Beyond burnout, physicians are experiencing a phenomenon called “moral injury” and the AMA House of Delegates says it is time to recognize the threat it poses to physician well-being and take action by developing recommendations to intervene.
As the leader in physician well-being, the AMA already provides organizational solutions that help physicians and health systems optimize practice efficiency, reduce burnout and rediscover the Joy in Medicine®.
But moral injury is different than burnout. While both create stress for physicians, burnout encompasses emotional exhaustion, depersonalization and diminished personal accomplishment because of mismatches between demands and resources. Moral injury, meanwhile, comes from systemic and institutional failures that produce guilt, shame, loss of meaning and erosion of professional identity when physicians cannot deliver care aligned with their ethical and medical obligations.
“The practice of medicine is fundamentally a moral activity, yet physicians routinely face barriers that can prevent them from delivering the care they know their patients need,” said Pauline P. Huynh, MD, secretary of the AMA Board of Trustees.
“When those barriers repeatedly conflict with physicians’ professional values, that harm can contribute to physicians reducing their hours, leaving positions or training programs, or exiting practice altogether,” said Dr. Huynh, an otolaryngologist. “At a time when the nation needs a strong and stable physician workforce to meet growing healthcare needs, recognizing and addressing moral injury is essential to retaining physicians, protecting access to care, and advancing our nation’s health goals.”
Systemic moral injury will not be solved by individual-level interventions that have shown some success in helping physicians who encounter burnout, interventions such as resilience training, mindfulness and well-being initiatives.
Instead, to address the factors that contribute to moral injury, leaders in medicine need to address organizational and policy conditions that create moral conflicts for physicians—conditions that many physicians encounter daily in their practice of medicine. Examples include prior authorization requirements, unjustified coverage denials, excessive productivity quotas and documentation requirements, and other practices in healthcare that can obstruct timely, evidence-based patient-centered care.
New directions to address moral injury
Nearly all physicians said they have encountered adverse effects from prior authorization, for example, with 26% reporting that prior authorization led to a serious adverse event for a patient in their care, according to the most recent AMA prior authorization physician survey.
Meanwhile, one in five physicians said they were planning to retire within two years, AMA research says, and a 2023 Elsevier report found that 12% of U.S. medical students pondered quitting their studies.
The sources for moral injury may be different for medical students, physician residents and fellows, and practicing physicians. For example, medical students learn about their patients’ social determinants of health, but realize resources are not available to address the needs.
Residents learning about the most evidenced-based interventions may find they cannot access that intervention based on a patient’s payer status, says a resolution introduced by the AMA Resident and Fellow Section. Attending physicians can sometimes find themselves spending too much time handling prior authorization requests and not enough time with their patients. The AMA is fighting to fix prior authorization by challenging insurance companies to eliminate care delays, patient harms and practice hassles.
To address the phenomenon of moral injury in medicine, delegates at the 2026 AMA Interim Meeting adopted new policy that recognizes moral injury as:
- The harm that occurs when healthcare professionals are compelled by systemic constraints to witness or to act in ways that transgress their moral beliefs and professional obligations, including the inability to deliver evidence-based, equitable, and patient-centered care.
- A distinct and significant threat to the wellbeing of medical students, residents, and physicians.
Delegates also directed the AMA to draw upon existing research and evidence and “develop recommendations for systemic interventions to address moral distress and moral injury among medical students, residents and practicing physicians, including institutional, financial, administrative and resource constraints that interfere with physicians’ ability to provide medically necessary, evidence-based and patient-centered care.”
Read about the other highlights from the 2026 AMA Interim Meeting.
