October 2026 – Tarrant County Physician Online

Physician Suicide: Addressing the Crisis

President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the September/October 2026 issue of Tarrant County Physician.

It’s time to break the silence on physician suicide. This may be an exceedingly difficult topic for many of you; perhaps you have experience with losing a colleague or a loved one to suicide. Some of you may even have your own struggles. Unfortunately, physicians still have one of the highest suicide rates of any profession, with 300 to 400 physicians a year dying by suicide in the US.^3,7 Here are some staggering facts: one in six physicians has thought about or attempted suicide.⁴ Physicians in total die by suicide at twice the rate of the general population.^2,11 Suicide is the leading cause of death among male residents and the second leading cause of death among female residents.³ Medical students are three times more likely to die by suicide than their peers of the same age.^3,7 Our residents are suffering. Our students are suffering. And we are suffering.

“Physician, heal thyself” is a biblical proverb that is often taken out of context. It does not mean we should treat our own illnesses. Rather, it reminds us that physicians, too, must care for our mental and physical health by getting support from those who have the knowledge and training to help us. Too often, physicians continue caring for others while ignoring or delaying care for themselves—whether for something as minor as a cold or as serious as heart disease or suicidal thoughts. Even today, society often assumes physicians do not get sick or struggle with mental illness. Many of us were trained to believe that acknowledging illness could be seen as weakness, so we press on without seeking care, even as we expect our patients to do otherwise. Physicians who seek help may also fear consequences with licensure, credentialing, or patient trust.^3,7,13 Our self-reliance and perfectionism can make asking for help even harder. And although we are trained to recognize risk factors in our patients, we may miss them in ourselves or our colleagues. This potential blind spot is especially concerning because physicians share many of the same suicide risk factors as the general population, including mental health disorders, impaired relationships, and self-criticism.^1,5,7

Burnout from high workloads, time pressures, moral distress, and relationship discord is a real issue for physicians. There are additional institutional and regulatory pressures as well, often associated with administrative burden and an increased sense that autonomy is being lost.^3,6,7 Decreased efficiency and errors may also occur.^4,6 There is a perceived lack of psychological safety for physicians. Let’s face it, our cultural norms discourage vulnerability and seeking help for ourselves.^7,9,13 Yet the relationships we hold, the identities we carry, and the quiet pressures we internalize all play a role in suicide risk. So how can we help? I have a couple of ideas.

Last year at Burnett School of Medicine at TCU, several faculty, staff, and medical students had a fantastic session with the program manager for the Jordan Elizabeth Harris Foundation. She told the story of the foundation’s young namesake, Jordan Harris, who died by suicide shortly before graduating from college. Her parents created this foundation to help prevent others from experiencing the loss of a loved one dying by suicide. Not only was this educational, but it was also a training session on how to respond in these situations. Anyone can help prevent suicide. Just observing a physician, or anyone for that matter, in distress, and reaching out, can save a life. This training program is called QPR, which stands for Question, Persuade, and Refer. Like CPR, any person can be trained to effectively provide QPR—they do not have to be a healthcare professional. The American Hospital Association developed an entire guidebook that looked not only at data regarding healthcare worker suicide but also data about effective prevention strategies that hospitals could implement.12

Thursday, September 17, is National Physician Suicide Awareness Day (#NPSADay). This is now an annual opportunity to break the silence and raise awareness of mental health issues and suicide in physicians. A partnership between The Physicians Foundation, All In: Wellbeing First for Healthcare, and the Dr. Lorna Breen Foundation was formed to address physician suicide with a particular campaign called Vital Signs. This campaign is designed to train organizations, clinics, and even individuals in suicide prevention. In this campaign, Vital Signs refers to warning signs of impending physician decompensation or suicide. This partnership recommends a variety of prevention measures including recognizing warning signs, encouraging mental health reflection, sharing suicide prevention resources, checking in with physicians who do not appear to be doing well, removing intrusive mental health questions to licensure and hospital privilege applications, and creating a culture of well-being in organizations. They also have toolkits and even training slides for organizations to use (for free).^12,13,14

And let’s not forget our own TCMS wellness program, which I mentioned in my first President’s Paragraph. Our Tarrant County Medical Society Physician Wellness Program facilitates confidential, non-reportable help with coaching sessions and four complimentary counseling visits for members OR spouses, including couples counseling. The website is listed with the mental health resources I have shared below; it is sponsored by Tarrant County Academy of Medicine.

