By Richard Payerchin (fact checked by Keith A. Reynolds and AC Baltz)
Medical Economics, March 24, 2026

Key Takeaways

• Nearly half of physicians report insufficient time for optimal care, and over one-third face patient loads they view as unsafe, underscoring operational constraints with direct clinical quality implications.
• Many clinicians recommend evidence-based interventions despite anticipating access failures from insurer utilization management, systemic barriers or patient cost exposure, fostering repeated ethical distress.
• Moral injury is differentiated from burnout by etiology and phenotype, emphasizing guilt, shame and loss of meaning arising from externally imposed constraints rather than individual coping deficits.
• A substantial minority are considering leaving their jobs, suggesting workforce destabilization linked to persistent financial and administrative pressures that undermine professional obligations.
• Single-payer universal coverage is positioned as the principal corrective, though interpretation is tempered by nonrandom sampling through advocacy networks and potential underrepresentation of departed clinicians.

It’s not just burnout when patient numbers increase but doctors are not allowed adequate time and treatments for them.

The pursuit of profit, not patient health, is causing alarming levels of moral injury to physicians who want to treat patients but instead must deal with systemic constraints across U.S. health care, according to results of a new study.

Anti-burnout initiatives, such as wellness programs and resilience training, have helped some physicians cope with workplace stressors. But they don’t change the course of “health care financialization,” in which health systems and insurers prioritize income over patients’ and physicians’ health interests. Those programs also don’t address the moral injury that physicians feel when they want to guide patients toward better health but can’t due to insurance restrictions or systemic racism, according to Physicians for a National Health Program (PNHP).

“Our research shows that the system is failing both physicians and patients,” PNHP President Diljeet K. Singh, M.D., Dr.Ph., said in a news release. “Doctors enter medicine to care for people, but are increasingly forced to navigate barriers that delay or deny treatment to generate profit. When clinical judgment is overridden by financial priorities, patient care suffers.”

What the findings say

“Moral Injury in Medicine: The Human Costs of Practicing in a Profit-Driven System” is the new PNHP report based on two years of research among doctors and patients, including surveys and interviews with 1,207 physicians. The findings are grim, though perhaps not entirely unexpected for physicians fed up when the emphasis on making money supersedes needed patient care.

Among the key findings:

• 47% of surveyed physicians say they often or always lack enough time to provide optimal levels of care to their patients
• 35% say they are required to care for more patients than they can safely manage
• 44% say they often recommend treatments they know their patients will not be able to access because of systemic barriers, insurer practices or financial costs
• 41% report often feeling complicit in structural racism perpetuated by the health care system in which they work
• 35% say administrative and insurer pressures to reduce costs affect their ability to provide the best possible care
• 25% say they are considering leaving their job due to this distress

The report was funded by the Robert Wood Johnson Foundation, a national nonprofit devoted to improving health care and health equity.

“Across the country, physicians and patients are navigating a health care system increasingly shaped by the pursuit of profit rather than health,” Kelsy McIntosh, MPH, program associate at the Robert Wood Johnson Foundation, said in the news release. “Physicians want to deliver high-quality, evidence-based care that aligns with their values and expertise, but too often encounter barriers designed to generate profits. Shining a light on systemic pressures can support designing systems that prioritize patient health over corporate profit.”

What to do next?

The report stops short of prescribing incremental fixes, arguing that the health care industry has repeatedly demonstrated an ability to circumvent or undermine regulatory reforms. Its primary structural recommendation is the implementation of a publicly financed, single-payer universal health care program, a position consistent with the name and organizational mission of PNHP.

The report acknowledges this advocacy context as a study limitation, noting that its survey was distributed through non-random, non-probability-based sampling that included the organization’s own membership networks, which may have attracted physicians who already share its policy views.

PNHP cites factors in Oregon, a state that “has experienced rampant financialization of health care systems, with several high-profile health care buyouts by large corporate entities.” Among the players: Amazon; OneMedical, a membership-based primary care chain of five clinics; and UnitedHealth Group subsidiary Optum, which has an aggressive ownership and growth plan there.

Oregon also has enacted some of the nation’s strictest controls on corporate practice of medicine, and has been edging closer to establishing universal health care at the state level, the PNHP report said.

PNHP notes that the particulars of geography, specialty and practice setting may not be representative across the country. The sample of doctors may underrepresent those who have already left clinical practice, the report said.

Moral injury in health care

PNHP uses the term moral injury, which is borrowed from military psychiatry to describe the psychological harm that occurs when a person is forced to act against their deeply held values.

“Physician moral injury arises when physicians are prevented from delivering evidence-based, optimal patient care due to systemic constraints beyond their control — particularly those imposed by profit-driven goals of the health care industry,” the report said, citing the work of researchers Wendy Dean, M.D., and Simon Talbot, M.D., who first applied the moral injury framework to medicine in 2018.

