The Wound Caused by Moral Injury
Many physicians are struggling with the stresses caused by their work environment
An article in The New York Times Magazine opined that “the corporatization of American healthcare has changed how physicians practice medicine, causing many of them to feel alienated from their work.”1 The author, Eyal Press, stated that many physicians confided they are struggling with the stresses caused by their work environment. Some of those interviewed were hesitant to talk with Press for fear of reprisal while others had signed nondisclosure agreements. Those who would talk complained they did not have enough time to properly interview their patients due to the hours needed to fill out required electronic health records. Others were frustrated by the need to get preapprovals for medication and therapy for patients with serious illnesses.
In general, these physicians were convinced that the current healthcare system made it difficult to properly care for their patients. Some indicated they were under constant scrutiny even to the point of having their productivity tracked on an hourly basis. Many also complained that the demands of administrators, hospital executives, and insurers forced them to stray from the ethical principles meant to govern their profession. They said they were caught between the Hippocratic oath and “the realities of making a profit from people at their sickest and most vulnerable.”
Today, approximately 70% of all physicians in the United States are paid by large hospital systems or corporate entities.2 This has led to increased depersonalization of healthcare where personal interactions are reduced in favor of speed and efficiency. Press cited a 2013 study by McNamara et al3 that found nearly 20% of emergency department physicians surveyed said they had been threatened for raising quality-of-care concerns and pressured to make decisions based on financial considerations that could be detrimental to their patients. When orders from a central command lead to denying medications or procedures to patients, the physician is often seen as the bad guy. The article pointed out that emergency department physicians were particularly at risk for losing their jobs and many can be fired without due process. This has led to medical residents pushing to unionize for protection from being singled out for saying anything that might attract negative attention of the administration or their superiors.
The article pointed out that both of these scenarios can lead to “moral injury” a term coined by the psychiatrist Jonathan Shay, MD, PhD, to describe the wound that forms when a person’s sense of what is right is betrayed by leaders in high stakes situations.
These problems may become more prevalent as the corporate takeover of the American medical system continues. Can this be the canary in the coal mine for dentistry? Do dental professionals want or need autonomy? Does corporate dentistry delivery the highest quality care? With the increased number of dentists joining dental service organizations, we will soon know the answer.
Thomas G. Wilson Jr., DDS
Editor in Chief twilson@belmontbusinessmedia.com
References
- Press P. Standard of care. New York Times Magazine. June 18, 2023:42-47.
- Primary Care Collaborative. Hospitals and corporations own nearly half of US physician practices. Available at: thepcc.org. Accessed January 30, 2024.
- McNamara RM, Beier K, Blumstein H, Weiss LD, Wood J. A survey of emergency physicians regarding due process, financial pressures, and the ability to advocate for patients. J Emerg Med. 2013;45:111–116.
From Decisions in Dentistry. March 2024; 10(2):6
