Moral distress among physicians in Norway: a longitudinal study

Objectives To explore and compare physicians’ reported moral distress in 2004 and 2021 and identify factors that could be related to these responses. Design Longitudinal survey. Setting Data were gathered from the Norwegian Physician Panel Study, a representative sample of Norwegian physicians, conducted in 2004 and 2021. Participants 1499 physicians in 2004 and 2316 physicians in 2021. Main outcome measures The same survey instrument was used to measure change in moral distress from 2004 to 2021. Logistic regression analyses examined the role of gender, age and place of work. Results Response rates were 67% (1004/1499) in 2004 and 71% (1639/2316) in 2021. That patient care is deprived due to time constraints is the most severe dimension of moral distress among physicians, and it has increased as 68.3% reported this ‘somewhat’ or ‘very morally distressing’ in 2004 compared with 75.1% in 2021. Moral distress also increased concerning that patients who ‘cry the loudest’ get better and faster treatment than others. Moral distress was reduced on statements about long waiting times, treatment not provided due to economic limitations, deprioritisation of older patients and acting against one’s conscience. Women reported higher moral distress than men at both time points, and there were significant gender differences for six statements in 2021 and one in 2004. Age and workplace influenced reported moral distress, though not consistently for all statements. Conclusion In 2004 and 2021 physicians’ moral distress related to scarcity of time or unfair distribution of resources was high. Moral distress associated with resource scarcity and acting against one’s conscience decreased, which might indicate improvements in the healthcare system. On the other hand, it might suggest that physicians have reduced their ideals or expectations or are morally fatigued.