If you practice medicine long enough, you learn to carry a lot—other people’s fear, pain, and uncertainty. This year, many clinicians are also carrying a heavier backdrop: volatile policy shifts, Medicaid “unwinding” that has pushed millions off coverage, and day-to-day headwinds that make caring feel like combat. That strain isn’t abstract; it shows up in our inboxes, our sleep, our patience, and, too often, our safety.
This Suicide Prevention Week, I’m writing to fellow physicians (especially those in DPC and direct care models) with equal parts clarity and hope: we can build practices that protect our ability to care, and we can get help without jeopardizing our careers.
What the data really says (and why words matter)
- Research is mixed on whether physicians overall die by suicide at higher rates than the general population; what’s consistent is that female physicians face a persistently elevated risk even as rates decline overall. A 2024 gender-stratified meta-analysis found increased suicide risk for women physicians compared with women in the general population, while risk for men physicians was not higher than men overall. PubMedBMJ
- Burnout and moral injury remain strong drivers of distress. National analyses link burnout, workload, and administrative friction to suicidal thoughts among clinicians—even when mortality comparisons vary by sex and time period. The Lancet
- The system around us is adding pressure. Since the post-pandemic eligibility “unwinding,” over 25 million people have been disenrolled from Medicaid, a reality that many of us are absorbing as we help patients navigate gaps in meds, coverage, and continuity. That policy churn is stressful for patients and clinicians.
The political climate, without the politics
Wherever you sit on the spectrum, it’s fair to acknowledge: U.S. policy is in flux. Coverage rules shift, prior auth expands and contracts, boards revise mental-health questions, and state legislatures pass laws that affect how we practice. Clinicians are left to carry the fallout in exam rooms. That environment can make us feel powerless; the antidote isn’t partisan—it’s protective structure in our professional lives and peer connection in our personal ones.
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DPC doctors: you have levers. USE THEM.
One reason many of us chose DPC (or direct specialty care) was to regain control of the inputs that most predict distress. This week, gut-check your practice against these protective levers:
- Panel & pace
Set a humane ceiling (e.g., 500–800 adults, lower for complex panels). Guard 30–60 minute visits as the default, not the exception. - Boundaries that actually bind
Post-call clinic? After-hours texting? Decide your rules, write them down, and honor them. Boundaries you enforce are protective; “soft” boundaries are just wishes. - Admin load off your plate
Ruthlessly automate refills, labs, results routing, and billing. If software can do it, let it. The “free” task you keep doing at midnight is rarely free. - Financial steadiness
Variable income is stressful. Smooth cash flow with employer groups, prepay options, or a small locums/direct-contracting cadence. (This week’s My DPC Story episode dives into concrete negotiating guardrails for independent shifts.) - Peer infrastructure
Build a two-deep bench for coverage and a small circle of peers who will notice if you go quiet. Put it on a schedule: 30 minutes, twice a month, cameras on. - Mental health as a standard of care
Normalize therapy and coaching. Consider adding a clinician assistance benefit (anonymous stipend or vendor). Document it like any other safety program.
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“Will I lose my license if I get help?”
This fear keeps colleagues suffering in silence. The landscape is improving: many state medical boards have revised or clarified application questions to focus on current impairment rather than a history of treatment, and national bodies encourage safe-haven approaches. Check your state’s current language (it may be better than you think) and advocate for continued reforms.
If you’re struggling today
- Call or text 988 (U.S.). It’s available 24/7 for anyone in distress—including physicians.
- Physician Support Line (1-888-409-0141): free, confidential, with volunteer psychiatrists who understand our world.
- Loop one trusted colleague in now, even if all you say is: “I’m not okay today.”
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A five-minute prevention ritual for your clinic
This week, try this with your team:
- Name the load. What’s felt heaviest in the last 30 days (coverage chaos, a patient loss, family strain)?
2. One subtraction. Remove a single recurring task from the physician’s plate by Friday.
3. Buddy check. Pair up, set a 60-second weekly check-in.
4. After-hours rule. Agree on one boundary (e.g., no portal replies after 7 pm) and auto-message it in your tools.
5. Post the lifelines. 988 and Physician Support Line—on the wall and in the team chat.
None of this replaces professional care. It does make it more likely we’ll still be here to deliver it.
Why this matters, now.
The science is clear enough to act: women physicians remain at higher risk; everyone in the trenches is vulnerable when workload and moral injury mount; and the policy climate is amplifying patient need and clinician strain. We don’t need another year of grim headlines to justify building protective practices and getting help early. PubMedThe Lancet
If you read nothing else, read this:
- Your worth isn’t your RVUs or your panel size.
- Getting help is a sign of professional responsibility, not weakness.
- Direct care models give us levers—panel, pace, pay, peers. Pull them.
If you lead a practice, make suicide prevention part of your safety program. If you’re a policy-minded clinician, keep pushing for coverage stability and for licensing questions that focus on impairment, not treatment. If you’re exhausted, tell one person today.
We need you here.
Resources
- 988 Suicide & Crisis Lifeline.
- Physician Support Line (1-888-409-0141).
- AMA: Preventing Physician Suicide (evidence and tools). American Medical Association
- JAMA Psychiatry & BMJ meta-analyses on physician suicide (gender-stratified). JAMA NetworkPubMed
- KFF Medicaid Unwinding Tracker (coverage loss context).
If this resonated, consider sharing it with one colleague and adding your own “five-minute ritual” in the comments.
Ruthlessly automate refills, labs, results routing, and billing. If software can do it, let it. The “free” task you keep doing at midnight is rarely free.
