In the world of medicine, moral injury refers to an emotional wound sustained when the demands of administrators, hospital executives, and insurers force practitioners to stray from their ethical principles. Seventy percent of doctors work as salaried employees of large hospital systems or corporate entities, taking orders from administrators and executives who do not always share their values or priorities. (Note: A new study finds that private equity firms own more than half of all specialists in certain U.S. markets, a situation associated with higher prices.)
Medical personnel are pressured to make decisions based on financial
considerations. The emphasis is on speed, efficiency, and relative value units
(R.V.U.), a metric that rewards doctors for doing tests and procedures and
discourages them from spending too much time on less remunerative functions,
such as listening and talking to patients. Making matters worse, in the eyes of
their patients, doctors become the scapegoats, the instruments of betrayal by
the health care system.
This situation has been taking a toll for years. The suicide rate among
doctors is higher than the rate among active military members; one in five
health care workers has quit his or her job since the start of the pandemic, and an
additional 31 percent have considered leaving. In the remarks of some doctors: “Every
day, you’re reminded how savage the system is;” “It’s turned us into a widget
factory of just throughput, getting people in, getting people transferred onto
money-making specialties, without really addressing their health care needs.
And it’s demoralizing and it’s not good care.”
To address the problem, some doctors join
unions, such as The
Valley Physicians Group of Santa Clara County, California, not to increase
their pay but to improve working conditions. Others have opened direct-care
practices in which patients pay a monthly fee. Such solutions don’t eliminate
all the problems, such as fighting with insurers, but at least they reduce
moral injury.
For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.
Brava, Connie! This says it all...thank you for speaking the truth on this timely subject.
ReplyDeleteExcellent article Connie. Here at the University of Florida, majority members of outstanding Orthopedic Surgery Department were asked to leave when they requested improved patient care. They did not seek increased salaries. A very positive benefit has developed while they are setting up independent community programs; the surgeons are enjoying time with their young children.
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