Corporate Manslaughter of Physicians and Medical Trainees
We live in a time when the healthcare system is collapsing not only in Canada, but also in the United States, the United Kingdom, and other countries. Nobody wants to hear about the plight of physicians, because we have become vilified since the days of people beating pans in honour of “healthcare heroes” during the height of the COVID-19 pandemic. And yet the plight of physicians and medical trainees is relevant, because one of the reasons for the collapse of the healthcare system is mistreatment of doctors and medical trainees, some of whom are either leaving the profession or ending their lives.
Corporate manslaughter refers to a corporation’s culpability in causing the death of a person through gross negligence or systemic failures. Medical institutions are corporations, and when physicians and medical trainees die by suicide, these corporations are rarely completely innocent. Systemic issues in the medical training environment, hospitals, clinics, and other medical organizations prioritize profits, archaic and problematic systems, and liability protection over the human element, leading to potentially fatal consequences.
Many medical professionals experience burnout, at levels so high that half of medical professionals screen positive for depression. Suicide rates of physicians are high, about 1 physician death per day in the United States alone. Marginalized physicians face worse statistics, such as neurodivergent physicians where 77% of autistic doctors consider suicide, and 1 in 4 autistic doctors have attempted suicide.
Make no mistake: the medical corporations responsible for training and employing physicians are aware of these numbers. They simply do not care enough to reform the system. They will pander resilience workshops and set up powerless offices to provide largely inconsequential emotional support. They will accommodate the mental health needs of their employees and trainees on a superficial level, a metaphorical bandaid on a deep laceration. But on a larger systemic level, little changes — if anything. On a large scale, medical corporations do not address systemic issues effectively because they do not feel responsible for physician suicides; they have not yet been held accountable through criminal charges or class-action lawsuits.
Systemic failures occur when physicians and trainees work in environments with inadequate staffing levels, excessive workloads, and lack of proper safety measures. Overworked and understaffed medical teams may face intense pressure to provide care to a high volume of patients, leading to rushed decisions and mistakes that could endanger both patients and medical staff. In some cases, a lack of appropriate safety equipment or protocols can also be dangerous, such as possibly facing exposure to infectious diseases. These situations lead to distress, burnout, and health risks for physicians. Working long hours, such as 24-hour on-call shifts, has the same effect as a mild level of alcohol intoxication, which makes for a dangerous drive home after an exhausting and sleepless night of work. Anyone who voices concerns about systemic issues faces potential discipline.
When a physician or medical trainee seeks resources for mental health support, they face further risks: stigma. Some medical licensing bodies inquire about mental illness during annual licensing renewal. Any such disclosure can potentially lead to enhanced scrutiny and invasive regular monitoring requirements. Rather than helping physicians with their mental health, this perpetuates stigma and leads physicians to feel afraid to seek help, lest they face adverse consequences that impact their career. If a physician discloses suicidal ideation, that is met with questioning their professionalism and ability to work in this profession; ableist physicians make comments to struggling medical trainees like, “If you can’t handle this, how could you handle a formal complaint or the demands of being a physician?”
Even more concerning is the loss of support systems that has become an expected, normalized part of medical training. In Canada, medical school hopefuls and postgraduate residency applicants tend to need to apply nationwide and potentially leave their families for training. A large number of residency applicants don’t even get matched, after years of successful medical training and tens of thousands of dollars of debt that they cannot afford to repay without a physician’s salary. If they do get matched, they may be forced to relocate to a new city, leaving their families behind. If they are unlucky enough to face a hostile culture in their program and a lack of support systems, the resulting isolation raises their suicide risk significantly. And yet, transferring programs between institutions is almost impossible due to several limitations within the current system, even for residents at death’s door due to workplace bullying. In some cases, these medical trainees have to either leave their training program and therefore the profession forever, or continue to tolerate a toxic workplace even if it is killing them.
Suicides of medical trainees or physicians tend to get summarized as simply a tragic story of mental illness, and their adverse experiences are covered up by the system. Yet mental illness is not inexorably fatal; there are psychological and social factors that cause a vulnerable person to collapse. It is absolutely possible to heal someone of mental illness such that the person in question need never die of suicide. As one physician wrote, “Though my daughter clearly had risk factors, the culture of the profession thwarted attempts to mitigate them.”
Physicians work in a caring profession that does not care about them. They are simply cogs in the machine, but who they are as people is irrelevant. Medical corporations have a responsibility to prioritize the safety and well-being of their medical professionals, as failing to do so can have fatal consequences. Institutions also bear a moral responsibility to protect the wellbeing of their physicians and medical trainees, as failing to do so undermines the fundamental principles of the medical profession. They ought to also bear a criminal responsibility for negligently or actively killing their medical trainees and physician employees. Hospitals, medical training programs, licensing bodies, and residency matching systems are all responsible if a medical professional dies because of systemic issues.
Call it what it is: corporate manslaughter of physicians and medical trainees.
