April President’s Message

April President’s Message

‘Moral injury’ a more accurate term than ‘burnout’

by Howard Chang, MD —

According to the 2024 Medscape Physician Burnout and Depression Report, my specialty has the highest rate of burnout, with 63% of emergency medicine physicians polled feeling burned out or both burned out and depressed.

Physician burnout is a prevailing concern in the healthcare industry, with increasing reports of doctors experiencing exhaustion, detachment and a general sense of despair. However, a growing body of evidence suggests that what is com­monly referred to as “physician burnout” may be better understood as moral injury. Rather than being a consequence of personal and professional shortcomings, moral injury among physicians stems from systemic issues that impede their ability to provide optimal care for their patients.

Before delving into the argument, it is essential to clarify the terms “burnout” and “moral injury” and their distinct implications for healthcare professionals. Burnout traditionally refers to a state of emotional, physical and mental exhaustion resulting from prolonged exposure to workplace stressors. In contrast, moral injury is a term originally associated with the military, describing the emotional and psychological impact of actions that infringe on one’s moral and ethical beliefs.

Physician burnout, as conventionally labeled, is often attributed to factors like long working hours, administrative burdens and the demanding nature of medical practice. Do we physicians, who all completed arduous residency programs (some before the 80- hour workweek mandate), lack resilience? I believe our “burnout” is actually better labeled and better understood as moral injury, wherein healthcare providers face ethical dilemmas and moral compromises that prevent us from efficiently fulfilling our duty to our patients.

The primary contributor to what is commonly labeled as physi­cian burnout is the systemic failures that prevent doctors from pri­oritizing patient care. In an era dominated by administrative tasks, clicking boxes on an EHR and bureaucratic hurdles, physicians find themselves spending more time on paperwork than with their patients. The erosion of the doctor-patient relationship is a source of profound moral distress for many of us, leading to frustration and a sense of powerlessness. We have lost agency in our ability to care for patients.

Physicians enter the profession with a commitment to ethical practice and the well-being of their patients. However, the current healthcare landscape often forces doctors to make compromises that challenge their moral compass. Issues such as resource allo­cation, conflicts of interest and institutional pressures can lead to situations in which physicians feel compelled to deviate from their ethical standards, resulting in moral injury.

We all shoulder an immense amount of emotional labor. Emo­tional labor is an integral part of healthcare professions, requiring physicians to manage their own emotions while providing support and empathy to patients and families. The continuous exposure to suffering, loss and difficult decisions will undoubtedly take a toll on your emotional well-being. The inability to address these emotions contributes to moral injury, as physicians grapple with the internal conflict between their professional duties and their own emotional well-being.

Additionally, physicians often find themselves navigating a healthcare system that lacks sufficient support mechanisms for their well-being. The stigma associated with seeking mental health assistance within the medical community further exacerbates the problem. The absence of effective support systems contributes to a sense of isolation and despair among physicians, perpetuating the cycle of moral injury.

Just a quick plug: The MSSC offers free and confidential tele­therapy sessions for our members. Information on this and other services is on our website: https://mssconline.com/membership/ physician-wellness/

To address what is commonly referred to as physician burn­out, a fundamental shift in the healthcare system is imperative. Rather than focusing solely on individual resilience, more yoga classes and coping mechanisms, systemic changes are needed to alleviate the moral injury we experience. This includes reducing administrative burdens, improving work-life balance and prioritiz­ing the doctor-patient relationship.

Rebuilding the doctor-patient relationship is paramount in miti­gating moral injury among physicians. This involves streamlining administrative processes, promoting team-based care and foster­ing an environment that values the human connection between doctors and their patients. By allowing physicians to dedicate more time to patient care, the healthcare system can address the root cause of moral injury and enhance the overall well-being of healthcare providers.

Shifting the narrative from physician burnout to moral injury represents a crucial step in understanding and addressing the challenges faced by healthcare professionals. Recognizing the systemic issues that contribute to moral distress is essential for implementing effective solutions. By supporting the physician practice and fostering a patient-centered healthcare system, we can work toward creating an environment where physicians can fulfill their moral obligations without compromising their own men­tal and emotional health.

Please take care of yourselves and each other, because if you don’t, who will?