Why are so many male anesthesiologists dying by suicide?


Pamela Wible: I’m sitting here today with mental health expert Sydney Ashland, who co-facilitates our physician retreats. We just came back from our 20th retreat and I’m reading through some e-mails and I’ve got one that I want to discuss with you.

“I’m a male anesthesiologist. I have been battling suicidal ideation for seven years and eight months. I vividly remember the day I was admitted. A colleague came into my locked office and saw me sitting at the desk with induction meds and an IV. My career was over and nearly my life. I know seven colleagues that have committed suicide, all male anesthesiologists.”

What’s unique about men in medicine that puts them at high risk? Obviously, anesthesiologists have access to lethal meds, but it’s got to be deeper than that. What do you think?

Sydney Ashland: I think that our men in general in society are experiencing a lot of double binds and unrealistic expectations, and then when you have a high-level expert, like a physician who is trained for so many years and who is under so much pressure and has so much responsibility, the idea that a physician is going to manage that and succeed professionally and personally is just ludicrous. We’ve set them up to fail and the fact that this anesthesiologist writes about his attempt to self medicate in order just to survive, I hear this all the time from physicians who get into addiction cycles, whether that’s medication, whether it’s alcohol, illicit relationships. It’s all a way of trying to cope and manage unbelievable amounts of stress.

Pamela Wible: Recently more men (& specialists) have attended retreats and asked for help. I’m so glad because I’ve been realizing just through the informal registry that I run now with the 949 names of suicide doctors that for every one female we lose in medicine to suicide, we lose seven men. It’s just been such a struggle for me to figure out how to encourage these men to reach for help instead of reaching for propofol, to call me instead of picking up a shotgun, instead of jumping from a hospital roof. I would love to be able to have these men actually reach out for help in advance. It’s great that I’m seeing more and more men at retreats. We had a radiologist recently, we’ve had surgeons.

Sydney Ashland: Surgeons. Yes.

Pamela Wible: The surgeon that came, we did a private retreat with him. I know a lot of men don’t want to reveal what’s going on with themselves in a small or large group of doctors, and so there’s something that happens when we can kind of sit with them alone and hear their full story. What have you noticed from the men that we’ve had recent contact with?

Sydney Ashland: Well, what I’ve noticed is that it usually takes a level of desperation for them to get vulnerable enough and release enough of their indoctrination to be able to ask for help. They believe that they’re supposed to have all the answers, that they’re the person that everybody comes to for all the answers. When they finally get desperate enough to say help, I don’t have it anymore, I can’t do this anymore, then it’s an act of desperation signing up for the retreat whereas with women it’s less of an act of desperation and more of an act of changing course, modifying the direction they were headed, and really changing the direction of their lives.

Sydney Ashland: For men, it’s incredibly difficult for them to ask for help and we’ve put them in that position because it’s perceived as weakness. Men are supposed to have the answers, they’re not supposed to be the ones asking for help.

Pamela Wible: It’s a lot of pressure, especially for people who are not given the ability to cry or emote freely in society like women. You have boys. You have several boys.

Sydney Ashland: Yes, I do. I know the energy it takes to raise young men in our current society, but this is reminding me of an orthopedic surgeon who I worked with recently who had this tremendous pressure, not only to do so many surgeries a week and to show up for his family and to make sure he didn’t get any malpractice suits, but he also was supposed to maneuver the politics of his hospital administration and his group practice. The politics in both areas were very different and that was his undoing. That was the final straw that allowed him to reach out for help was that he could no longer provide for his family, be there for his wife and children, execute seamless perfect surgeries, not get sued for malpractice, and maneuver politics. It was too much.

Pamela Wible: This is reminding me of the recent conversation I had with Dr. Oz where even on national television the whole vilifying physicians and holding physicians, especially male physicians, to such a high standard of performance where if they lose their temper in an operating room . . . maybe you want to share a little bit about what we heard from a recent surgeon who lost his temper in the operating room because . . . Wasn’t it because the chief RN in the OR was distracted.

