This morning, I woke up to a message from a friend that he had seen on social media a colleague he went to university with had, a few days ago, died by suicide. Last week, I had an email in my inbox from a young doctor in a training program informing me four of their trainee colleagues in the last 24 months have died by suicide. The week before, my parents sent me an article featuring the words of a devastated father whose son, also a training doctor, had died by suicide.

In 2017, I had an article published on this very platform titled “There is something rotten inside the medical profession,” a piece I penned anonymously about a spate of junior doctor suicides in my state of NSW, Australia, when I was a junior doctor in the hospital system. It garnered a lot of attention, and at the time felt it was the hole in the dam that then burst, with many more articles, responses, and initiatives by hospitals and colleges meant to address the shameful open secret, as I described, of doctor suicide in Australia.

At the time I was, I hate to admit, skeptical of real change. The reason for that is that I knew as all doctors in the system know that the answers to this problem lie not in resilience programs or EAP referrals, or even slightly improved pay or rosters. The answers are straightforward. They involve real accountability for bullies in the hospital system (doctors, nurses, and administrators). Next, they involve opening up of the training programs so junior doctors don’t spend years festering in unaccredited programs with no job prospects at the end of it. Finally, they involve loosening the reigns of controls of the colleges and making sure there are actually jobs for consultant doctors at the end of arduous training programs that don’t just involve another two years of fellowship then pressure to do a PhD to even be considered for a job.

Did any of those things happen? Maybe there was some discussion and certainly for a while there seemed to be the show of doing the right thing, of noises about reducing sexual harassment in hospitals (RACS Operating with Respect for one example), and based on the loud voices on social media crowing about mental well-being, you’d think that it sort of became a bit passe to be bullying people either directly or through systems that empower bullying in the medical profession.

But when I read this message this morning, on the back of all the other times I have read the words “doctor suicide” in the last nine years since I wrote that article, I think I can be unequivocal in my opinion that things haven’t changed, or the changes that should have happened to stop this scourge of pointless death have not occurred.

In fact, I have noticed another disturbing trend emerging: That not only junior doctors are dying by suicide but also consultant doctors. The reasons for this I am not privy to but I can assume to some extent bureaucratic pressure, arbitrary targets placed by administrators, and years of unrelenting pressure to then be subject to vexatious complaints for unavoidable complications, has resulted in the same feelings that pervade their junior colleagues. These are feelings, let myself be clear, of hopelessness, of disillusionment, and an overwhelming sense that the thing that has taken so much of their life and identity (I don’t want to say is their identity as I think medicine can be more of a succubus than a truly soul defining concept) has now spat them out reducing them to little more than a series of complaints to be answered, little or no thanks for their service, and a sense they are expendable. When a system has taken so much from you there is often no cloak of armour of sense of personhood left to protect the inner self, and compound that with the stressors of life the outcome is in some respects inevitable. It is not a surprise to me. It is not a surprise to any doctor. We all know how these people feel, and “but for the grace of God go I” is more often the response than confusion or being unable to relate. The fact that suicide is to some extent a relatable endpoint is a sickening truth and must be acknowledged.

I could wax lyrical for hours about my own experience, about others, about all the contact I have had since my article and two books were written on themes of distress in the medical system. But I am tired of that. For someone who has spent much of their time making sense of the nonsensical in medicine by trafficking in words, I am going to be clear again that the time for words, for platitudes, for meaningless interventions that do nothing is over.

What needs to happen is this: There needs to immediately be a register in Australia (state-specific, hospital- or clinic-specific, university-specific, and training program-specific) of attempted suicides and suicides of doctors of all levels in Australia. If possible to go back and add historical events; that should be done to. With that data available, it forces a light to be shined on the dirty grubby truth. Specific things and problem spots to address make accountability easier. Currently, everyone in medicine is siloed. Job prospects, exams, stress of the job, and a culture of cutthroat competition because of these aforementioned factors mean people are isolated. This only feeds the beast as the bigger picture is never made properly clear. No one is ever accountable because the true extent of the issue is never truly known. You can’t see the wood for the trees; we need to see the wood, every last splinter.

After that, with that data available, there needs to be a royal commission or national inquiry into this abhorrent situation. That is the only answer. This is little more than a manufactured health crisis. Studies have shown over and over the stress levels in training doctors match those of people in war zones. I do not buy pre-existing mental health issues or weakness or whatever excuse or justification is trotted out. The line from my original article still stands: There is one common denominator in all these deaths; the job.

Finally, much has happened in my own life since that article when I was 29 years old and a junior doctor in Sydney, namely, one year ago I had a baby boy. When I read the pain of the father and other parents like him who had lost his talented, wonderful son to suicide, a training doctor with so much to give the world, I thought about how I would feel if I were in his shoes and it was my son. And it was very clear to me what I would want.

I wouldn’t want cards, or words, or apologies, or even expressions of sympathy. I don’t want tepid acknowledgments from hospital admin, or the tears of his friends and colleagues. There is no ambiguity. What I would want is justice. What I would want is accountability. What I would want is my child’s life to be worth more than a gap that has to be filled in a roster and a half-hearted email from medical administration offering meaningless condolences. Enough is enough. Let’s blow the lid off the whole rotten, foul system and clean it out with buckets of light. The time has come to be brave and honour our dead, and stop others from joining them well before their time should be up.

I am no longer scared of the system or being punished by it. It is not lost on me the only difference between now and my anonymous article of 2017 is that I am no longer anonymous. Let us also make doctor suicide no longer something hiding in the shadows, festering in anonymity, and able to be swept under the rug. Every one of these doctors had a face, a name, a family, and a life. Frighteningly, every doctor currently considering self-harm or suicide also has a name, a face, a family, and a life. These people deserve better than what they have been given. We would never turn a patient away, no matter how advanced their pathology. It is now time to look at the pathology in our own profession, and now is the time to fix it.

Sonia Henry is a family medicine physician in Australia.