We entered this profession to heal—to listen to comfort, to save lives. Yet somewhere along the way, many of us learned to silence our own pain. We learned to wear resilience like armor, to treat vulnerability as weakness, and to fear that asking for help might cost us our careers. But silence has a cost. And too often, that cost is a life. Breaking the silence is not just an act of courage—it is an act of care. It is how we honor those we have lost, protect those still struggling, and reshape the culture of medicine into one that heals its healers. The question is no longer whether we should speak up. It is how we create spaces where speaking up is safe, supported, and sustained.

“The journey of a thousand miles begins with a single step.”
– Lao Tzu

References:

H. Makhija, J. E. Davidson, K. C. Lee, A. Barnes, A. Choflet, and S. Zisook, “National Incidence of Physician Suicide and Associated Features,” JAMA Psychiatry 82, no. 5 (2025): 451–458, https://doi.org/10.1001/jamapsychiatry.2024.4816.
D. Duarte, M. M. El-Hagrassy, T. C. E. Couto, W. Gurgel, F. Fregni, and H. Correa, “Male and Female Physician Suicidality: A Systematic Review and Meta-analysis,” JAMA Psychiatry 77, no. 6 (2020): 587–597, https://doi.org/10.1001/jamapsychiatry.2020.0011.
H. H. McClafferty, D. K. Hubbard, D. Foradori, et al., “Physician Health and Wellness,” Pediatrics 150, no. 5 (2022): e2022059665, https://doi.org/10.1542/peds.2022-059665.
Jon McKenna, “Medscape Physicians and Suicide Report 2025: ‘A Lot More Still Needs to Be Done,’” Medscape, February 21, 2025.
K. J. Gold, T. L. Schwenk, and A. Sen, “Physician Suicide in the United States: Updated Estimates from the National Violent Death Reporting System,” Psychology, Health & Medicine 27, no. 7 (2022): 1563–1575, https://doi.org/10.1080/13548506.2021.1903053.
Constance Guille and Srijan Sen, “Burnout, Depression, and Diminished Well-Being among Physicians,” New England Journal of Medicine 391 (2024): 1519–1527, https://doi.org/10.1056/NEJMra2302878.
S. B. Harvey, R. M. Epstein, N. Glozier, K. Petrie, J. Strudwick, A. Gayed, K. Dean, and M. Henderson, “Mental Illness and Suicide among Physicians,” The Lancet 398, no. 10303 (2021): 920–930, https://doi.org/10.1016/S0140-6736(21)01596-8.
US Preventive Services Task Force, “Screening for Depression and Suicide Risk in Adults: US Preventive Services Task Force Recommendation Statement,” JAMA 329, no. 23 (2023): 2057–2067, https://doi.org/10.1001/jama.2023.9297.
M. A. Oquendo and A. Porras-Segovia, “Barriers for the Research, Prevention, and Treatment of Suicidal Behavior,” Current Topics in Behavioral Neurosciences 46 (2020): 25–40, https://doi.org/10.1007/7854_2020_159.
S. K. Doupnik, B. Rudd, T. Schmutte, et al., “Association of Suicide Prevention Interventions with Subsequent Suicide Attempts, Linkage to Follow-up Care, and Depression Symptoms for Acute Care Settings: A Systematic Review and Meta-analysis,” JAMA Psychiatry 77, no. 10 (2020): 1021–1030, https://doi.org/10.1001/jamapsychiatry.2020.1586.
C. Zimmermann, S. Strohmaier, H. Herkner, N. Niederkrotenthaler, and E. Schernhammer, “Suicide Rates among Physicians Compared with the General Population in Studies from 20 Countries: Gender-Stratified Systematic Review and Meta-analysis,” BMJ 386 (2024): e078964, https://doi.org/10.1136/bmj-2023-078964.
American Hospital Association, “Suicide Prevention in the Health Care Workforce,” accessed August 10, 2026, https://www.aha.org/suicideprevention/health-care-workforce.
American Medical Association, “Preventing Physician Suicide,” updated August 7, 2025, https://www.ama-assn.org/practice-management/physician-health/preventing-physician-suicide.
The Physicians Foundation, “Campaign: Vital Signs,” accessed August 10, 2026, https://physiciansfoundation.org/research/campaign-vital-signs/.

