Moral Distress and Occupational Burnout in US Physicians

TL;DR

Physicians in the US experience high levels of moral distress, which is linked to burnout and intentions to leave or reduce work hours.

Contribution

This study is the first to quantify moral distress in physicians and link it to burnout and workforce retention intentions.

Findings

39.1% of physicians reported high moral distress (score ≥4) compared to other US workers.

Higher moral distress scores correlated with increased burnout, intent to leave, and intent to reduce work hours.

Emergency and general internal medicine physicians had the highest odds of high moral distress.

Abstract

What is the level of moral distress and the association between burnout, intent to leave (ITL), and intent to reduce work hours (ITR) among physicians and US workers?

In this survey study of 5741 physicians and 3501 US workers, the mean moral distress score for physicians was 3.29, with 39.1% reporting a high level of moral distress; physicians had higher odds of experiencing moral distress than other US workers. The prevalence of burnout, ITL, and ITR was higher for each 1-point increase in moral distress score among physicians.

These findings suggest that moral distress is common among physicians and experienced at higher rates than the general US working population.

This survey study evaluates moral distress among physicians and US workers and examines the association between moral distress, burnout, intent to leave, and intent to reduce clinical hours.

Exploring the relationship between moral distress and occupational burnout is necessary to understand the association between these constructs.

To evaluate moral distress among physicians and US workers, and to explore the association of moral distress with burnout, intent to leave (ITL) current position, and intent to reduce clinical work hours (ITR).

This cross-sectional national survey study included physicians from all specialties and a probability-based sample of employed nonphysicians. Participants were aged 29 to 65 years. Data were collected between October 19, 2023, and March 5, 2024. Data were analyzed from June 30 to October 20, 2025.

Moral distress was measured using the Moral Distress Thermometer (MDT, range 0-10), with a high level of moral distress defined by a score of 4 or higher. Burnout was measured using the complete Maslach Burnout Inventory (MBI). Professional fulfillment was measured using the Stanford Professional Fulfillment Index. ITL and ITR were measured using a standardized item with response options of none, slight, moderate, likely, and definitely.

This survey study included 5741 physicians and 3501 nonphysician US workers. The median (IQR) age of physicians was 53 (44-62), and included 3262 men (58.0%), 2255 women (40.1%), and 107 individuals who responded other (1.9%). The mean (SD) moral distress score for physicians was 3.29 (2.81), with 2243 (39.1%) reporting a high level of moral distress (4 or more considered high). On multivariable analysis, women physicians had higher odds of moral distress (OR, 1.29; 95% CI, 1.12-1.48). Compared with internal medicine subspecialists, emergency medicine physicians (OR, 3.16; 95% CI, 2.27-4.4) and general internal medicine physicians (OR, 1.92; 95% CI, 1.42-2.59) were more likely to report high levels of moral distress. Mean emotional exhaustion and depersonalization scores, as well as the proportion of physicians with burnout, were higher with each 1-point increase in moral distress score. The overall correlation between the emotional exhaustion score and moral distress score was R = 0.55 (P < .001) while the correlation between the depersonalization score and moral distress score was R = 0.50 (P < .001). Additionally, 1068 of 3477 physicians (30.7%) with a moral distress score less than 4 had burnout symptoms compared with 1675 of 2231 physicians (75.1%) with scores of 4 or more (P < .001). The prevalence of ITL and ITR was higher for each 1-point increase in moral distress score. For example, 619 of 3404 physicians (18.2%) with low moral distress reported ITL within 24 months compared with 748 of 2171 (34.5%) among those with high moral distress (P < .001). Compared with other US workers, physicians had markedly higher odds of experiencing moral distress (OR, 4.40; 95% CI, 3.84-5.06).

In this survey study, moral distress was common among physicians and experienced at higher rates than the general US working population. Understanding the differences between moral distress and burnout may allow organizations to more effectively implement interventions to address both concerns among clinicians.

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