Watan-The deteriorating economic and social conditions in Iran are adversely affecting resident doctors. Despite bearing significant responsibilities, they receive low wages and work under poor conditions, leading to higher suicide rates among them compared to other groups.
Cardiology specialist Parastoo Bakhshi, 35, had no choice but to leave her home in the Iranian capital and travel on March 19, 2024, to the southwest to assume her duties as a resident doctor at Ibn Sina Hospital in Nurabad city, Lorestan province, 460 kilometers from Tehran. She had delayed this step for a long time due to depression following the death of her parents, spending an entire year trying to change her mandatory service location, but her attempts were unsuccessful.
Bakhshi tried to accept her new situation, but on her first working day, she was insulted by an internal medicine professor who decided to deduct half of her salary. She ended her life just four days after officially starting her duties, as recounted by Ali Salhashour, Director of Public Relations and International Affairs at the Iranian Medical Council (the comprehensive union umbrella for doctors and the second-largest non-governmental organization in the country after lawyers) on his personal Instagram page.
Medical school graduates undergo a mandatory service period (two years) in areas designated by the Ministry of Health, according to Dr. Reza Qadri. He explains that the service period is two years for doctors working in provincial centers, while it decreases to 13 or 20 months if serving in villages or remote cities. He adds that mandatory service does not include major cities with abundant medical facilities, such as Tehran, leading graduates to spend this period in more distant provinces.
Qadri works in Zanjan city (326 kilometers northwest of Tehran) and completed his mandatory service in one of the villages of Miandoab in West Azerbaijan province (762 kilometers northwest of Tehran). He says that some graduates with low grades commit during the medical specialization exam to serve in remote areas for periods up to ten and a half years for general medicine graduates and seven years for specialists, according to the amended “Educational Justice in Admitting Students to Postgraduate and Specialized Stages” law of 2022, which gives them priority in admission.
However, he notes that some resort to intermediaries to return to service in provincial centers contrary to their commitment. He adds that the law grants resident doctors in remote areas privileges such as housing, furnishing, and several job benefits, but the reality is different; the housing may be unfurnished, and in some small areas, there may be no housing at all.
Sixteen specialist resident doctors committed suicide during 2023.
Victims of the country’s deteriorating conditions
Twenty resident doctors from various specialties across the country have committed suicide in the past year, according to Mohammad Ali Shahmoradi, former secretary of the Resident Doctors’ Union Council in Zanjan, speaking to “Al-Araby Al-Jadeed.” He notes that recent times have seen an increase in numbers, reaching four or five cases per month, but some are not announced. He attributes the rise in suicide rates to difficult working conditions, inability to adapt to local cultures, lack of resources, and mistreatment of doctors by health authorities.
Dr. Reza Lari Pour, spokesperson for the Medical Council, adds to the previous reasons the low wages, averaging $200 per month, which do not match the workload, as resident doctors work between 300 to 400 hours monthly. He points out that economic pressure, anxiety about job prospects, and personal circumstances such as family crises lead doctors to feel helpless and depressed, eventually resulting in suicide.
The deteriorating situation leaves resident doctors with no prospect of building a normal future life. According to Lari Pour, the difficulties faced by Iranian doctors are not new, but previously they endured them because the economic conditions were better, and there was a clear prospect for the resident doctor who could, for example, buy a Peugeot 206 car (currently priced at about $10,000) after a year of work. But today, they cannot afford it even after completing the four years of specialization.
Additionally, the new generation is less able than its predecessors to adapt to the physical and psychological challenges of the profession, such as being away from their families and most being unable to marry due to economic problems or work pressures, especially since they are over thirty, move to remote areas, and are not financially independent, which creates significant psychological pressure on them. Lari Pour concludes that the economic factor is the most important among the reasons and intertwines with other factors.