The report argues that framing physician distress as burnout rather than moral injury has led to ineffective interventions and allowed underlying system failures to go unaddressed. PNHP distinguishes the two conditions on both cause and symptom. Burnout manifests as exhaustion, depersonalization, and diminished personal accomplishment. Moral injury produces guilt, shame, loss of meaning and erosion of professional identity. It stems not from overwork but from being systematically prevented from fulfilling one’s professional obligations.

Standard burnout frameworks locate the problem within the individual physician and prescribe individual-level fixes such as resilience training, mindfulness, reduced duty hours and wellness programs. These approaches, the report argues, have consistently failed to slow physician attrition precisely because they treat a systemic problem as a personal one.

“There’s no amount of yoga that will make me less distressed about how my patients are harmed,” one family medicine physician said in an interview quoted in the report. “My staff is harmed. I’m harmed by this system.”

https://medicaleconomics.com…

By Patsy Newitt
Becker’s ASC Review, March 19, 2026

Physicians across the United States are experiencing a deepening crisis of moral injury, and they believe profit-driven healthcare systems increasingly block them from delivering the care their patients need, according to a sweeping new study by Physicians for a National Health Program, an advocacy organization of more than 20,000 physicians, medical students and health professionals who support a universal, single-payer national health program.

The March 17 report, which surveyed more than 1,200 practicing physicians and included focus groups, found that nearly half of physicians often or always feel unable to provide their patients with the best possible care, with two-thirds reporting moderate or severe distress as a result.

The study draws a sharp distinction between burnout — which implies individual depletion and is typically addressed through wellness initiatives — and moral injury, which the authors define as the distress physicians experience when they know what their patients need but cannot provide it due to constraints outside their control.

Physicians in the study were pointed in their rejection of burnout framing; as one family medicine physician said, “When we talk about burnout, it makes it sound like it’s my fault or my colleagues’ fault. The term points to the person being affected. It’s a form of victim shaming.” Notably, 40% of surveyed physicians often or always felt frustrated by the wellness activities their employers offered, saying they simply didn’t help.

The survey was distributed through a non-random, multi-modal recruitment approach using PNHP’s professional networks, medical societies including the Society of General Internal Medicine and the American College of Physicians, listservs, social media, and snowball sampling. It adapted eight items from the validated Measure of Moral Distress for Health Care Professionals and added 14 new questions capturing system-level pressures, financial constraints and administrative burdens. The mean overall moral distress score was 143, compared to 96 in the 2019 benchmark study, suggesting a significant worsening over time. For 18 of 22 survey questions, the most common distress rating was “very distressing,” the maximum level possible.

Here are 10 key things to know from the survey:

1. Forty-seven percent of surveyed physicians indicated their employer often or always prioritized financial goals over best patient care, and 50% felt betrayed by a healthcare system that hindered their ability to provide good care.

2. Additionally, 62% experienced moderate to severe distress over cost-cutting pressures from administrators or insurers.

3. Of the surveyed physicians, 45% often or always felt unable to provide patients with the best possible care, and 68% experienced moderate or severe distress as a result. An additional 47% often or always felt unable to provide optimal care simply due to inadequate time.

4. Forty-four percent of physicians often or always felt that lack of insurance approval blocked medically necessary services, and 51% often or always experienced excessive documentation requirements that compromised patient care.

5. Of the surveyed physicians, 35% often or always felt required to care for more patients than they could safely handle, and 43% often or always felt required to overemphasize productivity metrics at the expense of patient care.

6. Forty-five percent often or always encountered lack of resources or bed capacity that compromised care, and 43% said leadership often or always failed to respond supportively when such failures occurred. Three in 5 physicians experienced moderate or severe distress contemplating these situations.

7. The mean overall moral distress score was 143, compared to 96 in the 2019 benchmark study, suggesting a significant worsening. For 18 of 22 survey questions, the most common distress rating was “very distressing,” the maximum level.

8. On attrition, 27% of physicians had already left a position due to moral distress, 25% are currently considering leaving for the same reason and 42% had previously considered leaving but chose to stay. The workforce consequences are tangible: physician departures have contributed to clinic closures, elimination of services, and dramatically longer patient wait times.

9. Fifty-seven percent of physicians reported moderate or severe distress from working in systems that failed to treat vulnerable patients with dignity, and 41% often or always felt complicit in the structural racism their systems perpetuated. Physicians described patterns of race-based misdiagnosis, discriminatory care based on insurance status, and the rationing of life-sustaining treatment for uninsured and undocumented patients.

