I trained in anaesthesia at a major teaching hospital in Sydney. During that time, and in the years that followed, I became aware of at least two colleagues who took their own lives. Not patients. Colleagues. People I worked alongside, people I trained with, people who were building careers in one of the most demanding specialties in medicine.
They are not unusual. They are a statistic.
Anaesthesia's particular problem
Every specialty carries its own pressures, but anaesthesia has a specific vulnerability. Anaesthetists die by suicide at roughly twice the rate of the general population, and at 1.45 times the rate of other medical specialists. For drug-related suicide, that ratio climbs to 2.21. Surveys of anaesthetists have found that up to 16% report previous suicidal ideation.
The reasons are not mysterious. Anaesthetists work in high-acuity environments with constant exposure to critical events, death, and near-misses. They carry sole responsibility for keeping patients alive during surgery, often for hours at a time. The work selects for people who internalise stress rather than expressing it. And the specialty has historically had higher access to lethal drugs than almost any other.
Between January 2018 and December 2021, AHPRA recorded 16 deaths and four attempted suicides among practitioners subject to regulatory notifications. That is not a statistic about anaesthetists specifically, but about all practitioners caught in the regulatory process. The people I lost were caught in something broader: a system that compounds the pressures already inherent in the specialty, rather than alleviating them.
The mandatory reporting trap
Australia's mandatory reporting laws require health practitioners, including treating psychiatrists and psychologists, to report colleagues they believe are practising in a way that poses a substantial risk to the public. The threshold is deliberately high. In Western Australia, treating practitioners are completely exempt.
But the perception is what matters, not the threshold.
The Beyond Blue National Mental Health Survey, which received responses from over 12,000 doctors, found that 52.5% cited fear of lack of confidentiality as a barrier to seeking help. More than a third (34.3%) specifically feared the impact on their registration and right to practise. Forty percent believe that doctors with a mental health history are perceived as less competent by their peers.
So the system creates a paradox. Doctors who are struggling are the ones least likely to seek help, because they believe the act of seeking help could end their career. And every year, when they renew their registration, AHPRA asks vaguely worded questions about "impairment" that reinforce exactly that fear.
The 2018 amendments to the National Law raised the reporting threshold for treating practitioners, so that a doctor treating another doctor is only required to report if their patient poses a "substantial risk of harm" to the public. The intent was to make it safer to seek help. But as a 2025 MJA InSight article put it plainly: mandatory reporting remains a barrier to treatment for mental health. The reforms changed the law. They did not change the fear.
What the system actually does
Let's walk through what happens to a doctor who gets a notification lodged against them.
First, they receive a letter. Then they wait. The average investigation takes months. Sometimes years. During that time, the doctor continues working (or doesn't, if conditions are imposed), carrying the weight of an unresolved complaint while maintaining the appearance of clinical competence.
The psychological impact of this process is well documented. The AMA has stated publicly that the regulatory process itself has a "traumatic effect" on doctors. Not the outcome. The process. The uncertainty. The waiting. The knowledge that your career, your identity, and your reputation are in someone else's hands, and there is nothing you can do to speed it up.
In some cases, practitioners do not even get the relative mercy of a slow investigation. Under section 150 of the Health Practitioner Regulation National Law, the Medical Council can convene an immediate action hearing and suspend a practitioner's registration before any finding of wrongdoing. The power exists for genuine emergencies where the public is at immediate risk. But it has been used far more broadly than that.
In 2022, the NSW Court of Appeal found in Pridgeon v Medical Council of NSW that the Council had improperly used its immediate action powers and should have pursued the matter through a standard complaint process instead. The decision forced multiple other immediate action cases to be reviewed. In 2024, the Queensland Supreme Court reached a similar conclusion in Bay v AHPRA, with Justice Bradley finding that the Board's conduct was "profoundly unsatisfactory" and tainted by "apparent bias."
In April 2025, the AMA formally called for legislative reform, stating that AHPRA's immediate action power is an "extreme power used too readily and with too little oversight," and that practitioners are being "left to languish for years waiting for an outcome."
AHPRA received 13,327 notifications in the most recent reporting year, a 19% increase on the year before. Thirteen thousand practitioners going through some version of this process. And for many of them, the complaint will not result in any action at all. But the damage to their mental health has already been done.
When seeking help becomes evidence
I am aware of a case in NSW where a specialist self-reported a personal legal matter to AHPRA. No patient had been harmed. No complaint had been made by a patient or a colleague. The practitioner did what the system asks you to do: be transparent.
