Why Are So Many of Us Breaking?

This is a hard post to write. It is also important.

I have escorted trainees to the emergency room for urgent evaluations. A colleague has stayed at my house so they did not have to be alone. And I have helped absorb schedule changes so a peer could seek help privately, so that no one would notice.

I have also walked to work wondering if it was possible to just disappear. I am thankful the thoughts never went past that. In retrospect, I recognize how not normal that thought is.

Medicine is filled with service-oriented, intelligent, hardworking, creative, resilient people. Why is it that so many of us are breaking? Or have broken?

What the numbers say

For years I heard a version of the same statistic repeated at conferences and in hallways. A medical school class worth of physicians, lost every year. I have probably said something like it myself. When I went looking for the source, I could not verify it.

What I found instead was more complicated, and in one direction better than the story we tell each other.

The most current pooled analysis gathered thirty-nine studies across twenty countries.¹ Compared with the general population, male physicians showed a suicide rate ratio of 1.05, with a confidence interval that crosses one. Female physicians showed 1.76. And the effect sizes have been shrinking across the decades those studies cover.

Change the comparison group and the picture shifts again. Measured against other professions rather than against everyone, male physicians came in at 1.81.

Three things follow from that, and I want to be careful with all three.

Our female colleagues are carrying something the profession has not fixed. That number has been elevated for as long as anyone has been counting, and it has not moved the way the others have. We can do better.

This is not a character flaw, a “female” issue, or anything inherent to being a woman. It is about bias, discrimination, outdated societal expectations, and inequity.² Full stop.

The comparison group matters more than the headline. Suicide in any population should not be minimized. One life lost is too many. But understanding the systemic drivers is important.

We are a population of educated, employed, insured, and in many ways privileged people. Held next to peers who look like us on paper, there is a problem in medicine that needs to be fixed. That is the comparison that should keep leadership awake.

And the trend is improving. I want to sit on that one for a second, because we almost never say it out loud, and any success is worth acknowledging. Something has been working. Slowly, unevenly, but working.

Acknowledgment is not celebration, and it should not become celebration. We keep working until there are no lives lost.

The reason I was rearranging schedules

Go back to that third thing I listed at the top. I changed schedules so people could get help without anyone knowing.

Sit with what that means. A colleague needed care that any reasonable person would want them to have, and the safest route to it ran through a private favor from someone with enough authority to move a schedule and no obligation to write down why.

The workaround existed because the system was not safe. Every physician knows the questions. The licensing renewal that asks whether you have ever been treated for a mental health condition. The credentialing packet that asks it again in different words, then asks your references to confirm it. None of those forms ask whether you are well. They ask whether you have a history, and then they let you sit with what a yes might cost.

Here is the part that gives me actual hope, and it is recent enough that most physicians I talk to have not heard it.

As of May 2026, forty-four state medical licensure boards have had their applications formally reviewed and verified as free of intrusive mental health and substance use questions.³ Counting nursing, pharmacy, and dental boards alongside hospitals and care facilities, more than three million health workers now practice somewhere that no longer asks.

That did not happen on its own. It happened because a family who lost Lorna Breen decided the forms were going to change, and then went board by board until they did.⁴ It is worth knowing whether your state is on that list, and worth asking your credentialing office where your institution stands.

What helped, in the cases I know about

None of the things that worked were programs. It was a car ride to the emergency department with someone sitting in the passenger seat,  a guest room, or a schedule change nobody discussed. It was, in every case, one person who noticed and then did the specific, slightly awkward, logistically inconvenient thing.

I want to be precise about something, because the role changes the math. Those there were done as a peer and as a program director. I did not do them as a division director. Leadership makes parts of it easier. As a leader, you can move a rotation or create cover without asking anyone’s permission. It is possible to absorb a schedule problem so completely that nobody else ever learns there was one.

It is also possible for the same authority that lets you act to make you unsafe to talk to. When I was a peer, a colleague could tell me something at midnight and it went nowhere, because there was nowhere for it to go. When you sign the evaluations, or build the schedule, or write the letter, nothing is fully off the record. Everyone knows it. Some people will decide the risk is not worth it, and they will be making a rational calculation, not a paranoid one.

I do not have a clean answer to that. What I have concluded is that the further up you go, the more the people around you matter. Somebody in the group who holds no evaluative power over anyone. Somebody a struggling colleague can talk to without doing arithmetic first. If your division does not have that person, the position is open and nobody has told you.

