Patients are rightfully complaining about the state of the healthcare system and the quality of care they are currently receiving within it. The patients’ voices now include those of the main professional organizations representing their physicians.

A physician knows exactly which scan her patient needs. The insurance company says no. The clinic wants her to see four more patients before lunch. So she signs off on a plan she knows is second best, and she drives home feeling like she broke a promise. Tomorrow, she’ll do it again.

I am beginning to hear a chorus of voices from physicians who are telling me that they are seriously planning either to leave medicine entirely or to practice it in a totally different fashion, devoid of any insurance involvement. Three years ago, I thought that was unusual, but today I am hearing it repeatedly.

That feeling now has an official name. This month, the American Medical Association (AMA) adopted its first-ever policy on moral injury and called it a “distinct and significant threat” to physicians, residents, and medical students. The AMA describes moral injury as the harm that happens when the system forces health care workers to see or do things that go against their moral beliefs and their duty to patients. That includes not being able to give care that is proven, fair, and focused on the patient. Non-medical personnel or algorithms are making the decisions for them.

Moral injury isn’t the same as burnout. Burnout happens when people are asked to do too much with too little. Psychiatrist Wendy Dean, MD, who helped bring the idea of moral injury into health care, describes it as being let down by the people in charge in a high-stakes moment, in a way that pushes you to act against what you believe is right.

The numbers show how common this is. A national survey published in JAMA Network Open in 2026 found that 39% of physicians had high moral distress. Physicians had more than four times the odds of high moral distress compared with other U.S. workers. Among physicians with high moral distress, 75% had burnout, compared with 31% of those with low distress. About one in three with high distress planned to leave their job within two years.

Just this week, I had a fairly young physician tell me that he has been giving some thought to leaving medicine: “I think about it on and off.” When I asked what he would do, he looked at me and said, “I really don’t know.”

Dr. Dean says this problem has grown right along with corporate medicine. As more physicians become employees, they’re caught between the patients they promised to care for and the employers who decide whether they keep their jobs. A March 2026 report from Physicians for a National Health Program named prior authorization, coverage denials, and quotas for how many patients a physician must see as everyday roadblocks to good care. This is what one physician told me was “factory medicine.” She has since opened a concierge practice with a fellow physician.

Why Patients With Less Money Feel It First

This isn’t only a physician problem. It affects who gets care and how good that care is.

In a national survey of nearly 1,900 physicians presented in 2025, moral distress was higher among physicians who cared for a growing share of uninsured patients and a growing share of patients from racial and ethnic minority groups. A separate study of more than 2,000 clinicians in safety-net clinics, the clinics that serve low-income families, found that about 72% reported some level of moral distress. Many were upset because they couldn’t give the best care. Many were also upset from watching their patients and communities be treated unfairly.

Here’s how that turns into a problem for patients. Distressed physicians cut their hours or leave. A 2026 study of nearly 20,000 family physicians found that 43.5% reported burnout. Those with burnout were about 1.5 times more likely to change practices or stop practicing. Patients who lose their family physician may end up in the emergency room more often, spend more on care, and be less satisfied with the care they get. A patient with good insurance and a car can usually find a new physician. A patient on Medicaid, or with no insurance at all, often can’t.

Quality slips, too. A review of 170 studies covering nearly 240,000 physicians found that burnout was tied to twice as many patient safety problems. It was also tied to more than twice the odds of unprofessional conduct and unhappy patients. The U.S. Surgeon General warned that the country could be short 54,000 to 139,000 physicians by 2033, and that the burnout crisis will make it harder for the public to get checkups, emergency care, and procedures.

Outbursts, Silence, and Suicide

When people are pushed past their limits, it often shows in how they treat others. Health care has a long history of putting up with yelling, put-downs, and refusing to return calls or pages. In 2008, the Joint Commission, the group that accredits U.S. hospitals, warned that this kind of behavior can lead to medical errors and harm patients. It also required hospitals to have a code of conduct. In a survey of nurses and physicians at more than 100 hospitals, 77% had seen physicians act this way and 65% had seen nurses do it. The Joint Commission also reported that 40% of clinicians had stayed quiet during patient care instead of questioning someone who intimidated them. That silence puts patients at risk.

Burnout and bad behavior go together. A national study of U.S. physicians found that those with burnout had twice the odds of reporting at least one unprofessional act in the past year. An outburst is never excused. But it can be a warning sign that someone is close to the end of what they can take.

The most serious warning sign is suicide. A 2024 review of 39 studies from 20 countries found that female physicians died by suicide at a rate 76% higher than the general population. In the most recent studies, that gap got smaller, but it was still 24%. Male physicians had an 81% higher rate than men in other jobs with similar income and education. What about women physicians?

Nurses face an even greater risk. A University of Michigan study of U.S. deaths from 2007 to 2018 found that female nurses died by suicide at about twice the rate of women in the general population, and about 70% more often than female physicians. The researchers pointed to heavy workloads, long shifts, fear of what happens if they ask for help, and easy access to medications.

Is moral injury part of this? Research hasn’t proven a direct link in health care workers yet. But the term comes from the military, and among U.S. combat veterans, moral injury has been tied to more suicidal thoughts and suicide attempts. Many clinicians also avoid treatment. The Surgeon General’s advisory noted that licensing forms asking about past mental health care can scare health workers away from getting help.

What Health Care Leaders Say Must Change

The AMA’s new policy says physician well-being depends on fixing the systems that keep physicians from doing right by their patients, not just teaching them to cope. The AMA will now develop recommendations aimed at the money, paperwork, staffing, and other limits that get in the way of needed care.

Michael Tutty, PhD, lead author of the 2026 survey and an AMA researcher, says better rules for insurance and prior authorization could ease moral distress. He adds that AI note-taking tools may help with burnout but probably won’t do much for moral distress, because that is a larger system problem.

The Surgeon General’s advisory calls for ending policies that punish health workers who seek mental health or substance use care. It asks licensing boards to ask only about conditions that affect a person’s ability to do the job right now. It also calls for cutting paperwork, protecting workers from violence, and building on the Dr. Lorna Breen Health Care Provider Protection Act, a federal law named for an emergency physician who died by suicide in 2020. The authors of the 2024 suicide review add that every physician must have access to early, confidential treatment.

Dr. Dean and her colleagues will start a pilot program in January 2027 to prepare physicians for the parts of medicine that raise the risk of moral injury. She points out that some harm can’t be avoided in health care, but the avoidable kind can be reduced. She also says the AMA’s new policy matters less than what the organization actually does with it.

That’s the real test. A physician or nurse who isn’t allowed to do right by patients can’t stay forever. And when they leave, the patients with the fewest choices are the ones left waiting.

If you or someone you know is struggling, call or text 988 to reach the 988 Suicide and Crisis Lifeline.

My books are on my Amazon author page: https://www.amazon.com/author/drpatriciafarrell. They are also on Google Play Books. Search for “Patricia A. Farrell, PhD.”

CRITICAL READING: “BAD SCIENCE, REAL HARM” https://tinyurl.com/