Public Health Infrastructure at Work: Lessons from Ebola, New World Screwworm, Cyclospora, and the 2026 World Cup

Public Health Notes

By Kenton K. Murthy, DO, MS, MPH, AAHIVS
TCPH Assistant Director & Deputy Local Health Authority

This article was originally published in the September/October 2026 issue of Tarrant County Physician.

As physicians, we spend much of our careers focused on the patient in front of us. Public health often focuses on the patient we never see: the illness that was prevented, the outbreak that was contained, or the emergency that never materialized. When the system works as intended, its greatest successes can look like nothing happened.

The summer of 2026 has provided four very different reminders of why that infrastructure matters: a rapidly expanding Ebola outbreak in Central Africa, the return of New World screwworm to Texas, a large rise in cyclosporiasis associated in part with iceberg lettuce, and the successful completion of the largest FIFA World Cup in history. Each event required a different response, but all depended on the same foundation: timely clinical recognition, laboratory capacity, surveillance, clear communication, and coordination across jurisdictions and disciplines.

Ebola: A Global Threat Requiring Local Readiness
The current Ebola outbreak is caused by Bundibugyo virus, one of the Orthoebolaviruses that can cause severe hemorrhagic disease. As of August, the Democratic Republic of the Congo had reported over 4,000 confirmed cases and 1,916 deaths. The outbreak had become the largest Ebola outbreak recorded in the country. Uganda declared the end of its locally transmitted outbreak on July 28 after 42 days without a new locally acquired case, although ongoing transmission in the DRC leaves neighboring countries at risk for reintroduction._¹

For physicians in the United States, the immediate risk remains low. No cases associated with this outbreak have been confirmed here. CDC describes the overall risk to the American public and travelers as low and the likelihood of spread to the United States as very low.² Low risk does not eliminate the need for readiness. Early Ebola symptoms, including fever, fatigue, headache, myalgias, vomiting, and diarrhea, overlap with much more common illnesses. Recognition begins with a careful travel and exposure history, particularly during the 21 days before symptom onset.

If a patient has compatible symptoms and a relevant exposure, the first steps are to isolate the patient, implement appropriate infection-prevention precautions, notify the facility’s infection-prevention team, and contact the local or state health department to coordinate assessment and testing.³ That early call protects the patient, clinical staff, laboratory personnel, and the broader community. Local health departments, state agencies, and international partners have different responsibilities, but the value lies in how those responsibilities connect. In the affected areas, conflict, population displacement, limited diagnostic access, shortages of protective equipment, and infections among health workers have made control substantially more difficult. The biology of the virus is only one part of the outbreak; the strength of the surrounding system helps determine what happens next.

New World Screwworm: One Health in Real Time
Closer to home, New World screwworm is no longer only a threat approaching the southern border; it has been confirmed in Texas. The first US animal detection in the current outbreak was confirmed in a calf in Zavala County on June 3. By early August, the Texas Animal Health Commission reported confirmed animal cases on 35 premises in 15 counties.⁴

New World screwworm may sound primarily like an agricultural concern, but it is also a health issue with implications for veterinary medicine, wildlife, human health, and the Texas economy. The larvae of Cochliomyia hominivorax feed on living rather than necrotic tissue. Its reemergence reminds us that protecting health sometimes requires veterinary medicine, agriculture, wildlife management, laboratories, emergency management, and human public health to operate as a system.

