An estimated 300 to 400 U.S. doctors kill themselves each year -- a suicide rate thought to be higher than in the general population, although exact figures are hard to come by.
Some doctors believe the stigma of mental illness is magnified in a field that prides itself on stoicism and bravado. Many fear admitting psychiatric problems could be fatal to their careers.
And when the pain is too much, doctors have easy access to prescription drugs and a precise knowledge of how the body works.
"All physicians have access to neat, clean ways to commit suicide," said Dr. Robert Lehmberg, a Little Rock, Ark., surgeon who has battled depression and long considered suicide "an exit strategy if absolutely necessary."
The American Medical Association has called physician suicide "an endemic catastrophe," and pledged two years ago to work to prevent the problem.
But the suicides have persisted. So the American Foundation for Suicide Prevention has launched a campaign in hopes of making troubled doctors seek help.
The foundation, the American College of Psychiatrists and Wyeth Pharmaceuticals, a maker of antidepressant pills, paid for the program. It includes a documentary titled "Struggling in Silence" that begins airing on public television stations this week.
"It really has been swept under the carpet," said Dr. Paula Clayton, the suicide foundation's medical director.
The foundation says 300 to 400 doctors commit suicide each year, based on estimates from research, but that more studies are needed to get a more precise count.
Another estimate of 250 yearly comes from an online article by Dr. Louise Andrew and in American Medical News, an AMA publication. But a spokesman said the AMA doesn't track doctor suicides because accurate numbers aren't available.
Suicide figures in broader society are not completely reliable because suicide is often not given as the cause of death.
A 28-state study from 1984 to 1995 found female doctors were more than twice as likely as women in the general population to kill themselves. Men were more than 70 percent more likely inside the medical profession than overall to commit suicide.
One explanation is that most suicide attempts in the broader population are unsuccessful, said Dr. Erika Frank, who specializes in research on physician health.
Depressed doctors frequently decide to self-medicate but don't seek psychotherapy that could help them deal with underlying issues, said Dr. Glenn Siegel, who runs a suburban Chicago program that treats doctors with drug abuse, depression and other psychiatric problems.
"It's not a safe topic to be as open about in that profession because you're responsible for the well-being of others," Siegel said. "If you're admitting something like that, you're saying maybe you're not fit to do your job."
Adds Lehmberg, who is featured in the documentary: "You just would rather take a risk with your health than your career. It's not like you get a second chance with it."