I want to be honest about how that feels from the inside. Every one of those moments was uncomfortable. You are never certain you are reading it right. You worry about overstepping with a colleague you respect. That discomfort is not a signal to wait. It is what the situation feels like when you are doing it correctly.

If you are worried about someone, ask plainly. Are you thinking about suicide. Not a softened version, not a version that lets both of you off the hook. Asking directly does not put the idea in anyone’s head. What it does is tell the other person the subject is allowed in the room, which for a physician may be the first time anyone has offered that.

Then stay. The offer that helps is not a phone number. It is a ride, a night, a covered shift, a walk to the parking ramp. Something with your own inconvenience built into it, because that is the part that reads as real.

And if it is you

If you are in crisis right now, 988 is free, confidential, and staffed around the clock.⁵

If you would rather talk to another physician, the Physician Support Line is answered by volunteer psychiatrists, takes no appointment, and reports to no one. No employer, no licensing board, no chair.⁶ You do not have to be in crisis to call. Most people who call are not.

And if you are somewhere below that, in the flat gray place where the days run together and nothing sounds like anything, that counts too. That is not a character issue and it is not the cost of doing this work. The line between exhaustion and something that needs treatment is hard to see from the inside, which is exactly why we are bad at seeing it in ourselves.

The people I described at the top of this post are all still practicing. Every one of them. That is not a small thing and I do not want it buried at the bottom of an essay about suicide. Physicians who get help get better. We treat this illness in our patients and watch it resolve. It resolves in us too.

The walk to work

I still walk to work. Most mornings I do not think about that stretch of years when the walk was different. Sometimes I do.

What I notice now is other people on the same sidewalk. The resident who is quieter than she was in July. The partner who has stopped coming to lunch. I do not know what any of that means, and I have been wrong about it before, both ways.

But I know what I needed on the mornings I was wondering whether it was possible to just disappear. Nobody needed to fix it. Somebody needed to notice, and then say something out loud, and then not leave.

That is available to all of us. It costs a conversation.

Notes and resources

1. Zimmermann C, et al. Suicide rates among physicians compared with the general population in studies from 20 countries: gender stratified systematic review and meta-analysis. BMJ, 2024. PubMed 39168499. Rate ratios: male physicians 1.05 (95% CI 0.90 to 1.22); female physicians 1.76 (1.40 to 2.21); male physicians versus other professions 1.81 (1.55 to 2.12).
2. On drivers rather than rates. Jagsi R, Griffith KA, Jones R, et al. Sexual Harassment and Discrimination Experiences of Academic Medical Faculty. JAMA. 2016;315(19):2120-2121. doi:10.1001/jama.2016.2188. Also Paradis KC, Kerr EA, Griffith KA, et al. Burnout Among Mid-Career Academic Medical Faculty. JAMA Netw Open. 2024;7(6):e2415593. doi:10.1001/jamanetworkopen.2024.15593, which found personal burnout roughly twice as likely among women (adjusted OR 2.29, 95% CI 1.54 to 3.41) and an independent association between work-related burnout and a workplace sexual harassment experience in the prior two years (adjusted OR 1.71, 95% CI 1.11 to 2.62). Citations located via PubMed.
3. Dr. Lorna Breen Heroes’ Foundation, Wellbeing First Champion Challenge, figures as of May 15, 2026. drlornabreen.org/removebarriers. State-by-state detail: identifying the champions.
4. Dr. Lorna Breen was an emergency medicine physician who died by suicide in April 2020. The foundation established in her name leads the ALL IN: Wellbeing First for Healthcare coalition. drlornabreen.org.
5. 988 Suicide & Crisis Lifeline. Call or text 988, or chat at 988lifeline.org. Free, confidential, 24 hours a day. Veterans press 1. Spanish, press 2 or text AYUDA to 988.
6. Physician Support Line, 1-888-409-0141. Free, confidential, and anonymous peer support from volunteer psychiatrists for US physicians and medical students. No appointment. Monday through Friday except federal holidays, 8:00 AM to 11:00 PM Eastern. physiciansupportline.com.

If you are having thoughts of suicide, please use one of the numbers above. If you are in immediate danger, call 911 or go to your nearest emergency department.