Being a doctor comes with some serious rewards. Helping people overcome sickness and injury is fulfilling. The opportunity to learn and grow never ceases. And the pay isn’t too shabby, either. Of course, the career is not without risks. Burnout remains pervasive. Exposure to harmful pathogens, radiation, and chemicals is an everyday possibility. Even though hazards and stress are parts of every job, life as a physician brings its own blend of harms—some of which can be deadly. In this article, we’ll explore causes that increase the risk of physician mortality. First, the good news Don’t let the introduction scare you too much. Despite an increased risk of death from certain causes, physicians still tend to live longer than those in other professions. In a nationwide study published in the American Journal of Preventive Medicine, researchers pulled data on nearly 4 million deaths that occurred between 1984 and 1995. White male physicians had an older mean age at death (73.0) than white male lawyers (72.3) and white males of other professions (70.9). Data were similar, although ages at death were lower in all categories, for Black males. Mean age at death for Black male physicians was 68.7, while it was just 62.0 for Black male lawyers and 65.3 for Black males of other professions. “Our finding that physicians die older than do others is not unexpected, given the healthy work effect, physicians’ high socioeconomic status, and prior data showing that physicians tend to make healthy choices,” the researchers wrote. The top 10 causes of death for white male physicians in 1990 (heart disease, cancer, cerebrovascular disease, accidents, COPD, pneumonia/influenza, diabetes mellitus, suicide, liver disease, and HIV/AIDS) were essentially the same as those of the general population in the same year. On the other hand, these doctors were significantly less likely to die from alcoholism, colorectal cancer, bacterial diseases, respiratory diseases (including lung cancer), digestive system diseases, acute myocardial infarction, and non-ischemic heart disease. Altogether, the data suggest two possibilities: Either healthier people choose medicine as a career, or people who’ve received medical training make healthier choices. Now, the bad news In a few stand-out areas, doctors appear to be at greater risk of dying than the general population: cerebrovascular disease, accidents, and suicide. In a closer look at ICD-9 codes, white male physicians were more likely to die from external causes of injury—like transport accidents, accidental poisoning, and self-inflicted injury—as well as hepatitis, malignant melanoma, Alzheimer disease, and pancreatic cancer. Suicide is the second most common cause of death for 10- to 34-year-olds in the United States, so it’s no surprise that medical students, residents, and attendings are affected. Even though their rates of burnout and suicidality are similar to age-matched graduates before medical school, within months of starting classes, rates far exceed those among their peers. In the American Journal of Preventive Medicine study mentioned earlier in this article, researchers pointed to suicide as the cause of death in physicians between 0% and 4% of the time. That may not seem like much, but it’s a significantly higher average than the 0.001% rate in the general population cited by the American Foundation for Suicide Prevention in 2018. Another article, published in The Journal of the Missouri State Medical Association, cited studies that found suicide rates as much as 40% higher in male doctors and 130% higher in female doctors than the general population. “This is likely attributable to doctors’ immense professional burden and (encouraged) neglect of their own well-being,” the authors wrote. Accidents are common in healthcare settings. Sharp injuries, blood-borne pathogens, hazardous chemicals, anesthetic gases, equipment hazards, and more all contribute to serious injury and sometimes death. On top of that, serious workplace violence is about four times more common in healthcare than in private industries, according to OSHA. Even outside of the clinic, accidents appear to befall physicians more often than other professionals. Measuring the risk of accidents by proportionate mortality ratio (PMR)—where 100 represents a risk that matches the general population, and higher and lower numbers represent increased or decreased risk respectively—researchers found a 125 PMR for accidents as a cause of death in physicians. Perhaps surprisingly, the highest risk for physician mortality by accident was air and space transport accidents (328 PMR), followed by drug-related causes including suicide (326 PMR), and accidental poisonings (232 PMR). Cerebrovascular diseases, like aneurysms, stroke, and arteriovenous malformations, were 9% more likely to be the cause of death for physicians (PMR of 109) than among the general population. However, a more recent study published in 2017 and conducted on 28,062 physicians in Taiwan found that they had a lower risk of stroke compared with the general population, despite their higher prevalence rates of hypertension, hyperlipidemia, and coronary artery disease. The takeaway Data on physician death rates is sparse overall. Most relevant studies are getting old (the American Journal of Preventive Medicine article was published in 2000), which leaves big gaps in our knowledge. The global coronavirus pandemic might also throw a monkey wrench in mortality data for the foreseeable future, with reports suggesting more than 1,800 healthcare workers have died from infection. Still, current data suggest many of the concerns raised in the 2000 paper are relevant today. Suicide among physicians merits attention because of its prevalence. More studies are needed so we can better understand the risks inherent to the medical profession—and the steps that need to be taken to prevent unwarranted physician deaths. Source