Sydney Ashland: She was on the Internet using the monitor for her own personal shopping.

Pamela Wible: As a result this surgeon lost his temper and became frustrated and maybe said a curse word or something like that and so what do you think happened? Well, the hospital came down on him, frequently punishing male doctors who are losing their temper for legitimate reasons in the operating room without addressing the core issue that causes the frustration.

Sydney Ashland: Exactly. In this particular situation you’re referencing, it was not extreme. It wasn’t anything you could even call abusive. That’s the crazy making part. We hear stories all the time about men in administration who are actively abusive and denigrating and intimidating to students, and yet you have a male physician who graduates and who is successful who then just tries to set a boundary, who then just tries to be assertive, who is immediately punished in such a way that it causes them to retract their energy, to isolate, to internalize the experience, so that then they’re no longer able to express their feelings and it puts them at a higher risk for heart disease and ulcers and other autoimmune disease processes—and mental health issues—even suicide. It’s absolutely insane.

Pamela Wible: They’re often then labeled as disruptive, unprofessional, and a number of other terms, sometimes sent to physician health programs. Do you want to comment on that?

See: “Unprofessional”—how one word is used to censor, harass, and intimidate doctors.

Unprofessional Doctors

Sydney Ashland: Well, physician health programs that are sometimes about just continuing to fund their own survival, and so there’s not a lot of investment in actually seeing the physician make progress.

Pamela Wible: Or be healthy.

Sydney Ashland: Yes.

Pamela Wible: The conflict of interest is that they’re funding themselves off of charging physicians three times the going rate for the public for similar services and they’re geared towards substance abuse, not mental health so I don’t feel like they really are a successful entity anyway in addressing the very deep fundamental mental health issues that have sometimes started at day one of medical school for these highly intelligent brilliant people.

Sydney Ashland: Right and for problem solvers, when they’re in a PHP meeting, which I recently heard this one where the person doing the interview was interrupted by three different phone calls while they were interviewing the doctor who had been referred to PHP, when this physician began to feel as if they were really impinging on this interviewer’s time, he began speaking really quickly in order to get through the questions so as to not monopolize the time and so this interviewer could get to all the phone calls they needed to make, whereupon the interviewer said, “Uh, do you think you might have issues with mania because I’m noticing you’re speaking really quickly?” It was all an attempt to accommodate the interviewer who was interrupting the session with phone calls. I mean, I just was in shock at that one.

Pamela Wible: Yeah, it’s completely pathologic.

Sydney Ashland: Right.

Pamela Wible: Recently, on that national TV spot I was eluding to earlier, I was asked to comment on a surgeon who had “strangled a nurse” with an elastic cord and of course, I wasn’t there and I don’t feel like I’m the right one to comment on national TV about a case that I’m not fully aware of, however, since I was placed on the spot I went ahead and researched what I could and I just want share that in that particular case, you have a surgeon who is overreacting in a way that, of course, nobody condones, strangling a nurse or becoming violent against somebody else, however, those charges were later dropped as unsubstantiated. The issue at play there was that there was a nursing medication error and the surgeon overreacted and so rather than blame somebody who’s overreacting to a life or death threatening situation that could injure a patient, I think the most important thing is for us to look at the system that has created an environment in which people feel that they are so unsupported that they get to that last hour of frustration they can no longer hold back and so they say a curse word or they potentially do this terrible assault maneuver. (View 58-second TV clip below).

The thing to address is the environment that pits us against each other as healers. Rather than placing us in a safe environment where we are supported with infrastructure that helps us, where we can emote safely, because let’s just face it, we are witnessing life and death situations every day and we do need help. We need debriefing sessions, we need time to emote, we need to talk about the difficult things that we see everyday in medicine, and there’s no time to do that.

Sydney Ashland: There’s no time and there are no tools because when we train our students that they need to put up and shut up, and that they need to internalize all their stress and use unhealthy ways of adapting, then those become lifelong habits and lifelong habits die very hard. This is not about demonizing men in medicine and making it impossible for them to be the feeling, compassionate, empathic healers that they are because they are as well. It is not just women who are compassionate and empathic. Some of the most gratifying sessions that I’ve had have been with men who are gifted healers, who are experts in their field, who have spent years and years and years becoming experts, and we need to allow them to be the gifted healers that they are.

