Moral Injury and the Cost to Physicians

Marissa Smith
United States

Physicians are not burning out, but struggling with “moral injury,” according to Wendy Dean, M.D., senior medical officer and acting vice president of Business Development and Simon Talbot, M.D., reconstructive plastic surgeon at Brigham and Women’s Hospital and associate professor of surgery at Harvard Medical School.

In their article published in STAT news, Dean and Talbot describe how physicians are impacted adversely by their work thanks to a broken health care system. When physicians first choose their careers, many follow a calling, entering with a desire to help people. But throughout their careers, many physicians experience at least one a “constellation of symptoms” in having to continuously navigate multiple competing allegiances in health care that pit against one another the needs of the patient, the constraints of the insurer, the demands of the healthcare system, and the sense of duty instilled during decades of training.

Even institutions like the Mayo Clinic, that have been tracking, investigating and addressing the constellation of symptoms that fall under ‘burnout,’ report that at least one-third of their physicians experience exhaustion, cynicism and decreased productivity, and many report rates of nearly 50 percent.

Dean and Talbot say the crux of burnout versus moral injury, however, lies in the semantics of control. Physicians endure decades of training and years of sacrifice (physically, financially, emotionally) developing masterful resilience in the process.  If any group of individuals can figure out a way to prevent the staggering number of suicides within their ranks, this group can. However, burnout, suggests a failure of resourcefulness or grit, pinning both the source of and solutions to challenges faced by providers back onto physicians.

While acknowledging that wellness committees and ‘Code Lavender’ teams may triage hyper-immediate needs with snacks and water bottles, the authors say these techniques do not address the systemic, institutionalized moral injury sustained by physicians who simply are working towards the best outcomes for their patients.

What physicians need, Dean and Talbot argue, is leadership that acknowledges the competing allegiances facing physicians and recognizes that caring for doctors and allowing them to take the best care of their patients results in better outcomes, all of which is good for business.

To read the article published in STATNews, click here.

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