When you choose a new doctor, it’s easy to find out a lot information about a physician — what medical school they attended, their board certifications, their recent publications, and what health insurances they accept.

But what you may not know is that your doctor probably has a higher risk of dying from suicide than you.

“We’ve known for a number of years that somewhere between 300 and 400 U.S. physicians die by suicide every year,” Dr. Lotte Dyrbye, professor of medicine and medical education at Mayo Clinic, told Healthline. “That equates to one or two medical school classes.”

The suicide rate among physicians, in fact, is higher than the rate for the general population.

doctor suicides

In addition, men in general are four times more likely than women to kill themselves. Female physicians, though, are just as likely as male physicians to take their own life.

Many explanations have been proposed for the high rate of suicide among doctors, including greater access to more effective ways of killing themselves, barriers to mental health treatment, and even being barred from practicing medicine.

“The saddest thing is when a doctor isn’t fit to practice and can’t get care,” Dr. Reid Finlayson, medical director of the Vanderbilt Comprehensive Assessment Program for professionals, told Healthline. “We found a very high rate of suicide among doctors who are unfit to practice.”

In a 2015 study by Finlayson and colleagues, the rate of suicide was much higher among doctors being evaluated by the Vanderbilt program to see if they were fit to return to work, compared to the general population.

Read More: What Is Suicide and Suicidal Behavior? »

Increasing Burnout Among Doctors

However, one risk factor for suicide fails to explain why so many doctors kill themselves.

“Doctors are committing suicide more often,” Dyrbye said, “but they’re not more likely to be depressed than the general U.S. population.”

Some researchers point to another culprit.

“There’s much more burnout in physicians than in the general U.S. working population,” Dyrbye said, “[and] we’ve shown that the prevalence of burnout is increasing in physicians over time.”

In a 2008 study in the Annals of Internal Medicine, Dyrbye and her colleagues found that burnout was linked to suicidal thoughts among medical students.

“Even if you screened negative for depression,” Dyrbye said, “just having burnout was an independent predictor that over the next 12 months there’s a high likelihood you’re going to develop thoughts of suicide.”

Burnout could be related to the stress of caring for patients, known as compassion fatigue, or even working conditions.

“Some of the things that we think of, in terms of what’s driving the burnout [among physicians], are related to working efficiency,” Dyrbye said.

Dealing with electronic medical records, insurance claims, and other administrative tasks may keep doctors from caring for their patients — which is the reason they became doctors in the first place.

Also, as practices swell in size, doctors may feel like they have little control over their work. This, coupled with increasing workloads, is a recipe ripe for burnout.

“Physicians have lost the helm of their professions and have lost their souls,” Dr. Pamela Wible, a family physician and founder of the Ideal Medical Care Movement, told Healthline. “And it happened in medical school.”

Read More: Long Hours, Short Visits, Red Tape Are Making Doctors Burn Out »

Setting Medical Students up for Failure

Among medical students, suicide is one of the most common causes of death, second only to accidents. In one study, 6 percent of medical students and residents reported having suicidal thoughts.

This is not just a matter of medical students not “having what it takes.”

“In the very beginning of medical school,” Dyrbye said, “medical students have mental health profiles that are better than U.S. peers, who also recently graduated from college.”

Of course, medical students bear some responsibility for their own mental health. But some people see medical school as the underlying cause.

“You don’t take a group of high-functioning people, many of whom were valedictorians, and in great mental health shape, put them through medical school and suddenly over half of them are not functioning well,” Wible said.

Read More: Mental Health Problems for College Students Are Increasing »

Real Health Care Reform

It can be challenging to connect doctors and medical trainees with the mental health help they need.

“There’s still a lot of stigma about depression and addiction, even within the medical profession,” Finlayson said. “It’s very hard for sick doctors and particularly for their families when these things go wrong.”

Doctors with depression or suicidal thoughts may also be concerned about the effect a mental health diagnosis will have on their medical license.

As part of medical licensing, some states require doctors to indicate whether they have been diagnosed or treated recently for mental health problems, such as depression or suicidal thoughts.

“Physicians are obviously reluctant to do that. That’s their livelihood,” Dyrbye said. “And if their license were to get suspended, then they can’t take care of patients.”

Programs like Vanderbilt’s and other physician health programs attempt to help physicians improve their mental health. But some experts are calling for changes to the entire medical field.

“As physicians we need to engage in self-care strategies,” Dyrbye said, “but healthcare organizations and employers also need to look at what in the work environment is modifiable.”

This also includes a change in the culture of medical education, which Wible says dehumanizes medical students, with long-reaching effects on the entire system.

“Patients are receiving care from physicians and medical students who’ve been traumatized by their training,” Wible said, “and have not been allowed to seek help without serious repercussions to their careers.”