Physicians across the United States are experiencing a deepening crisis of moral injury, and they believe profit-driven healthcare systems increasingly block them from delivering the care their patients need, according to a sweeping new study by Physicians for a National Health Program, an advocacy organization of more than 20,000 physicians, medical students and health professionals who support a universal, single-payer national health program.
The March 17 report, which surveyed more than 1,200 practicing physicians and included focus groups, found that nearly half of physicians often or always feel unable to provide their patients with the best possible care, with two-thirds reporting moderate or severe distress as a result.
The study draws a sharp distinction between burnout — which implies individual depletion and is typically addressed through wellness initiatives — and moral injury, which the authors define as the distress physicians experience when they know what their patients need but cannot provide it due to constraints outside their control.
Physicians in the study were pointed in their rejection of burnout framing; as one family medicine physician said, “When we talk about burnout, it makes it sound like it’s my fault or my colleagues’ fault. The term points to the person being affected. It’s a form of victim shaming.” Notably, 40% of surveyed physicians often or always felt frustrated by the wellness activities their employers offered, saying they simply didn’t help.
The survey was distributed through a non-random, multi-modal recruitment approach using PNHP’s professional networks, medical societies including the Society of General Internal Medicine and the American College of Physicians, listservs, social media, and snowball sampling. It adapted eight items from the validated Measure of Moral Distress for Health Care Professionals and added 14 new questions capturing system-level pressures, financial constraints and administrative burdens. The mean overall moral distress score was 143, compared to 96 in the 2019 benchmark study, suggesting a significant worsening over time. For 18 of 22 survey questions, the most common distress rating was “very distressing,” the maximum level possible.
Here are 10 key things to know from the survey:
1. Forty-seven percent of surveyed physicians indicated their employer often or always prioritized financial goals over best patient care, and 50% felt betrayed by a healthcare system that hindered their ability to provide good care.
2. Additionally, 62% experienced moderate to severe distress over cost-cutting pressures from administrators or insurers.
3. Of the surveyed physicians, 45% often or always felt unable to provide patients with the best possible care, and 68% experienced moderate or severe distress as a result. An additional 47% often or always felt unable to provide optimal care simply due to inadequate time.
4. Forty-four percent of physicians often or always felt that lack of insurance approval blocked medically necessary services, and 51% often or always experienced excessive documentation requirements that compromised patient care.
5. Of the surveyed physicians, 35% often or always felt required to care for more patients than they could safely handle, and 43% often or always felt required to overemphasize productivity metrics at the expense of patient care.
6. Forty-five percent often or always encountered lack of resources or bed capacity that compromised care, and 43% said leadership often or always failed to respond supportively when such failures occurred. Three in 5 physicians experienced moderate or severe distress contemplating these situations.
7. The mean overall moral distress score was 143, compared to 96 in the 2019 benchmark study, suggesting a significant worsening. For 18 of 22 survey questions, the most common distress rating was “very distressing,” the maximum level.
8. On attrition, 27% of physicians had already left a position due to moral distress, 25% are currently considering leaving for the same reason and 42% had previously considered leaving but chose to stay. The workforce consequences are tangible: physician departures have contributed to clinic closures, elimination of services, and dramatically longer patient wait times.
9. Fifty-seven percent of physicians reported moderate or severe distress from working in systems that failed to treat vulnerable patients with dignity, and 41% often or always felt complicit in the structural racism their systems perpetuated. Physicians described patterns of race-based misdiagnosis, discriminatory care based on insurance status, and the rationing of life-sustaining treatment for uninsured and undocumented patients.
10. Nearly half of practicing physicians reported often or always making diagnostic or treatment recommendations they knew their patients would not be able to pursue, due either to insurance barriers or financial toxicity, and for 7 in 10 of those physicians, this provoked moderate or severe distress.
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