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What Will It Take to Heal Providers’ Moral Injury?

Much was made of physicians and other healthcare professionals leaving practice due to being overworked during and in the aftermath of the COVID-19 pandemic. In 2021, 334,000 healthcare professionals quit. Based on the many articles, surveys, and studies covering the topic, many did indeed leave because of the suffering that they and their patients endured as they grappled with the virus. But today, with a sharp decline in COVID cases and deaths and a system that is “back to normal”, 20% of physicians say they still intend to quit. 


A quick Google News search turned up 483 articles about physician burnout. Burnout is a syndrome defined by a state of of physical and emotional exhaustion due to chronic and prolonged workplace stress. The case for burnout among healthcare professionals during and following a pandemic is easily made. But there is evidence that healthcare providers’ struggle with the psychological, biological, and spiritual impacts of working in the US Healthcare System pre-dated the COVID-19 pandemic. 

The long list of challenges with the US Healthcare System—with its racism and inequities, profit-seeking, bureaucracy, high costs, low trust, and poor quality—date back decades. And COVID-19 was a tragedy that blasted away the last vestiges of “the System works”.

But it was in July of 2018, more than a year before COVID-19 was identified as a novel virus and nearly 2 years before it was declared a pandemic, that Drs. Simon Talbot and Wendy Dean published an article entitled “Physicians Aren’t ‘Burning Out’. They’re Suffering Moral Injury.” In the article, Talbot and Dean identify burnout as a symptom of the larger syndrome of Moral Injury.

The term was first coined in 2009 as part of a study designed to explore the occurrence in warriors and soldiers. Moral injury was effectively defined as a specific trauma that arises when people face situations that deeply violate their conscience or threaten their core values. 

Back then, post-traumatic stress disorder (PTSD) was the predominant diagnosis for soldiers who displayed symptoms of psychological, behavioral, and social stress. But the study authors explored whether, like physicians today, PTSD might actually be a symptom of moral injury.

For providers, the moral injury is the result of an “increasingly complex web of providers’ highly conflicted allegiances—to patients, to self, and to employers…leaving them unable to consistently meet patients’ needs, and resulting in profound impact on providers’ wellbeing (Talbot and Dean, 2018).” 

The problems are complex, systemic, and persistent. However, we know that no version of the American Healthcare System survives without healthy physicians and providers. The solutions will be compassionate, inclusive, sustainable, and they must, ultimately, function as a system within the healthcare system (@Robbie Pearl). 

So, where do start?

Talbot and Dean posited that the answer lay in “a truly free market of insurers and providers, one without financial obligations being pushed to providers, that would allow for self-regulation and patient-driven care…with goals aimed at creating a win-win where the wellness of patients correlates with the wellness of providers, thereby avoiding the ongoing moral injury associated with the business of health care”.

At the Wonder Guild, we are building a free-market solution to support physicians and providers who want to transition to a Direct Health Care model (a broader application of the Direct Primary Care model to physicians and providers in other specialties or those in hybrid models.

Our new product (still in stealth mode) centers on creating equitable care and outcomes for patients and wellness for physicians and providers and includes (1) an integrated set of services to support practice-building and growth and (2) all of the resources physicians and providers need in order to avail your patients of 95% of the care and services they will ever need. No upfront fees. No new EHRs, practice management, or revenue cycle management software to learn. No one telling you how to run your practice.

If you are a physician or other licensed healthcare provider who wants to grow your direct health care or hybrid practice, message me. I’d love to have you join our beta.