Moral injury has replaced “burnout” as a term to describe the burdens and betrayals many physicians experience in their day-to-day work in the U.S. healthcare system.
“I think it’s on the continuum,” Michael Anderson, MD, a pediatrician and co-executive director of WittKiefer’s Physician Leadership Institute, told Becker’s. “I think there’s mild burnout, there’s significant burnout and then there’s, ‘Oh my gosh, I can’t practice what I want to practice because of some sort of obstacle or some sort of burden.’ As I looked more in the definitions, burnout is that feeling of tiredness or frustration or what have you. But to me, moral injury is the inability of a physician to truly care for his or her patient. And obviously, the long term consequence of that moral injury can be really significant.”
A study published in JAMA Network Open in March evaluated the “moral distress” of 5,741 physicians and 3,501 other U.S. healthcare workers from Oct. 19, 2023, to March 5, 2024. It found that the mean moral distress score among physicians was 3.29 on a four-point scale, with 39% reporting a score of four or higher.
Additionally, 30% of physicians surveyed with a moral distress score of less than four still reported other symptoms of burnout.
It’s an issue that has permeated surgical specialties as well as primary care and hospital-based roles, a trend that could continue as surgical volumes in the U.S. continue to rise and ASCs become an increasingly popular choice as a site of service for patients and physicians.
A study published May 20 in the Journal of the American College of Surgeons found that among 224,629 surgeons, 15,753 left clinical practice over a median of eight years, equaling a cumulative attrition rate of 9.7%. Annual attrition ranged between 1.5% and 1.7% from 2013-18, peaked at 2.5% in 2019 and stabilized to the former trend in 2019, with a rate of 1.3%.
The study analyzed 19 subspecialties and found the highest attrition rates for these three: oral and maxillofacial surgery (annual attrition rate of 6.9%), OB-GYN (5.9%), and plastic and reconstructive surgery (5%).
“These findings show that surgical attrition is a real problem,” Timothy Pawlik, MD, PhD, a surgical oncologist and study co-author, said in a May 20 news release. “[We] need to address it in a nuanced and tailored way, focusing on certain subspecialties that are highest risk, and focusing on mid-level providers who are most likely to leave surgery.”
Some of the origins of moral injury or burnout among surgeons in particular may also be tied to the constant pursuit of perfection that is deeply embedded in surgical practice, Angela Chaudhari, MD, vice chief of staff and chief of gynecology and gynecologic surgery at Northwestern Memorial Hospital in Chicago, told Becker’s.
Dr. Chaudhari built out a peer-support network in response to the high stress and burnout she witnessed among colleagues in her department.
“I was very worried about my colleagues who experienced adverse events and complications, with surgeries and deliveries in my particular case,” she said. Dr. Chaudhari now serves as the director of the P2P Network at Northwestern Medicine, where her goal is to “support [surgeons] using techniques of stress first aid and peer support after adverse events, complications, near misses.”
The network also increasingly supports physicians with stress related to litigation and peer review. Through the P2P Network, team members or supervisors of an affected surgeon can connect them with a network of volunteer peer supporters across the health system that will then reach out to them to check in on their wellbeing and initiate a conversation.
“And that conversation is not meant to rehash an event, or figure out what they did wrong,” Dr. Chaudhari said. “But it really is a conversation geared towards understanding how they’re coping with it and how they’re moving past it to be able to take really quality care of future patients.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.