Moral injury is a term I’ve returned to often in recent years. It describes the distress physicians feel when we’re unable to practice medicine in a way that aligns with our moral and professional values. Many of us entered medicine with the same purpose: to help people heal. Yet too often, the structures around us make that harder than it should be to fulfill this purpose. I hear about this tension from colleagues across the country and have felt it in my own practice. I’ve also seen it reflected in the number of physicians stepping away from the profession at a time when our communities need us the most. Talking about moral injury isn’t easy, but avoiding the conversation hasn’t served us. When we call out what we’re facing, we can begin to address the roots of the problem at the personal, institutional, and systemic levels and rebuild the sense of purpose that called us to this work in the first place. Why I Still Believe in This Work Even on the hardest days, I draw inspiration from the stories of my colleagues and patients. They give me strength and a sense of understanding. I think of Dr. Michael Mason, a geriatrician with The Permanente Medical Group in Northern California. His dedication to patients with complex needs is a reminder that meaningful progress doesn’t always look dramatic—sometimes it’s a steady, quiet commitment to doing what is right. He was recently recognized as Physician of the Year by the Napa Solano Medical Society for his extensive work on behalf of older adults. I also think of Dr. Stella Dantas, a colleague at Northwest Permanente, who just completed her term as president of the American College of Obstetricians and Gynecologists. She spent the past year championing physician well-being, fighting medical misinformation, and advocating for reproductive healthcare at a moment when the work has never been more urgent (Mirel, 2024). Her leadership demonstrates what it means to show up fully for patients and colleagues during the most trying times. And then there are the patient stories that remind me of the profound impact physicians have and how extraordinary human resilience can be. Kathryn Gallagher, an 80-year-old weightlifter, returned to her workout routine after a heart valve replacement at Kaiser Permanente San Francisco (Oakley, 2025), and the Cuevas triplets were born healthy at just 34 weeks at Kaiser Permanente Fresno (Scott, 2025). These stories are a reminder that despite everything we’re up against, we have the best seat in the house to watch the miracle of humanity unfold. All these moments, no matter how big or small, reconnect us to why we entered this profession. But they are not enough on their own. Inspiration can replenish us, but it cannot fix the systems that wear clinicians down. Pressures That Make Moral Injury So Difficult What makes moral injury so tough is not just the volume of work but the friction between our values and the realities of delivering care today. It’s about the hours lost to documentation instead of connecting with patients, the inbox messages that follow us home and chip away at our personal time, the weight of responsibility without the resources to meet it—and increasingly, the fear for our own physical safety in the workplace. None of these challenges are new. But they are accumulating, and they are affecting our ability to practice medicine in a way that feels sustainable. I hear physicians say, “I know what my patients need — I just don’t have the time or support to deliver it. ” That is moral injury. And it is a signal that we must change the system, not ask clinicians to simply endure more. Giving Time Back to Clinicians One of the most meaningful ways we can relieve pressure is by reducing the administrative load that has crept into every corner of clinical practice. It’s part of why I believe so strongly in tools that give time back to physicians. At Kaiser Permanente, we’ve expanded the use of artificial intelligence (AI) -enabled ambient documentation tools. These tools capture the patient-physician conversation—securely and with patient consent—and create a draft note that clinicians review and finalize. I use this technology myself, and the difference it makes is valuable. When documentation is handled in the background, I’m able to stay fully present with patients, and the visit feels more natural and human. Tools like ambient scribes are not a replacement for clinical judgment. They are not a cure for moral injury. But they do free us from some of the administrative burdens that erode both efficiency and joy for the work that we do. They also allow more of our energy to go where it belongs—to patient care. For smaller hospitals or health systems, adoption of time-saving tools doesn’t have to be all-or-nothing. Starting a pilot program with a specific department can yield insights that set the stage for a broader rollout. The most important step is choosing tools that integrate smoothly with the existing electronic health record and genuinely help clinicians, rather than introduce new frustrations. Once the technology is in place, leaders can track key metrics such as physician documentation time, reported levels of burnout, reported impacts on the quality of clinical visits, and other feedback to ensure that tools like ambient scribes are delivering value to patients, the health system, and its physicians. Meeting the Needs of an Aging Population Another challenge physicians face is the growing clinical complexity of the patients we serve. People are living longer, often with multiple chronic conditions that require high levels of coordinated care. The work is rewarding, but it is also demanding. To meet this need sustainably, we must design care models that support clinicians, not overwhelm them. One promising example is an initiative in Kaiser Permanente Northern California, where we used an AI model to identify about 8, 000 patients at high risk for emergency department visits and hospitalization. Each care team focused on these patients includes a physician, nurse, social workers, pharmacist, and care manager. A project team was able to identify the specific causes for which each patient was at risk—medical, pharmaceutical, social, or mental health—and created a system that alerts only the relevant specialist on each team, such as a pharmacist for pharmacy-related needs. For example, if the algorithm flags a mental health need, the care team can make an appropriate referral. This approach has streamlined care; previously, teams caring for patients with chronic, complex needs oversaw about 200 patients each. Now, each team manages about 1, 500 patients, because with clear prioritization, team members can focus on the right issues at the right time. This approach reduces unnecessary hospitalizations and emergency department visits, saving about 1. 