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Physician Burnout or Moral Injury? 3 Reasons the Distinction Matters

Jackson Physician Search
January 31, 2023

Dr. S is on the brink of giving notice of resignation to her employer. Though she was hoping to secure another job before handing in her resignation, at the end of her exhausting days, she has no energy to update her CV or return calls to the recruiters who leave her messages almost daily. She is mentally and physically exhausted. Her youthful enthusiasm for practicing medicine has been replaced with apathy and cynicism. She no longer feels she has the ability to make a difference with patients, and she isn’t all that confident a new job will change that. 

Dr. S is suffering from classic symptoms of burnout, and she is far from alone. According to a joint study from Jackson Physician Search and MGMA, 65% of physicians experienced burnout last year — up from 61% the year prior.  In addition, a study published in Mayo Clinic Proceedings (and reported on by the New York Times) found similar numbers. In the study, 63% of physicians reported at least one symptom of burnout. 

The employer response to physician burnout tends to be programs related to wellness and stress management — physician support hotlines, mental health programs, on-site yoga, or guided meditation apps. But what if physician burnout isn’t about stress management at all? A growing movement reframes physician burnout as a moral injury, but will the new name spark a fresh response? We’ll explore both terms to understand why the distinction matters.    

Physician Burnout: A Problematic Definition

For all the discussion about physician burnout, the term itself can be ambiguous. At Jackson Physician Search, we use the term to describe the long-term, cumulative stress and depersonalization that doctors experience amid growing burdens in the practice of medicine. The World Health Organization (WHO) listed burnout as an “occupational phenomenon” in the ICD-11, defining it as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” According to WHO, burnout is characterized by:

  • feelings of energy depletion or exhaustion;
  • increased mental distance from one’s job, feelings of negativism or cynicism related to one’s job;
  • and reduced professional efficacy.

While this certainly describes the symptoms Dr. S is experiencing in our opening scenario, she may take issue with the implication that these symptoms — experienced by more than 3 in 5 physicians — are a result of her somehow failing to manage her own stress. Instead of considering the impact of the system in which physicians are confined to practice, the WHO definition suggests a lack of resiliency at the individual level is to blame for the epidemic of physician burnout. Is it any wonder some physicians may feel ashamed of their burnout or view it as a personal failing?

Introducing Moral Injury

In an effort to more accurately describe the root cause of the symptoms associated with burnout, in 2018, physicians Simon G. Talbot and Wendy Dean published an article in STAT News introducing “moral injury” as the root cause. The term had been previously used to describe the response of soldiers to their actions in war, which may have gone against the moral code used in their civilian lives. In a later article for the Federal Practitioner, Talbot and Dean further describe the term’s application to physicians: 

“Moral injury, on the other hand, describes the challenge of simultaneously knowing what care patients need but being unable to provide it due to constraints beyond our control. Moral injury is the consequence of the ever-present double binds in health care: Do we take care of our patient, the hospital, the insurer, the EMR, the health care system, or our productivity metrics first?”

3 Reasons the Distinction Between Burnout and Moral Injury Matters

The reframing of physician burnout as a moral injury allows us to rethink the cause of symptoms associated with burnout, which is essential for several reasons: 

  1. It empowers physicians to let go of any guilt or shame they may feel about the part they have played in their burnout. The symptoms associated with burnout are not the result of a personal lack of resilience; instead, they are evidence of a failure within the broader healthcare system. By understanding the reasons for feeling burned out, physicians are in a better position to ask their employers for what they need to mitigate burnout
  2. It changes the way employers approach burnout mitigation. Instead of offering stress management tools, employers must provide an environment where physicians have the autonomy to act in the best interest of their patients.  
  3. It could spark a broader industry understanding of the problems within the system, namely, the power of payers to dictate treatment plans and the prioritization of profits over patient care. Casting a spotlight on these issues increases the likelihood of finding creative, scalable solutions. 

Of course, a rose by any other name still smells as sweet, and physician burnout called “moral injury” is still just as crippling to physicians. That said, if reframing the concept of burnout promotes a better understanding of the problem, we can assume (or at least hope) better solutions are soon to follow. 

If you are seeking a new physician job with an employer where you will have the autonomy to make a difference, the recruitment team at Jackson Physician Search has the experience and insight to help you with your search. Reach out today or search for physician jobs online now.

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