel to learn a basic part of women's health care,' Lohr said. 'There are many trainees out there at the moment who would like to obtain abortion skills, but cannot get it locally, and so they get diverted into doing something else.' Lauren Wiener, a New Jersey medical student, had originally planned to travel to Arizona in summer 2022 to learn how to provide abortions. But when Roe's fall led Arizona abortion providers to temporarily stop working, Wiener had to cancel her trip. Instead, she ended up undergoing a week-long training at Bpas last fall. 'It is something that you need to know how to do, because there are emergency situations,' Wiener said of abortions. 'You might not want to electively perform an abortion at 24 weeks, but if someone comes in and they're miscarrying, you need to know how to evacuate that uterus. It's a skill you need to have to save a life.' While training in the US dwindles, the country's increasingly conservative approach to abortion has also put it at odds with much of the rest of the world. Only four countries – including the US – have tightened their abortion laws over the last 30 years, while more than 60 countries and territories have loosened theirs, according to a tally by the Center for Reproductive Rights. Mexico is one of them. In 2023, its supreme court decriminalized abortion nationwide; the procedure is now available in about half of all Mexican states. And providers aren't the only people taking advantage of Mexico's liberalized abortion laws: last year, Fundación MSI provided first-trimester abortions to 62 women from the United States. 'Training, training, training – it is key, to have less danger for actual patients,' said Araceli Lopez-Nava, managing director of MSI Latin America. 'We understand how difficult the situation is becoming in the US, so we're happy to help.' The organization has the capacity to train up to 300 doctors a year to perform abortions, Lopez-Nava estimated. MSI is not, however, a solution for everybody. Would-be trainees need to speak Spanish. And although the organization has in past years trained medical students, MSI's Mexico clinics have started focusing on teaching residents who have already performed 20 abortions. Because residents have already chosen their specialties and secured berths in residency programs – which can be highly competitive – they are more likely to become abortion providers. Training in Mexico can also be pricy, especially since the program does not pay for travel and lodging. Ramos's entire trip cost about $5,000, although a scholarship helped him cover most of the costs. 'It's a way, at least for me, to be exposed to a different medical system, learn from different providers from a different country, exchange knowledge,' Ramos said. 'I feel like I'm being adequately prepared to meet the needs of my patients in the US.'