Pamela Wible: I want to talk about three things that I believe may put men at higher risk for suicide. First, they’re socialized in a western culture to be the fix-it guy and the guy in charge and perfect and all that. Number two, I think because of high testosterone levels, (higher than women) that men are much easier to kind of get to anger and impulsive behavior. Number three (maybe due to their lower estrogen levels) they’re less likely to cry and emote and reach out for help. Women physicians will often call a friend, cry on the phone, go visit a female relative maybe and have a talk with their girlfriends sort of thing. I don’t think male anesthesiologists are doing this. So they have access to lethal meds, they have impulsivity, and they’re not likely to emote.

Sydney Ashland: Well, I just want to interject a caveat here that we’re not talking about all male physicians. Of course, there are exceptions to the rule and we’re just trying to talk about systemic issue that is generalized, but yes, I think that the cards are stacked against them and the very three real contributing factors that you’ve just listed are the primary cause. What is the answer today? The answer today is to begin to give men permission to assert themselves and to show up in a way that does not mean internalizing and tamping down their natural inclination to speak their truth, to allow their expertise to shine and be accepted and embraced.

Pamela Wible: Sometimes physicians just don’t want to ask for help and I think that’s the take home message today. It’s okay to ask for help.

If you are a male physician reading this, please ask for help.


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26 comments on “Why are so many male anesthesiologists dying by suicide?
  1. Alan Briley, RN says:

    I work in an Emergency Department – actually the same Emergency Department for 26 years – as a registered nurse, not as a physician. I am considered, “The Go to Guy,” because of my length of time in the ED, by techs, nurses, physicians, and hospital administration, even though (by choice) I work as a staff nurse. My nurse manager, who has her MSN, is supportive, intelligent, and caring, but she doesn’t see the pressure I am under as an informal leader and resource person. Instead of following the chain of command or leadership/mentor structure, EVERYONE COMES TO ME. I feel a tremendous amount of stress, fear of failure, and inability to focus on our patients in the ED due to this demand on my knowledge, no matter how I try to direct staff members to the proper resources available and provided in our department. Even the hospitalists direct questions to me, stating, “A— knows, ask him, he’ll keep you straight until I write the orders.” I was a paratrooper, an Airborne infantryman and sniper, and then a squad leader, responsible for the lives and well being of eleven men in combat, but for years I have been responsible for the lives of thousands of patients who come through our ED, and also providing knowledge and answers to nurses and physicians who have their own patients! I am tired. My wife loves me and supports me, but I feel so drained when I get home, I feel like I am failing her. I have no outside social life except for my running friends, and I am no longer close to my grandchildren. My youngest son, who is 42, just attempted suicide, and is in an inpatient facility for treatment. He told his counselor he hates me, and I am the reason his life sucks. So now I’m responsible for a 42 year old man, while his two siblings, who received much less of my time, are successful and responsible adults. I read your articles, and try for self improvement, but I am tired. Please keep up your work, your encouragement, and your retreats. Maybe, I’ll find what I need to eliminate this feeling of hopelessness, and continue on for 12 more years. May God bless you and strengthen you.

    • Pamela Wible MD says:

      While it is an honor to be the smartest guy in the room that everyone depends on in an emergency, it IS unsustainable as you have noted above. Medicine has a way of stealing your whole life out from underneath you. You deserve to be supported and to have proper boundaries so that you can function well within the ED and at home in your personal life. So I guess I’m begging you to set some boundaries and care for yourself. Ask your manager for help in enforcing the proper chain of command. Direct people to other resources. Limit your hours. Do what it takes to heal. I’d love to speak with you (actually sending you a private email now).