What followed was an investigation by the Health Care Complaints Commission. As part of that investigation, the HCCC issued a formal notice under section 34A(1)(b) of the Health Care Complaints Act 1993 to the practitioner's treating psychiatrist, requiring production of "a complete copy of all patient records" including "psychiatric assessments and reports, psychological assessments and reports and any related correspondence." Not a summary. Not a fitness-to-practise assessment. Everything.
The psychiatrist was given 15 days to comply. The notice stated explicitly that failure to produce the records was a criminal offence carrying a penalty of up to $22,000 and "may constitute unsatisfactory professional conduct" under the Health Practitioner Regulation National Law. In other words: hand over your patient's complete psychiatric file, or face prosecution and a threat to your own registration.
The practitioner was given no explanation of who within the HCCC would read these records, how they would be stored, or what they would be used for. Under section 37A of the same Act, self-incrimination is explicitly not a valid reason to refuse, and any documents produced are admissible in disciplinary proceedings.
Think about what this means for every doctor reading this. If you seek help for your mental health, and you are ever subject to a regulatory investigation for any reason, your complete psychiatric history can be compelled. Every session note. Every diagnosis. Every medication. Every private disclosure you made in confidence to your own treating doctor, on the understanding that it was protected by therapeutic confidentiality. All of it becomes part of an investigative file, and your psychiatrist faces criminal penalties and a threat to their own career if they try to protect you.
This is not a hypothetical. This happened. And every doctor who hears a story like this (and they circulate, because doctors talk) adds it to the mental calculus of whether seeking help is worth the risk. For many, the answer is no.
The 52.5% of doctors who cited fear of lack of confidentiality as a barrier to seeking help are not being irrational. They are making a perfectly reasonable assessment based on how the system actually operates.
The culture problem
Medicine trains you to be resilient. To push through. To absorb trauma and keep functioning. Anaesthetists in particular are trained to manage crises without showing distress, to make critical decisions under extreme pressure while appearing calm.
That training is excellent for the operating theatre. It is catastrophic for personal wellbeing.
When 47.5% of doctors in training report emotional exhaustion and 45.8% report high cynicism, the problem is not individual weakness. It is structural. The system takes people who are predisposed to self-sacrifice, puts them through a decade of high-pressure training, gives them responsibility for human life on a daily basis, and then punishes them for developing the psychological consequences that anyone would develop under those conditions.
And then, when something goes wrong (a complaint, a bad outcome, a media article), it removes the one thing that gave them purpose: their professional identity. A doctor who cannot practise is, in their own mind, no longer a doctor. That loss of identity is not a career setback. For some, it is existential.
What needs to change
The 2018 reforms to mandatory reporting were a start, but they have not changed behaviour. Doctors are still afraid. The data is clear on that.
Four things would make a material difference:
1. National consistency on treating practitioner exemptions. Western Australia already exempts treating practitioners from mandatory reporting obligations. Every other state should follow. If a doctor cannot speak honestly to their own doctor, the system is broken at its most fundamental level.
2. Remove impairment questions from annual registration renewal. Asking practitioners annually whether they have an "impairment" does not protect the public. It discourages disclosure. Replace it with a positive obligation to maintain fitness to practise, without requiring self-incriminating declarations about mental health history.
3. Protect therapeutic records from compelled production. Section 34A of the Health Care Complaints Act 1993 allows investigators to compel production of a practitioner's complete psychiatric records with nothing more than a letter from an investigations officer. No judicial oversight. No independent review of whether the records are relevant. No limits on who within the commission can read them. If we are serious about encouraging doctors to seek help, their therapeutic records need the same protection as legal professional privilege. At minimum, compelled access to psychiatric records should require a court order, not an administrative notice.
4. Fund confidential, independent support services outside the regulatory framework. Doctors need somewhere to go that is structurally separate from AHPRA, from their employer, and from their insurer. The Doctors' Health Advisory Service exists, but it needs to be better resourced and its independence from regulatory bodies needs to be absolute and visible.
The cost of doing nothing
Every year we lose doctors to suicide. Not because they were weak, but because they were human, and the system does not allow for that.
I trained in a specialty where you learn to keep people alive in the worst possible circumstances. The colleagues I lost were exceptionally capable. They did not fail at medicine. Medicine, and the systems around it, failed them.
We can keep publishing studies and holding conferences about doctor wellbeing. Or we can change the four things that would actually make a difference.
The people I trained with deserved better. The people training now still do.
If you or someone you know is struggling, contact Lifeline on 13 11 14 or the Doctors' Health Advisory Service in your state.