Causes of Moral Distress in Academic Radiologists: Variation Among Institutions.

Abstract

Purpose: To assess whether causes of moral distress vary by academic institution. Moral distress is experienced when health care providers are unable to provide the right care to patients because of institutional or resource constraints.

Materials and methods: A survey was performed based on Moral Distress Scale-Revised for Health Care Professionals for 16 clinical scenarios assessing frequency and severity of moral distress among academic radiologists. The survey was sent to members of the RSNA Quality Improvement Committee for distribution to their department. Measure of Moral Distress for Health Care Professionals (MMD-HP) was calculated for individuals and moral distress index for clinical scenarios. MMD-HP were compared by sex, ethnicity, age, years of practice, weekly work hours, practice setting or type, and consideration of leaving the workplace. Statistical analysis was performed using Kruskal-Wallis test and Kendall ordinal correlation.

Results: In all, 126 respondents from five institutions from five different states were included in the analysis. MMD-HP ranged from 24 to 66 (maximum 266). Median MMD-HP was higher in radiologists working >60 hours per week (59 versus 32.5, P = .048). Radiologists across institutions consistently reported four main sources of moral distress: pressure to perform unsafe numbers of studies (108 of 126, 85%), high workloads impeding resident teaching (102 of 126, 81%), lack of administrative support for patient care issues (102 of 126, 81%), and pressure to conduct unnecessary imaging (111 of 126, 88%). Higher MMD-HPs correlated significantly with job turnover intentions or past job changes (P < .001). The average percentage of radiologists with an intention to leave or having left as position was 44% with a range of 26% to 84%.

Conclusion: Moral distress is pervasive in radiology, with four primary causes consistently identified across academic institutions. Strong association between higher moral distress levels and job turnover intentions highlights its impact on workforce retention.