    • Sometimes formalize your leadership role helps. It gives you the authority to be more directive and compensates you. In order to justify this role you might try keeping track of how many interruptions you experience in a given shift. Once you document how much you are being used you probably could move into a different role. If you don’t want to do that, creating a script ahead of time that redirects folks to the nurse manager or back to dr can help. Requires being very consistent and boundaried even when it is uncomfortable.

  2. Dr. Nobody says:

    I love the idea that male physicians are killing themselves because they aren’t allowed to scream at nurses in the OR! Maybe the physician population is no different than the rest of society, males choose more effective methods and thus die by suicide more often. Females attempt suicide more frequently but “fail” because of choosing more ineffective methods. There is an element of denial in this interview that men “dont get to” cry. Men definitely know how to cry and are allowed to cry if they want to. Men don’t cry because they trade the ability to feel/ask for help for higher status, value and respect. Men who do go ahead and cry and whine for help lose respect and position for doing so. For many men the preservation of their masculine identity and privilege is more important than their very lives (which is why they engage in dangerous behavior, join gangs and the military etc).

    • Pamela Wible MD says:

      I strongly believe in order to change the toxic culture in medicine we need to muster up some compassion for each other and the complexity of the circumstances we find ourselves in when working in teams during life-and-death situations. Vilifying and demonizing others without solution-oriented discussion may help transiently release anger though won’t have the long-term impact in healing our dysfunctional medical system. I can’t imagine that you are serious when you write: “I love the idea that male physicians are killing themselves because they aren’t allowed to scream at nurses in the OR!”

  3. KO says:

    Hi Pamela,

    Just want to say how amazing this all is and how much it speaks to a soul and a heart that had been so adversely affected by medicine- yet I love medicine so much.

    Hoping so sincerely I get to make it to a retreat.

    Thank you for all you do- so many nights I have felt so hopeless so dark- it’s efforts like yours that pull me out just enough to keep me afloat and now give me the strength and courage to hopefully get back to residency and practicing.

    • Pamela Wible MD says:

      Oh just called you. No answer. Left voicemail and email. I’m thrilled that I am able to play some small part in your healing and help you get back to the profession you love. When practiced properly—-without third-party profiteers stealing your dream—-medicine is the most fulfilling profession on the planet! Call me back 🙂

  4. RITA LOSEE says:

    What a mess we’ve made of our “health care system!” How can anyone be/get healthy in an environment where compassion and the ability to speak our truth and honestly express our concerns exist only rarely? Thank you for this honest exchange!

    • Pamela Wible MD says:

      Once patients understand what is really going on in our hospitals, outrage and public pressure should create huge culture change and halt these suicides. Unreal the tragedies I’ve witnessed.

      • Cindy Troll says:

        Why is it ok for anesthesiologists to abuse drugs, but there are people out there who need their pain treated and can not receive help due to all the media hysteria about the opioid crisis. Now when a person goes to pain management its like a FBI interogation. It’s not enough to pass UAs, but your expected to worship these so called pain specialist.
        I worked in surgery and ER for years and there is no excuse for any staff member to abuse medications. I was setting up for a surgery in operating room scrubed in and the anesthesiologists was stumbling around and he hit the floor. I pulled his mask down and his eyes were rolled in the back of his head. This was the second time he had over dosed in the operating room and then he was given a teaching job. I ran out into the hall and told the staff
        bringing in pt. don’t come in here.
        All people working in health care industry should have to do monthly unannounced UA’s and that includes
        anesthesiologists, surgeons, nurses, surgical technicians, all ER staff the whole hospital, general practitioners every where. I don’t understand why hospitals go out of their way to hide the fact that anesthesiologists and surgeons abuse drugs while working in surgery? If all surgeries were recorded in video with audio that would help, but hospitals hide things and hiding hurts the pt. When will doctors turn in other doctors for abusing drugs? All the staff in the surgery is under stress and pressure not just the anesthesiologists.
        There is no excuse for anyone in working in surgery or the ER to abuse medication that is suppose to be used for pts! If a anesthesiologists is suicidal or abusing medication he should quit or be terminated and no free pass. People who work in healthcare are suppose to be pt advocates.

