Another International Survivors of Suicide Loss Day has passed. Its a day of remembrance started by former senator Harry ReidHarry Mason ReidImpeachment trial throws curveball into 2020 race Harry Reid: Early voting states Iowa, New Hampshire 'not representative of the country anymore' The Memo: Democrats confront prospect of long primary MORE after he lost his father to suicide. And again, we havent talked enough about physician suicide, which has become an epidemic.

One doctor dies by suicide every day and it is estimated that 135 people are affected by every suicide. Imagine how many people are affected when a doctor dies. Patients, colleagues, and the institution itself become the survivors to tell the story.

Multiple studies show that suicide rates are higher among physicans than the general public, the highest suicide rate of any profession, and this vulnerability manifests in providers throughout the course of training and practice.

Medical school is devastatingly expensive (up to $400,000) and physically, intellectually, and emotionally exhausting. Physicians emerge from medical school and residency into a profession that offers far less autonomy than most expect; care is micromanaged at every level-and more modest financial rewards than a generation ago.

The prestige, access, and wealth that once accompanied the a medical career are substantially diminished. However, we have failed to prepare our youngest providers for this new reality.

A review of 195 studies and 129,123 medical students concluded that at least 25 percent of medical residents report depressive symptoms and 11 percent struggle with suicidal thoughts. In recent studies, 40 percent of residents and 45 percent of physicians reported feeling burned out. While there is some controversy about what exactly burnout is, there is no doubt that providers who feel depressed, disengaged, and exhausted represent a serious public health crisis.

Institutions need to provide top-down changes in culture, structure, and strategy to effectively address this epidemic. The growth in wellness programs represents a small step in the right direction.

However, these programs focus disproportionately on individual self-care outside of work and school rather than cultural changes to help providers feel safe, supported, and connected in the workplace.

Medical schools need to reduce barriers to seeking help and implement support systems within the organization. The medical director of the American Foundation for Suicide Prevention (AFSP) says we need to change the culture of medicine. Likewise, state licensure boards must stop framing the mere fact of having received mental health services as a potential disqualifying factor.

We also need to break the stigma that still attaches to receiving mental health care. Ironic and sad as it may be, those in the helping profession may face the same or higher social stigma towards getting professional help especially in regards to mental health concerns.

Fear of reporting mental illness to a licensing board hampers help-seeking for even routine mental health issues. Moreover, respect for families privacy often hampers open discussion of completed suicides which may reinforce the shame and secrecy attached to suicidality.

Unfortunately, physicians and other health-care providers continue to routinely sacrifice their own self-care to care for others because, physicians are at their core, healers, and the work of medicine is inevitably hard and occasionally heartbreaking. We cannot address this issue by making medical training or practice easy. We can, however, foster resilience and help-seeking in our health workforce.

If you or someone you know needs help, please call the national suicide prevention lifeline 1-800-273-8255.

Jay Behel, Ph.D., is an associate dean of student affairs and assistant professor in the Division of Behavioral Sciences at Rush Medical College in Chicago. Jennifer Coleman, Ph.D., is a clinical psychologist with the Road Home Program at Rush University Medical Center.

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