In a comprehensive cross-sectional study examining causes of death among U.S. medical residents from 2015 to 2021, researchers found that suicide remained the leading cause of death. The rates have not changed since a previous study period from 2000 to 2014.

Between July 2024 and March 2025, the study researchers analyzed data from 370,778 residents and fellows who participated in 961,755 person-years of training.  

They found that, from 2015 to 2021, 161 residents (50 [31.1%] female; median [IQR] age, 31 [29-35] years) died during training. Forty-seven residents (29.2%) died by suicide, 28 (17.4%) by neoplastic diseases, 22 (13.7%) from other medical and surgical diseases, 22 (13.7%) from accidents, and 21 (13%) from accidental poisoning. Mechanisms of death by suicide included firearms (13 deaths), intentional overdose of drugs or other substances (13 deaths), hanging, strangulation, or suffocation (9 deaths), self-harm with a sharp object (7 deaths), and other means (5 deaths).

The research team, led by Nicholas A. Yaghmour, MPP, of the Accreditation Council for Graduate Medical Education, submitted yearly lists of deceased residents and fellows to the National Death Index to determine causes of death. They found that the death rate from neoplastic diseases decreased significantly from 2000 to 2014 (incidence rate ratio [IRR] = 0.59), while rates of other causes remained unchanged. The study period included the first 2 full years of the COVID-19 pandemic (2020 to 2021), during which one death (0.6%) was attributed to COVID-19.

Highest Risk During Transitions

A concerning pattern emerged regarding suicide timing. Of the 43 resident deaths by suicide (not including 4 fellows), 9 occurred in the first academic quarter of the first year of residency, representing nearly half (48.7%) of all resident deaths in this period. Another concentration of six suicides occurred in the fourth quarter of the second year of residency.

"The relatively high number of suicides during the first academic quarter of residency and the final quarter of the second year suggests heightened distress during major academic and professional transitions," the authors noted. Residents face challenges of adapting to both personal and professional changes while transitioning from medical school to graduate medical education in their first quarter, while those in 3-year programs anticipate expanded clinical and educational responsibilities by the end of year 2.

Specialty-Specific Concerns

The research revealed notable specialty-specific patterns across the full 22-year window (2000 to 2021).

• Pathology residents had the highest suicide rate (19.76 deaths per 100,000 person-years) and were significantly more likely to die by suicide than internal medicine residents (IRR = 4.98).

• Psychiatry residents had the highest death rate from neoplastic diseases (9.67 deaths per 100,000 person-years) and were significantly more likely than internal medicine residents to die from neoplastic disease (IRR = 2.56).

• Anesthesiology residents had the highest death rate from accidental poisoning (15.46 deaths per 100,000 person-years) and were significantly more likely than internal medicine residents to die from accidental poisoning (IRR = 11.69).

Lower Than General Population

Despite these findings, resident death rates from 2000 to 2021, including rates of death by suicide, were lower than age- and gender-matched peers across causes. For residents aged 30 to 34 years, the overall IRR for death compared with the general population was 0.12.

Still, the authors noted that the "findings call for more effective well-being research and interventions that proactively address distress before it escalates to suicidality. Efforts should focus on mitigating distress during key transition periods and addressing related challenges such as depression, burnout, and shame."

Resident and fellow rates of death across cause categories did not change significantly between the periods of 2000 to 2014 and 2015 to 2021, except for the reduction in deaths from neoplastic diseases. In the second period, the most common cause of death was suicide, followed by neoplastic disease. The authors concluded by calling for future research to "qualitatively explore the trainee experience, emphasizing the drivers and mitigators of distress."

The authors declared having no competing interests.

Source: JAMA Network Open