Nearly two in five physicians reported high moral distress, and higher distress was associated with more burnout, lower professional fulfillment, and greater intent to leave practice or reduce clinical hours, according to a cross-sectional survey study published in JAMA Network Open.
Researchers surveyed 5,741 physicians and 3,501 US workers between October 2023 and March 2024 using the Moral Distress Thermometer, a 0 to 10 scale in which scores of 4 or higher indicate high moral distress. Burnout was assessed using the Maslach Burnout Inventory, and professional fulfillment using the Stanford Professional Fulfillment Index.
Physicians had a mean moral distress score of 3.29, with 39% reporting high moral distress. Compared with other US workers, physicians had more than four times the odds of high moral distress.
Higher moral distress was associated with higher burnout. Burnout prevalence ranged from 18% among physicians with a moral distress score of 0 to 92% among those with a score of 10. Overall, 31% of physicians with scores less than 4 had at least one burnout symptom compared with 75% of those with scores of 4 or higher.
Professional outcomes were also associated with moral distress. Physicians with scores less than 4 were more likely to report high professional fulfillment (47% vs 13%). Intent to leave practice within 2 years was reported by 18% of physicians with low moral distress compared with 34% of those with high moral distress. Intent to reduce clinical hours was reported by 24% vs 34%, respectively.
On multivariable analysis, women physicians had higher odds of moral distress. Compared with internal medicine subspecialists, emergency medicine physicians and general internal medicine physicians had higher odds of moral distress. The odds of moral distress increased with each additional hour worked per week, whereas older and married physicians had lower odds.
Moral distress and burnout were correlated and frequently co-occurred but remained distinct constructs.
Limitations included potential response bias due to low survey participation rates, reliance on self-reported data, and the cross-sectional design, which precluded determination of causality. The use of a single-item measure for moral distress may not capture the full complexity of the construct.
Michael A. Tutty, PhD, of the American Medical Association, and colleagues concluded that “moral distress is common among physicians and experienced at higher rates than the general US working population.”
Study authors reported relationships with the American Medical Association and other industry entities; full disclosures are available in the original article.
Source: JAMA Network Open