There have been no reports of locally acquired human infestation in the United States, and CDC characterizes the current risk to people as very low.⁵ Clinicians should nevertheless recognize the presentation: a rapidly worsening, painful, foul-smelling wound; bloody drainage; visible larvae; or the sensation of movement in a wound or body opening. Treatment requires removal and safe disposal of all visible larvae and eggs, repeat examination of the lesion, wound care, and treatment of secondary infection when present. Suspected human cases should be reported immediately, and intact larvae should be preserved for identification rather than discarded.⁶

The Texas response demonstrates collaboration beyond traditional health departments. USDA, the Texas Animal Health Commission, Texas Parks and Wildlife, CDC, DSHS, local health authorities, veterinarians, producers, and laboratories all have distinct roles. Surveillance, animal-movement controls, wound inspections, public education, and release of sterile male flies are being used together. The sterile insect technique helped eradicate indigenous New World screwworm from the United States in 1966. Its renewed use is a reminder that public health tools can be biological, regulatory, clinical, and operational at the same time.⁴

Cyclospora and Iceberg Lettuce: The Value of Routine Reporting
The 2026 rise in cyclosporiasis illustrates the importance of routine disease surveillance and foodborne outbreak investigation. From May 1 through August 3, CDC reported 10,468 laboratory-confirmed, domestically acquired cases in 47 states, including 517 hospitalizations and, unfortunately, two deaths. CDC was also reviewing tens of thousands of additional illnesses that were not yet laboratory confirmed or required further investigation.⁷

One major subset of these illnesses was linked epidemiologically to iceberg lettuce sourced from central Mexico. Taylor Farms de Mexico recalled affected iceberg lettuce on July 17. Although Texas was not among the 15 outbreak case states listed at that time, recalled products had been distributed through Texas retail and food-service channels.⁸

For clinicians, cyclosporiasis should be considered in patients with prolonged or relapsing watery diarrhea, fatigue, anorexia, weight loss, bloating, and cramping, particularly when symptoms begin about a week after a produce or restaurant exposure. Testing may need to be requested specifically because routine stool examinations and some gastrointestinal panels do not automatically include Cyclospora. Trimethoprim-sulfamethoxazole is the treatment of choice; for immunocompetent adults, CDC lists one double-strength tablet twice daily for seven to 10 days.⁹ Every appropriately ordered test and timely report adds one piece to a much larger puzzle. Epidemiologists, laboratorians, environmental health specialists, regulatory agencies, clinicians, and industry partners then work together to compare exposures, identify clusters, trace products, and prevent additional illness. Clinical medicine and public health are not separate systems; they are complementary parts of the same healthcare continuum.

The World Cup: Preparedness That Stayed in the Background
Perhaps the most overlooked public health success is the event that concludes without a public health emergency. The 2026 FIFA World Cup brought 48 national teams and millions of visitors to 16 host cities across the United States, Canada, and Mexico over 39 days.¹⁰ Despite signs across Tarrant County stating “We Are Dallas,” Arlington actually hosted nine matches and welcomed hundreds of thousands of visitors, and local agencies monitored communicable disease, food safety, heat, air quality, medical surge, and other routine and event-related risks.¹¹

The work began well before the first whistle blew. Locally, healthcare systems, public health, emergency management, EMS, fire, law enforcement, laboratories, airport authorities, and municipal and regional partners established communication pathways and response plans. Nationally, CDC participated in a federal coordination structure; held regular calls with public health officials from all US host sites; deployed epidemiology, laboratory, informatics, and preparedness personnel; and created a shared dashboard for disease trends, heat, and air quality. Twenty port health stations maintained around-the-clock protocols at US ports of entry.¹⁰

At the close of the tournament, available public reporting indicated that no major tournament-associated public health emergency had occurred.10 That does not mean there were no public health concerns to monitor—it means those concerns did not become a defining incident. Risks were anticipated, information was shared, and agencies knew how to reach one another when a signal required attention. An uneventful outcome is often the product of very eventful preparation.

What Public Health Infrastructure Actually Means
Public health infrastructure is not simply a building, a department, or an organizational chart. It is the workforce that answers a report after hours; the laboratory that can identify an uncommon pathogen; the data system that connects cases across counties and states; the epidemiologist who conducts a detailed interview; the infection preventionist who protects a clinical team; the veterinarian who recognizes an unusual wound; the regulatory authority that can remove a contaminated product; and the communication network that provides accurate guidance without unnecessary alarm.