34% of resident doctors consider suicide
The methods of suicide among doctors vary, but most, according to Shahmoradi, take overdoses of drugs or medications. He points to two recent cases: the first of a resident doctor in southern Iran who committed suicide with sedative pills after being abused by residents of the area where he was staying, and the second of a pregnant female doctor residing in Kermanshah city who committed suicide with an overdose of “Digoxin” (a drug used to treat congestive heart failure, and overdoses of it lead to death).
About 30% of resident doctors consider suicide, says Dr. Vahid Shariat, president of the Scientific Association of Psychiatrists, to “Al-Araby Al-Jadeed,” citing a scientific study. He notes that data from the Iranian Medical Council document the suicide of 16 specialist resident doctors during 2023, “but the Ministry of Health has more accurate figures, though unfortunately, these data are confidential and not disclosed.”
This percentage aligns with a survey titled “Factors Associated with Suicidal Ideation Among Resident Doctors in Tehran During the COVID-19 Pandemic: A Multicenter Cross-Sectional Survey,” conducted by a research team led by Dr. Fahimeh Saeed, assistant professor in the Department of Psychiatry at the University of Rehabilitation and Social Health Sciences in March 2024, involving 353 resident doctors, which revealed that 34.3% of those surveyed had suicidal tendencies.
The number of resident doctors is 15,000, with suicide rates among them about 100 cases per 100,000 people, which is 12.5 times higher than in the general population, which, according to official forensic data, is 8 cases per 100,000. Shariat describes this increase as “very large and concerning,” asserting that the state of denial and rejection by responsible authorities “unable to provide solutions” worsens the situation.
Iranian universities lack centers dedicated to providing psychological counseling for medical students and promoting a culture of solidarity and support in the workplace, as noted by Dr. Lari Pour. He has called on health authorities to establish such centers, stating, “A doctor in their thirties needs financial support from their parents, and if married, they will face an even more challenging living situation.” He points out that the Ministry of Health does not offer any facilities for resident doctors, such as housing or loans.
In the past, a specialist could open a clinic and build a comfortable life, which alleviated the hardship of local displacement during mandatory service. However, today, according to Dr. Qadri, many specialists are unable to rent clinics within cities like Tehran, where prices vary by area (ranging from $800 to $2,000), forcing some to open clinics on the outskirts of the capital.
Decline in Social Status
Dr. Amir Hossein Jalali Nodoushan, head of the Oversight Committee of the Scientific Association of Psychiatrists (a non-governmental organization) and a specialist in psychological and mental illnesses, describes the Iranian medical community as being in the process of descending from a group that enjoyed special social status to a lower rank. Doctors, especially residents, have become convinced that they are losing their social and economic standing. Nodoushan acknowledges that most segments of society have become more helpless and impoverished, but this social and economic decline is more apparent and impactful within the medical community.
He does not consider doctors’ suicides to be individual cases linked solely to the person who took their own life; rather, he views it as an issue affecting the entire society, expressing a “dilemma in their aspirations and a decline in their societal value.” He explains that the doctor was a symbol of happiness in society and a source of empowerment and energy for people. Therefore, when a doctor commits suicide, it makes citizens feel a serious and significant imbalance, leaving a negative impact on the expectation of a clear and happy future for the new generation, whether they want to become doctors or not. Thus, a doctor’s suicide is a “social issue and should not be reduced to a problem of an individual, family, or union.”
Dr. Arash Anisian, head of Sina Al-Ahli Hospital in Tehran, stated to “Al-Araby Al-Jadeed” that the Education Deputy of the Iranian Ministry of Health is responsible for resident doctors. Over the past year, the ministry has taken steps such as partially increasing salaries from $200 to $250 and reducing working hours.
However, Anisian believes these measures are “insufficient” and do not meet the needs of resident doctors, given the living and psychological pressures and “loss of hope for the future” due to low wages. He points out that resident doctors are between 30 and 40 years old and bear family responsibilities, but their salaries do not cover their needs, forcing them to work additional jobs after their shifts.
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