        • Pamela Wible MD says:

          Why is it ok for anesthesiologists to abuse drugs?

          It’s not okay. That’s why I we did this podcast.
          To shine a light on the lack of resources to help
          our healers in the OR so they can care for us.
          We all have something to lose when we ignore
          the obvious.

    • Gunther says:

      Ms. Losee, it is not just the health care system alone, it is also in the rest of our society as well. Our bosses and many parents have a tendency to shut down people and it has been that way for a long, long, long time; otherwise, the USA would be like Denmark in being number one in the basic standard of living and the people being very happy with their lives. They also tend to condone bullying and narcissism in the workplace as well.

  5. Heather says:

    Dr. Wible,
    I applaud your efforts at bringing attention to the lack of support, both systemic and emotional to the doctors that are out there suffering. It truly saddenes me to know that people who take care of others professionally are not able to get the necessary assistance.

    I am but a patient with a chronic illness, however, have a brilliant daughter who is intent to pursue a career in medicine. I believe that your efforts to bring attention to this issue are so wonderful and needed. Thanks for your continued efforts to make change, in both supporting a profession that needs help and in educating the layman community.

    With much regard,

    • Pamela Wible MD says:

      As long as we continue to address the truth of the bullying, hazing, suicide crisis in medicine, I can assure you that medical education will be much safer and saner for your daughter. Let’s keep going . . . we have lives to save!

  6. Gunther says:

    Using words like “unprofessional” and delusion” to silence doctors who have legitimate complains is kind of like using the words “Communists”, “Socialists”, “anarchist” and “cop hater” to silence individuals and organizations that want political, social, economic and police reforms in the country. In addition, if you are in the military, the military would try to use their mental health department to labeled you in order to get rid of you because you dare to dissent from them. If you also argue with police officers on the Internet, they will tell you to take your medications, seek mental help, and learn how to write properly considering the fact that many of them are on medications (including alcohol), should have been mentally screen to see whether they can handle the job, need mental help themselves, and are incapable of writing a proper police report without a whole lot of grammar, punctuation, and spelling mistakes plus being able not to have their reports be torn apart by lawyers who are good at tearing them apart.

    Nowadays, American society is definitely rigged against men with letting them have feelings and emotions and has been that way ever since we put stoic men on the pedestal like Clint Eastwood and John Wayne plus having the political, social, and economic system being rigged against them and being treated as expendable parts; however, too many guys don’t seem to realize it until is too late for them.

  7. AV says:

    I have a few thoughts about anesthesiologist: first, they have ready access to lethal drugs and are skilled enough to be successful. Second, their workday is a lot like an air traffic controller’s, busy at the beginning and end of a case and mostly boring on the middle but they can’t leave their seat, then occasional episodes of pure terror. Third, they get blamed by the more glamorous and better paid (?) surgeons a lot. Time everyday to ruminate on and obsess over perceived failures. Also their schedules are completely tied to the surgeons’ schedules. The ones I know are also extra sensitive to pt pain and pain management lives in anesthesia in my institution, and they seem to feel patients’ pain more than other surgical people.

  8. pete says:

    Pamela, I am a student in school interested in having a future with anesthesiology. This information was very helpful and gave me another view on this career that I would have never came up with on my own. I do understand that ofcourse, not everyone is the same but, If I were to pursue this career, would it be possible to work outside of a hospital (as a private party) and possibly switch to a different job if the environment is too difficult? What other work options would I have with a 12-year education and degree in anesthesiology?

    -thank you very much

  9. Anesthesiologist says:

    I think that the thing that prevents medical students and residents from speaking out is the overwhelming fear of pissing the wrong people off and effectively ending one’s hopes of ever becoming a doctor. It’s a huge, huge fear in my opinion. And, in my judgement, it is just this atmosphere (where there is no recourse against recurring and possibly much greater petty, malignant, and toxic behavior) that underpins the sense of helplessness that leads to these suicides. But, do you know what is almost as bad? When, once you are a practicing physician, you can be made to feel just as helpless. When I worked as an anesthesiologist at a community hospital, I was told point blank by the anesthesia department head that anesthesiologists were the “whores” of the OR implying that I would not be treated any better than a whore. The surprising this is, she was exactly right. What proceeded after that discussion was nothing less than a nightmare for me personally and later, for her as well. I could go into detail, but it’s unnecessary.

