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.”