10. Nearly half of practicing physicians reported often or always making diagnostic or treatment recommendations they knew their patients would not be able to pursue, due either to insurance barriers or financial toxicity, and for 7 in 10 of those physicians, this provoked moderate or severe distress.

https://beckersasc.com…

By Claudia Fegan, M.D.
Chicago City Council, Committee on Health and Human Relations, March 10, 2026

My name is Dr. Claudia Fegan, I retired in December of 2024 after 12 years as the Chief Medical Officer of Cook County Health, and 24 years with the system. I am the National Coordinator of Physicians for a National Health Program, a national organization with over 25,000 members, based here in Chicago. I am grateful to all the members of this committee who have already signed on to Alder Cruz’s Resolution Supporting Medicare for All. While many people think access to health care is a national issue to be addressed by congress, this is a crucial issue for Chicago, and I’m thankful for the opportunity to address you today and explain why it is so important to address now, prior to the midterm elections.

As the resolution points out, the city of Chicago spends over $600,000,000 annually to provide health insurance to city employees. Think for a moment what the city could do with those funds if we had universal health care, if employers were no longer expected to pay for their employees to have access to health care. Employers are not expected to be responsible for the education of the children of their employees or guarantee their access to police or fire protection. What could Chicago do with an extra $600,000,000?

A poll of voters from November 2025 showed 90% of Democrats and the majority of independent voters support Medicare for All. Voters want to regain control of their health care and lower costs. We are the only industrialized country that does not guarantee access to health care for everyone living within our borders. Not just every citizen, everyone living here. We already spend enough on health care; we spend more money per person than any other country in the world. We allow patients to be denied access to care they need to maximize the profits of the insurance industry.

There has been a lot written about burnout among people in health care. This past year PNHP partnered with the Robert Wood Johnson Foundation to assess that burnout. Surveying over 1100 practicing physicians, we found what has been labeled as physician burnout is often moral injury inflicted by the financialization of the practice of medicine in this country. We found it has harmed the morale of the entire health care workforce, leading to increased shortages and decreased access to care as professionals retire early, cut back on their hours or leave the practice of clinical medicine altogether. Tragically, there are increasing totals of suicides among physicians. More and more, physicians are frustrated by their inability to offer patients the most appropriate care. They are stymied by required prior authorizations that issue inappropriate denials of care, make treatment recommendations their patients cannot pursue and create conflicts between health goals for their patients and the financial goals of the institutions that employ them.

It would be life-changing for Chicago to take the lead here and make a statement by supporting Medicare for All. If the city that sent the first Black woman to the Senate, that first sent Barack Obama to the Senate and then to the White House could send the message that health care is important for everyone, it would have a tremendous impact and continue our local tradition of initiating progress.

The tide is going to turn in this country. We need to build our power and be prepared to take what we need when the opportunity presents itself. We must be represented by people who have the courage to support our agenda. Medicare for All is something representatives have to be willing to fight for. We have a Congress that has acquiesced its power to a president who doesn’t believe in checks and balances. We will not get universal health care while Donald Trump is in the White House. We must be prepared for when Trump is gone. In 3 years, we must be prepared to seize the opportunity when it presents itself.

Last year, one-third of Americans delayed getting care they needed or skipped care entirely. That is the highest number since Gallup started asking questions about this 30 years ago.

I am reminded of a woman I admitted to the hospital one night a few years ago. Both of her breasts were rock hard. They were infiltrated with cancer with palpable lymph nodes in her axilla. She worked as a hairdresser, owned her own shop but had no health insurance. She was sitting at home waiting to die. She believed she had no other choice. She knew she could not afford her care. Her daughter made her come in. Remarkably we were able to get a dramatic response with treatment. No one should ever have to sit at home waiting to die in this country, when we have treatments that can be lifesaving.

Families are desperate for solutions to their everyday health care problems, skyrocketing drug prices, rising copayments and deductibles, surprise medical bills; and are tired of having to switch doctors because of the revolving door of job-based health insurance.

The United States has struggled with the effects of ‘For Profit” Health Care for decades. The country has never embraced access to health care as a basic human right.

In the United States, we know some 28 million people or 8% of the population are uninsured and that 45,000 people die each year as a direct result of not having insurance.

If there is a lesson for the rest of the world to learn from the United States, it is the lesson of the private insurance industry. The insurance companies have a fiduciary responsibility to make as much money as possible for their shareholders. They also determine which patients have access to which care. There is an inherent conflict of interest here. By eliminating the waste and greed of private insurance, we can afford to cover everyone in our country for all necessary care, and end the scourges of surprise bills, skipped medications, and medical bankruptcy. Medical illness or medical debt is the number one cause of bankruptcy in this country, even though the majority of people who declared bankruptcy had insurance at the time of their precipitating illness.

There will always be limitations on how much money is available to spend on health care. Those decisions need to be based on societal need, cost effectiveness and population health, not profits and financial yields.

We already spend enough money on health care in this country; we just allow too many people who do none of the work of delivering health care to take profit from it. I am asking the Chicago City Council to have the political courage to lead the way and to tell our nation that health care needs to be a right for everyone. Thank you so much.

Read the full Chicago City Council resolution HERE.