The term “moral injury” was originally coined around the military, describing the psychological distress from participating in or witnessing events that directly contradict one’s deeply held moral beliefs.
In time, this phrase has extended its reach. Moral injury in healthcare is now used to describe how healthcare professionals are struggling to balance their duty as care providers and the “realities of making a profit from people at their sickest and most vulnerable,” outlined a New York Times article. The article describes that HCPs are “noticing how the emphasis on the bottom line routinely puts them in moral binds …”
For HCPs the problem doesn’t end there. As the primary interface for patients, clinicians feel they have become the scapegoats for the problem. Psychiatrist Mona Masood said, “They’re just seeing the doctor who can only spend 10 minutes with them in the room, or the doctor who says, ‘I can’t get you this medication because it costs $500 a month.’” Although physicians don’t have much choice in treatment costs or what insurance providers will approve, they take on the burden of telling patients when something cannot be done.
Some believe unions are an answer to reducing moral injury in healthcare, having a safety net to push back against bad practices and offer the patient care they were trained to give. Some leave large organizations to start direct-practice care, offering care based on their own rules and values. For others, leaving the profession altogether is the solution.
We asked the members of Figure 1 for their thoughts on this issue. Here is what more than 350 HCPs had to say.
What Do You Think About the Corporatization of Healthcare?
We asked the Figure 1 community for their thoughts on how corporatization has affected their job satisfaction. An overwhelming majority of 90% said corporatization of healthcare has negatively affected their jobs. Only 3% said it positively impacted them and the remaining 7% were neutral.
One respondent shared, “Corporations, I know you’re not listening but the patients are your priority, NOT your shareholders and executives.” Another member said “I remember back in the late 1980s, visiting with the administrator of the small [health system] newly converted to one of the largest nationwide healthcare companies. He said something like this: Now that we are a for-profit hospital, patients will now be seen not as people, but as accounts. Now each account must either 1. make the hospital a profit, or 2. be a tax write off. The 1s must far exceed the 2s. Over the last 20 years, I’ve watched this exact same thing happen to another hospital. It’s bad for patients and bad for employees as well!”
Is Moral Injury in Healthcare Becoming Too Much?
When asked if they were considering leaving healthcare altogether due to moral injuries they have suffered, 43% of respondents said yes, 36% said no, and 21% were unsure. With nearly half our respondents stating they are considering leaving their career and almost a quarter on the fence about it, it is quite clear that moral injury is a huge problem in healthcare that affects everyone.
One respondent shared, “I actually had to surrender my Registered Nurse license due to how negative the healthcare system is.”
What’s the Solution?
We asked the Figure 1 community what steps could be taken to combat the pressures of corporate demands to reduce moral injury in healthcare. Fifty-two percent of our respondents said the best way is to develop more independent practices, not owned by corporations. Twenty percent said to create more unions and 9% said to strike for better working conditions. The remaining 19% discussed various other options.
One respondent stated, “I left a salaried position for my own private practice and never looked back. I may make less but that is my choice to provide care the way I was trained, not meet an accountant’s demands. May not be right for everyone. That is a personal decision.” And another said, “I think some kind of revision or restructuring of the insurance companies is greatly needed as THEY highly influence patient care, across the board.”
One respondent summed up the sentiments of what many think about moral injury in healthcare when they shared, “The US health system has been based on profits for too long. I know there are complaints about single-payer systems, but we cannot go on like we are for much longer. When most of our time is spent with the computer, not the patient, and neither the patient nor the provider is very content with the care given, something’s gotta change. The insurance companies are taking a huge chunk of the health care dollars, and our outcomes are appalling compared with other high-resource countries.”
Published August 14, 2023
Join the Conversation
Sign up for Figure 1 and be part of a global community of healthcare professionals gaining medical knowledge, securely sharing real patient cases, and improving outcomes.
