Moral injury: Why fixing the system is the path forward

In a recent commentary in the Journal of Healthcare Management, Maria Ansari, MD, FACC, co-CEO of The Permanente Federation, shared her perspective on a growing challenge facing clinicians: moral injury. Moral injury is the distress that physicians feel when they cannot practice medicine in a way that aligns with their personal and professional values. Dr. Ansari argues that addressing the root causes of moral injury — rather than simply urging physician resilience — is essential to keeping doctors from leaving health care at a time when they’re badly needed.

Moral injury has become an urgent issue within modern medicine. According to a recent JAMA Network study, nearly 40% of physicians say they have experienced high levels of moral distress, more than workers in many other fields. This kind of distress has serious consequences, including burnout, thoughts of cutting back hours, or leaving the profession altogether. The study concluded that health care leaders and organizations will have to tackle the structural drivers — such as restrictive policies, excessive bureaucracy, and resource limitations — to truly address the problem.

Finding moments of inspiration

In the commentary, Dr. Ansari observed that most physicians enter the profession with a shared purpose: to help people heal. However, a disconnect between what patients need and what the system allows them to provide, a rise in administrative burdens, inbox messages that follow them home, and concerns about workplace violence all serve to undermine that calling.

Dr. Ansari noted that despite the challenges, she draws inspiration from colleagues who find ways to pursue their passions. She mentioned Stella Dantas, MD, who recently completed a term as president of the American College of Obstetricians and Gynecologists, where she championed physician well-being and fought medical misinformation.

Related podcast: Stella Dantas, MD, on physician leadership, burnout, and the future of women’s health

Patient stories provide similar moments of inspiration, like the 80-year-old patient returning to weightlifting after heart valve replacement and the premature triplets thriving after complex neonatal care. Such moments, Dr. Ansari wrote, “reconnect us to why we entered this profession.”

Structural solutions to fixing the moral injury problem

At the same time, Dr. Ansari argues that a larger shift toward value-based care, which rewards outcomes rather than volume, may help reduce the friction between what physicians believe patients need and what the system incentivizes.

Ultimately, addressing moral injury will require changes at multiple levels, from technology and care models to workplace safety and leadership culture. But Dr. Ansari remains optimistic that meaningful reform is possible.

“Moral injury is real,” she said. “But so is our collective ability to confront it.”

Read the full commentary here.