A recent study concerning moral injury (MI) among interventional radiologists has found that the condition is “prevalent” throughout the field, and has been shown to negatively correlate with quality-of-life (QoL) indicators.
Principal investigator Andrew J Woerner (University of Washington, Seattle, USA) et al introduce MI within healthcare as the “lasting impact of repeated ethical dilemmas and moral conflicts” when physicians are unable to act in the best interest of their patients due to institutional or systemic constraints. Woerner and colleagues identify MI as a “risk factor” associated with burnout, which in previous studies has been correlated with medical errors, they note.
Using the MI Symptom Scale-Healthcare Professionals (MISS-HP) survey, Woerner et al report a total of 365 interventional radiologists returned MISS-HP and QoL responses. Of the respondents, 299 (81.9%) were male, 65 (17.8%) were female, and one preferred to not disclose gender. The ratio of female and underrepresented minorities in their study population was “similar” to ratios reported for the interventional radiology (IR) workforce in the USA, suggesting “demographically representative sampling”, the investigators state.
Among participants, 209 (57.3%) were familiar with the concept of burnout alone, 115 (42.5%) were aware of both burnout and MI, and one (0.3%) respondent was familiar with MI only. Woerner and colleagues outline that 146 (40%) of practice settings were academic, 121 (33.2%) were community based, 84 (23%) were hybrid, and 14 (3.8%) centres were reported as “other”.
Respondents included 299 (8.19%) practicing interventional radiologists and 66 (18.1%) interventional radiologists-in-training. The authors highlight that trainees were included in their survey population in an attempt to assess for the presence and impact of MI in early career interventional radiologists. Of trainees included in the study, 66 (18.1%) were interventional radiologists-in-training, 23 (6.3%) were <1 year post-graduate, 149 (40.8%) were 1–10 years post-graduate, 73 (20%) were 11–20 years post-graduate, and 54 (14.8%) were >21 years post-graduate.
Of their results, Woerner et al report that 233 (61.1%) of interventional radiologists who responded scored ≥36 on the MISS-HP and thus were categorised as having profession-related MI. They note that MISS-HP scores “varied across the practice experience durations”, noting the following subgroups listed in a decreasing order of the mean MI score: 10–20 years, 1–10 years, currently in training, >20 years, and <1 year (43.5, 40.5, 37.9, 36.8, and 36.5; p<0.05). Overall, they emphasise the “significant difference” in mean MI between the >20 years and 10–20 years of practice subgroups (36.8 ± 11.5 versus 43.5 ± 13.6; p<0.05).
Of their QoL data, the authors state that mean QoL for the entire cohort was 71.1 ± 17.0 (range: 0–100), suggestive of “good” QoL. However, they report that the mean QoL for the MI subgroup was “significantly different” from that of the rest of the group (67.6 ± 17.0 versus 76.6 ± 16.0; p<0.05). Continuing to expand on their data, Woerner et al note significant disparities between QoL between practice groups with >20 years versus 10–20 years of experience (73.9 ± 19.8 versus 66.4 ± 16.9; p<0.05).
Discussing their results, Woerner et al reflect that these data show an association and “potential causative link” between MI and QoL in interventional radiologists. However, they note that their results are suggestive of “lower burnout and increased wellness” in interventional radiologists who have practiced for a longer period of time.
In the open response section, the investigators also comment that respondents identified “ineffective leadership, barriers to patient care, corporatisation of medicine, non-physician administration, futile procedures, turf battles and reduced resources” as the main contributors to burnout and MI.
To initiate address of these issues by identifying MI, Woerner and colleagues hope that “moral repair” can be achieved to reduce the impact of MI on interventional radiologists. They aver that this could be achieved by: “Improving autonomy, reducing bureaucracy, enhancing administrative support, promoting physician-led leadership, ensuring sufficient staffing, reforming the medical system, unionising physicians, fostering transparency with insurance companies, increasing vacation time, and pursuing retirement or leaving medicine.” However, the authors note that unfortunately, “many” proposed solutions are “challenging” and “impractical”, as they are intrinsically linked to “external or systemic barriers” and institutional structures, which are “beyond the scope” of their study.
Concluding their discussion, the authors reiterate that MI is prevalent among interventional radiologists in the USA and negatively impacts QoL. They further that future research should explore how various radiology subspecialties compare via MI and QoL metrics, to “inform the department/hospital leadership on the various challenges across the radiology disciplines”.