  10. Robert Duncan says:

    The Dr. Oz clip is very illuminating. 3 women discussing what is wrong with men.

  11. Mary says:

    Not in the medical field but just happened to read all of this subject matter.Am very much upset ?. Would like to help if possible.

  12. Hip says:

    My view is that apart from the psychological stress and long hours medical professionals are exposed to, a very important factor in physician suicide is their possible higher exposure to viruses, as a result of sick patient contact.

    When I caught a coxsackievirus B4 virus, and this same virus spread to over 30 friends and family, it triggered depression, anhedonia and anxiety in several people, as well as triggering several physical illnesses in such as viral myocarditis, type 1 diabetes and bowel ruptures.

    Viruses such as coxsackievirus B and echovirus are often never fully eliminated from the body, but may persist as a chronic low-level intracellular infection, called a non-cytolytic enterovirus infection (it’s similar to latency, but the virus remains active inside the cell).

    We need to research the mental health effects of viruses such as coxsackievirus B.

  13. Pamela Wible MD says:

    Fram an anesthesiologist friend who reports her thoughts on why this specialty leads in suicides:

    1) There’s always the individual story at play, but in general I think there’s a little anxiety that goes into being a good anesthesiologist: we tend to be a little OCD, it’s something that helps see the sharks in the water and diminish patient risk. That may relate to some PTSD from growing up.

    2) There’s ready access to controlled substances so I think substance abuse is higher, partly from that. And that’s clearly associated with suicidality.

    3) Often Admin’s is pushing throughput: as in, be as fast as you can. This is the first hospital I’ve worked in (18 yrs) that isn’t timing the turn-around time to get into the OR. This turn-around time, even if not our fault, is often blamed on anesthesia.

    4) Surgeons don’t actually very often care what we are concerned about in terms of mitigating patient risk. One of the reasons I left anesthesia to do a pain fellowship was a 1.5 hour conversation with an orthopod who was angry I cancelled his elective 2 level lumbar fusion for a patient whose Na+ was 114.

    5) It’s not uncommon for the surgeon or the CRNA or the charge RN of the OR to be malignant narcissists. The sociopathic nature of that disorder wrecks havoc on one’s self-esteem and otherwise destroys a life.

    6) EMRs suck for us too. Like the current one takes literally 5″ to start up and 5″ to close down, that causes all sorts of issues when that time is the most dynamic for us with the patient.

    7) Patients are often in life-threatening situations.

    • Pamela Wible MD says:

      In addition she mentions: “There’s one other BIG thing. That’s that the CRNAs, generally, think their education is equivalent and we have nothing to offer the patient. CMS, when I was a resident, allowed their sickest patients to be cared for without an anesthesiologist pre-operatively. Then in 2015 or 2016, CMS allowed CRNAs to do interventional pain medicine WITH NO TRAINING WHATSOEVER. That was quite a blow personally, when I left a successful private practice to go to a pain fellowship at 1/8th the salary because I wanted to take care of that complex population as best I can.”

  14. C Ferris says:

    I have been an anesthesiologist for 25 years. I left surgery in residency because of hazing and absurdity which you have appropriately described in your blogs/articles. Anesthesia not much better. The abuse from most surgeons and the lack of respect from Administration is beyond rational. . The pressure to keep some of these morbidly obese hypertensive multiple medical problem-ed patients alive for unnecessary surgery which pays for the hospital administrators Tesla payments…. never mind the inherent stress of trying to keep people alive for a living. Combine all this with a vast knowledge of pharmaceuticals, physiology and the access to controlled substances and you get addiction and suicide. In a couple of European countries the mandatory retirement age of anesthesiologists is 55 – mostly for the reason that after that age one can not stand it any further for a multitude of reasons. I completely understand being almost 55

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