PNHP

Physicians for a National Health Program (PNHP) is partnering with the Robert Wood Johnson Foundation (RWJF) to study the impact of financialization on U.S. health care. Starting in the fall of 2024, and continuing through the summer of 2025, we will engage current health care professionals to better understand moral injury and distress, how these issues impact racial inequities in health care, and how best to remedy this worsening problem.

Take our brief moral injury survey

Toolkit: Share our moral injury survey

Dr. Diljeet Singh explains our research project

What is “moral injury?”

As health care has been transformed from an essential service to a profit-driven business, the morale of the entire workforce—including physicians, nurses, and allied health professionals—has suffered. This trend has led to shortages as professionals are retiring early, cutting back work hours, quitting clinical medicine, and tragically committing suicide in increasing numbers.

These responses have often been misdiagnosed as “burnout,” but the lack of efficacy of standard treatments for burnout has led insightful scholars such as Drs. Wendy Dean and Simon Talbot to identify “moral injury” as a more accurate culprit.

Moral injury in health care is described as the challenge of knowing what care patients need, but being unable to provide it due to constraints beyond physicians’ control. As a result, our focus on burnout is insufficient and, in fact, causes harm by leading to a reliance on ineffectual “wellness” programs and an obscuring of root causes. Without adequate data on moral injury, the ability of policymakers and stakeholders to address our health care crisis will remain limited.

Gaps in the literature

In an effort to better understand moral injury in health care, PNHP will survey workers throughout the medical profession and will conduct a series of 20-40 one-on-one interviews with currently practicing physicians. We will gather data points on the impact of financialization from our survey, and identify narratives from our interviews to more compellingly illustrate these data points. These elements will form the basis of our fall 2025 report, which will provide actionable recommendations for stakeholders.

Our project follows the rigorous practices of the Association for the Accreditation of Human Research Protection Programs (AAHRPP), and we have obtained Institutional Review Board approval by the independent Pearl IRB, along with our consultant at Cambridge Health Alliance’s institutional IRB.

See the following documents for specifics on our survey, and the broader moral injury project:

Take our moral injury survey

The first part of our moral injury project consists of an intake survey to help us better understand the impact of financialization in U.S. health care, and how it intersects with racial health inequities. You can take our 10-minute survey at pnhp.org/survey.

Please note the following to better understand our survey process:

  • Questions were developed in consultation with a working group of prominent physicians and academics, and through insights gleaned from a series of physician focus groups conducted over the summer of 2024.
  • Our main audience for the survey is physicians who are currently practicing in the U.S., but we are collecting survey responses from all health professionals.
  • We have secured Institutional Review Board (IRB) approval via Pearl IRB and Cambridge Health Alliance.
  • This survey functions as an intake tool for a series of 1:1 interviews to be conducted over the spring/summer.
  • We will release a high-level report of findings at PNHP’s 2025 Annual Meeting (Nov. 1-3 in Washington, D.C.), and will share this report with PNHP members, allies, and elected officials.
  • We will author an academic paper detailing the results of our moral injury research, which will be submitted for journal publication at the end of 2025.

For reference, we have uploaded a PDF version of our complete moral injury survey HERE.

Share our moral injury survey

To properly understand the impact of financialization on U.S. health care, and how it intersects with racial health inequities, we will need to engage with thousands of currently practicing physicians. This means tapping our active PNHP members and going beyond this cadre of single-payer activists.

We need you to share the pnhp.org/survey link with currently practicing physicians in your network! To help you with this outreach, PNHP has put together a toolkit that includes:

We’ve also developed a one-page info sheet with information about our moral injury project.

Dr. Toby Terwilliger provides outreach tips

Respecting your privacy

PNHP’s moral injury survey covers delicate topics and gives participants the opportunity to share experiences from their practice—as well as experiences with specific employers, insurers, and other parties.

Rest assured that survey responses will be anonymized through the use of unique ID numbers and that nobody outside of PNHP’s survey team will ever have access to individual replies.

We also ask survey respondents to share their email address, so we can follow up regarding potential 1:1 interviews. Please note:

  • Individuals who are not already in PNHP’s database can opt in to receive updates about our moral injury project.
  • If respondents are added to our email list, they can unsubscribe at any time (link at the bottom of all PNHP emails).
  • PNHP will never sell or share emails collected through our moral injury survey.

Moral injury workshop (Nov. 2024)

PNHP president Dr. Diljeet Singh helped lead a workshop on moral injury at our 2024 Annual Meeting in Chicago. Download Dr. Singh’s slideshow HERE.

Social media graphics

Use this graphic to encourage people in your network to take the survey. Download HERE.

Use this graphic to encourage people in your network to learn more about our moral injury project. Download HERE.