The same sequence appears repeatedly. A clinician or veterinarian recognizes something unusual. A laboratory provides confirmation. Local public health investigates the patient and immediate exposures. State partners identify broader patterns. Federal and international agencies compare signals across jurisdictions. Regulatory, animal health, emergency management, and healthcare partners then act within their respective authorities. No single organization can perform the entire chain, and delays at any handoff can allow a manageable event to become more difficult.

This is not an argument for alarm or for applying the same response to every signal. Good public health is calibrated. It distinguishes common illness from low-probability, high-consequence disease; confirms findings before drawing conclusions; communicates what is known and unknown; and adjusts the response as evidence changes. Strong infrastructure makes that proportional response possible.

The Physician’s Role
For practicing physicians, participation in this system is straightforward but essential:

Ask about travel and exposure when a patient’s syndrome or timing is unusual, particularly for acute febrile illness after travel to an outbreak area.
Order the test that matches the clinical concern, including a specific request for Cyclospora when prolonged or relapsing watery diarrhea warrants it.
Report early. A call to infection prevention or the local health department is not a declaration that a diagnosis is confirmed—it is the beginning of a coordinated risk assessment.

Beyond these examples, vaccination, antimicrobial stewardship, thoughtful diagnostic testing, and routine communicable disease reporting all strengthen the systems our patients depend on. Every clinician contributes to the larger public health enterprise, often without realizing it.

Public health is most visible during a crisis, but it is most effective before a crisis fully develops. Ebola, New World screwworm, cyclosporiasis, and the World Cup have very different challenges, yet they share a common lesson: timely information, defined roles, trusted partners, and coordinated action can protect both individual patients and entire communities. The strongest systems are built through relationships among clinicians, hospitals, laboratories, local health departments, state agencies, federal partners, and international organizations long before an emergency occurs. When those elements are in place, nothing happening may be the most meaningful outcome of all.

References:

World Health Organization, “Ebola Disease Caused by Bundibugyo Virus—Democratic Republic of the Congo,” Disease Outbreak News, August 1, 2026, https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON614. W World Health Organization
Centers for Disease Control and Prevention, “Ebola Outbreak: Current Situation,” July 22, 2026, https://www.cdc.gov/ebola/situation-summary/about-current-outbreak.html.
Centers for Disease Control and Prevention, “Screening and Evaluating an Ill Person for Viral Hemorrhagic Fevers,” updated August 3, 2026, https://www.cdc.gov/viral-hemorrhagic-fevers/hcp/diagnosis-testing/index.html. C CDC
Texas Animal Health Commission, “New World Screwworms,” accessed September 2, 2026, https://www.tahc.texas.gov/emergency/nws.html.
Centers for Disease Control and Prevention, “New World Screwworm Outbreak,” updated August 11, 2026, https://www.cdc.gov/new-world-screwworm/situation-summary/index.html.
Centers for Disease Control and Prevention, “Clinical Overview of New World Screwworm,” February 24, 2026, https://www.cdc.gov/new-world-screwworm/hcp/clinical-overview/index.html. C CDC
Centers for Disease Control and Prevention, “Surveillance of Cyclosporiasis,” updated August 11, 2026, https://www.cdc.gov/cyclosporiasis/php/surveillance/index.html. C CDC
US Food and Drug Administration, “Investigation of 15-State Outbreak of Cyclospora Illnesses: Iceberg Lettuce (July 2026),” July 2026, https://www.fda.gov/food/outbreaks-foodborne-illness/investigation-15-state-outbreak-cyclospora-illnesses-iceberg-lettuce-july-2026. ” “OUR WORLD”+1
Centers for Disease Control and Prevention, “Clinical Overview of Cyclosporiasis,” February 29, 2024, https://www.cdc.gov/cyclosporiasis/hcp/clinical-overview/index.html. C CDC
Centers for Disease Control and Prevention, “Statement on CDC Public Health Readiness & Response for the FIFA World Cup 2026™,” July 19, 2026, https://www.cdc.gov/media/releases/2026/statement-on-cdc-public-health-readiness-response-for-the-fifa-world-cup-2026.html. C CDC
City of Arlington, “City of Arlington Prepares for FIFA World Cup 2026™,” February 20, 2026, https://www.arlingtontx.gov/News-Articles/2026/February/City-of-Arlington-Prepares-for-FIFA-World-Cup-2026%E2%84%A2.