Monday, August 7, 2017

Causes of death among residents

What is the leading cause of death among residents in all specialties?

A. Accidents
B. Neoplasms
C. Suicide
D. Miscellaneous diseases

If you answered C, you were wrong. The correct answer is B, neoplasms. Suicide was the second most common cause, followed by accidents and miscellaneous diseases.

A study in Academic Medicine looked at resident deaths over a 15 year period and found that of the 381,614 individual physicians in ACGME training programs, 66 died of suicide. For the over 1.6 million person-years studied, the suicide rate for residents was 4.07 per 100,000 person-years—well below the figure of 13.07 per 100,000 years in the general population of people aged 25-34.

Residents in age groups 35-44 and 45-54 had suicide rates higher than the 25-34 group and higher than the rates of those in comparable general population age groups.

More suicides occurred during the first and second years of training and during the months of July through September and January through March. In my opinion, the months that deaths occurred in can be explained as follows. In the first three months of the academic year, residents in the first and second years may feel overwhelmed and subject to self-doubt—the so-called "impostor syndrome." By the time January and February roll around, it is mid-winter, and it seems like the year will never end.

Residents had a much lower rate of death from accidents, including those related to automobile crashes, than the general population.

The overall death rate from all causes was also lower for residents than the rate of the general population at 16.91 per 100,000 person-years and 105.4 per 100,000 person-years, respectively.

The authors were surprised that resident rates of suicide were lower than age- and gender-matched populations especially because suicide rates for medical students and practicing physicians are higher.

They concluded that suicide was probably the only area in which prevention strategies, such as a supportive environment and medical and mental health services, could reduce the death toll.

Program directors, faculty, and residents themselves should probably show heightened vigilance in the first and third quarters of the academic year particularly for first and second year trainees.


Jack Williams said...

I think that the overwhelmingness felt by residents is the flip side of the problem of unmatched doctors who, for all intensive purposes, are unemployed doctors. It is not unreasonable to consider it as a form of stress, hence, I don't shy away from suggesting that it worsens the neoplasms and contributes in some way to the accidents. The ACGME in coordination with the AHA can, by removing some of the regulations and inserting the unmatched doctors into the residency programs, respictively, solve the unmatched doctors' problem and reduce the overwhelmingness. The unmatched doctors would then share the work load with the residents who would then feel less overwhelmed.

Debra Gottsleben said...

Interesting that older residents had higher suicide rates than younger residents. Wonder why that is? Maybe more stress outside of residency (spouse, chil(ren), other obligations)?

Unknown said...

I think it would be ridiculously cost-efficient for residency programs to provide infant care at night for residents.

Particularly for a single parent in residency, night care for the infant could be the difference between sanity and non-sanity.

Hiring a night nanny is expensive.

Group care at night for tiny children would be both cheap (because childcare workers are relatively inexpensive) and it would be a relatively easy job since I assume most of the kids would sleep through the night.

If offered in the hospital, or on hospital grounds, it might even be convenient enough for residents to catch some shut-eye with their baby in between calls.

This program would particularly benefit those crazy ladies who are trying to 1) become a doctor and 2) breastfeed an infant at the same time.

Oldfoolrn said...

My hats off to any resident who can breastfeed an infant.

Skeptical Scalpel said...

Jack, there has been a federal government mandated cap on funding for residency positions for almost 20 years. The ACGME and the med schools have been trying to get it lifted for years. It's not as simple as you think.

I would not expect to see hospitals paying for 24-hour child care any time soon.

I agree that breast feeding a baby during residency would be challenging. I'm sure someone has done it, but I don't know how.

Anonymous said...

It may be that the reason resident have less accident fatalities than the general population is that they have considerably less time to be out of the hospital to have said accidents. It would be interesting to try and controll for time succespible to accidents and determine the risk

Skeptical Scalpel said...

Interesting thought. You may be right.

Anonymous said...

The higher suicide rate among older residents makes you question the current trend of admitting older students to medical school.

Skeptical Scalpel said...

Anon, interesting point. I'm not sure about that as a policy.

Korhomme said...

Re; the point about more suicides among older residents and should older students be admitted.

There are two possible answers to this. Perhaps young students, when they become old residents, are so burnt out or whatever that they see no future; or, old students, as even older residents, simply can't hack it.

But we don't actually know which of these two scenarios might be correct (or if there is something else going on).

Skeptical Scalpel said...

Korhomme, In truth we don't even know if this paper is accurate. On Twitter some people commented to me that they didn't believe the data. For example, some of the deaths categorized as accidents and a number of the so-called accidental poisonings may have been suicides. I urged those who felt that way to address their concerns to the authors of the paper.

Amy Stuckey said...

So, the moral of this story. If you don't kill yourself, cancer secondary to overwhelming amounts of pressure and stress will kill you slowly. Uplifting.

Skeptical Scalpel said...

Amy, that's one way to look at it. And I thought I was pessimistic.

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