Abstract
Purpose :
Moral injury (MI) is an important predictor of physician distress, encompassing the ethical, moral and emotional challenges of patient care. To date, the prevalence of MI among ophthalmologists has not been studied. The purpose of this study is to determine the prevalence of MI among ophthalmologists and identify contributing factors.
Methods :
The standardized Moral Injury Symptoms Scale – Healthcare Professionals version (MISS-HP) was administered to ophthalmologists through national subspecialty listservs, alongside a questionnaire assessing contributing risk factors. A prevalence calculation was performed to determine the number of respondents who met criteria for MI. T-test and relative risk reduction (RRR) calculations were used to compare MI levels between ophthalmologists based on gender, length and context of practice, and other factors.
Results :
A total of 221 out of 234 responses from ophthalmologists practicing in the United States met criteria for statistical analysis. The prevalence of MI was 42% (92/221). Respondents were predominantly male (59.7% [132/221]) and white (78.3% [173/221]). Mean MISS-HP scores were 36.07 (50% [42/84] ≥ 36) among female ophthalmologists and 31.21 (36.2% [47/130] ≥ 36) among their male counterparts (p=0.0015 < 0.05). Providers caring for > 5% of patients without insurance reported a mean MISS-HP score of 31.21, compared to those seeing fewer uninsured patients at 36.07 (p=0.064 > 0.05). Scores did not significantly vary between physicians in academic, private or publicly owned practices (p=0.44 > 0.05). The RRR for MI was 0.71 (p=0.028 < 0.05) among those in practice >15 years (n=126) compared to <15 years in practice (n=93). Likewise, the RRR for MI was 0.57 (p=0.0009 < 0.05) among providers with religious commitment (n=116) compared to those with no religious commitment (n=100).
Conclusions :
Self-reported MI may serve as a proxy for physician distress distinct from burnout and job dissatisfaction. Our data suggest that female ophthalmologists are at higher risk of moral injury, while increased length of practice and religiosity may be protective factors. The prevalence of MI reported in this study ought to be alarming and deeply humanizing, providing urgency for further investigation, open discussion, and compassionate collaboration to minimize this threat to physicial wellbeing.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.