Graduating from medical school and starting residency training should be one of the most exciting times in a physician’s career. Instead, for two newly-minted New York City doctors, who ended their lives within a week of each other this summer, this period marked a morbid end. They represent a tragic and rarely discussed phenomenon in the medical profession: Doctors commit suicide at a rate more than twice the national average. Every year approximately 400 physicians take their own lives. That is roughly one per day, or the equivalent of two entire graduating medical classes each year.

As a recent graduate of an internal-medicine residency, I know that physician depression and suicide are not routinely discussed in medical school or training. Significant time is given in medical education on how to recognize depression and suicidal thoughts in patients, but never once did I hear of my own increased risk of suicide.

One might expect that older physicians, after years in an emotionally and often physically taxing profession, bear the burden of an increased suicide risk. But it is really a phenomenon of young physicians. Suicide accounts for 26 percent of deaths among physicians aged 25 to 39, as compared to 11 percent of deaths in the same age group in the general population.

It does not take long for physical and mental exhaustion to overtake a young doctor. A 2006 study at the University of Pennsylvania demonstrated that over the course of the first post-graduate year of training, commonly known as “intern” year, rates of burnout–a triad of symptoms comprised of emotional exhaustion, depersonalization, and a sense of decreased personal accomplishment–soared from 4.3 to 55.3 percent. Not surprisingly, increased rates of burnout were associated with increased rates of moderate depression, affecting nearly one-third of interns by the end of the year.

Physician training can be an extremely stressful undertaking, from managing crushing education debt while receiving a minimal salary, to an 80-hour workweek, to having to keep up with the frenetic pace of evolving medical knowledge, all while being responsible for life-and-death decisions. However, none of these reasons–individually or combined–can fully explain why doctors have significantly higher rates of suicide. The complex issue is made only more complex by silence among medical professionals.

One recent study found that only half of depressed interns obtained mental health services. How can it be that physicians, whose lives are spent providing care, are not seeking their own necessary care? Responses for avoiding help include lack of time, lack of confidentiality, a desire to manage their mental health independently, and professional stigma. Nearly half of the interns in the study believed their colleagues would have less confidence in them as medical providers if they sought psychiatric treatment. Threat of judgment from other physicians serves as one of the largest roadblocks to seeking psychiatric care. And yet, there is not one doctor I know who would ever want a colleague to suffer. How can the medical community begin to rectify this self-destructive paradox? As physicians, we believe that initiating a dialogue with our patients is the best way to enact healthy behavior changes. The profession would do well to adopt this same technique to best care for our own.