5 million annually per team. More importantly, it also demonstrates what is possible when we use technology to support clinicians. We are also expanding virtual care to meet patients where they are while providing clinicians with more flexibility. Being able to care for patients through video, phone, or secure messages can ease pressure on in-person schedules and help physicians balance professional and personal demands. This flexibility has been invaluable during crises—wildfires and pandemics, for example—and will remain essential as healthcare continues to evolve. Protecting Physicians from Violence One of the most alarming trends in recent years has been the rise in workplace violence against healthcare workers (Permanente Medicine, 2024). A recent survey from the American College of Emergency Physicians (2024) found that 91% of emergency physicians experienced some form of violence in the past few years. That statistic should stop all of us in our tracks. When physicians feel unsafe at work, it affects everything—their mental health, their ability to focus, and their trust in the systems meant to protect them. A distracted physician may be perceived as less capable of providing focused, empathetic, and error-free care, directly impacting patient confidence. Permanente Medical Groups have made a concerted effort to protect physicians from violence by strengthening our safety protocols. This includes an increased security presence, including metal detectors at some facilities and enhanced surveillance where appropriate. But just as important are the human-centered elements: training clinicians to recognize signs of escalating behavior, establishing clear zero-tolerance intervention protocols, and offering immediate support, including counseling and peer response, after an incident. Healthcare worker safety is not optional—it is foundational. We cannot address moral injury without addressing this crisis. Value-Based Care is Empowering To truly support clinicians, we must confront a difficult but necessary truth: Elements of our healthcare system that perpetuate moral injury and harm must change. Physicians are not the problem. Burnout is not a personal failure. And moral injury is not about resilience. It is about the environment and conditions we work in. I believe a major part of the solution lies in shifting how we define and measure success in healthcare. I strongly believe in a value-based approach to care, which prioritizes prevention, coordinated care, and long-term outcomes. I believe this approach corrects a major problem at the heart of healthcare’s traditional, fee-for-service model. When reimbursement is tied to doing what is best for patients—not the volume of tests and services delivered—clinicians are empowered to practice the kind of medicine they were trained to provide. Value-based care also makes room for teamwork. It allows clinicians to lean on one another and draw on diverse specialties and expertise. It encourages innovation and supports community health, and ultimately, it reduces the friction between what physicians value and what the system rewards—a central driver of moral injury. Reclaiming Meaning Through Connection, Rest, and Leadership Even as we push for systemic changes, we cannot ignore the importance of caring for ourselves and each other. I say this not as a platitude but as someone who has had to learn this lesson repeatedly: Physicians need rest, connection, and support. We need leaders that model balance and compassion. And we need organizational workplace cultures that understand well-being is not a luxury—it is essential to delivering safe care. I’m proud that many of our Permanente Medical Groups have been recognized by the American Medical Association’s Joy in Medicine program for their commitment to clinician well-being (Permanente Medicine, 2025). This recognition reflects years of intentional work to support clinicians’ mental health, create predictable schedules, reduce administrative burdens, and build community. But the real measure of success is not in awards. It is when clinicians feel seen, heard, and valued. It is when we can go home at the end of the day feeling tired but fulfilled—not depleted and frustrated. It is when the system supports our healing as much as we support the healing of others. Finding Hope in Challenging Times Despite the profound challenges facing our profession, I remain hopeful—not because the work is easy, but because I believe deeply in the people who choose this calling. And I believe that change is not only possible but already beginning. Moral injury is real, but so is our collective ability to confront it. I am proud to be part of a physician-owned and led practice because we as physicians are the ones most likely to solve this problem. When we advocate for better tools, safer workplaces, fairer systems, and more support for clinicians, we are not just addressing a workforce issue, we are strengthening the future of medicine. I think back to the stories that inspire me: the dedicated colleagues, the resilient patients, the moments of grace that show up even in challenging times. They remind me that while the system may be strained, the heartbeat of medicine remains strong. We are in this together. And together, I believe we can do the work necessary to shape a future where practicing medicine feels not only sustainable, but deeply meaningful.
Maria Ansari (Sun,) studied this question.