While no organization collects official data on physician suicides, Pamela Wible, a family medicine doctor in Eugene, Oregon, who writes about the phenomenon, says that at least 400 doctors kill themselves annually. That’s the size of an entire medical school class.

Wible believes that the numbers are higher than that, since doctors close ranks around each other and prod coroners to rule the cause of doctor deaths as “unplanned”—even when they are obviously not. “Accidental overdoses?” Wible asks. “You’ve got to be kidding me. Doctors calculate doses for a living.”

Because doctors have the knowledge of anatomy as well as access to lethal doses of drugs, they have a far higher suicide “completion” rate than the general population. A 2005 essay published in JAMA found that male doctors killed themselves at a rate 70 percent higher than other professionals; among female doctors, that rate ranged from 250 to 400 percent higher.

“Unfortunately,” says Bradley Hall, a Bridgeport, West Virginia, addiction medicine physician, “suicide is one thing doctors are pretty good at.”