The Experience of Moral Distress by Primary Care Providers in an Academic Family Medicine Practice

Purpose: Moral distress is defined as the inability to take one’s perceived moral course of action due to factors beyond one’s control (Jameton, 1993). Moral distress has been linked to increased intent to leave a position (Corley et al., 2001; Epstein & Hamric, 2009; Hamric, Borchers and Epstein, 2012; Sinsky et al., 2013). Moral distress has been infrequently studied in the primary care setting, however when interviewed about job satisfaction, primary care providers (PCPs) are often deeply dissatisfied. The purpose of this study was to identify causes of moral distress in PCPs and their proposed interventions to reduce moral distress.
Methods: This qualitative pilot study used semi-structured interviews to identify causes of moral distress in PCPs (physicians and nurse practitioners [NP]) in an academic family medicine practice. Interviews were recorded, transcribed, and analyzed using conventional content analysis by the researcher and an expert in moral distress.
Results: Of 35 eligible participants, 12 completed the study (34% participation rate). Most were white, female and practiced for less than 10 years. Thirty three percent of PCPs had considered leaving their position due to moral distress. This study identified five causes of moral distress and five internal constraints contributing to moral distress. PCPs proposed several interventions to reduce moral distress in primary care.
Discussion: Moral distress is present in PCPs. Causes identified stemmed from systems issues that caused the PCP to feel devalued and powerless to enact change. Interventions to reduce moral distress are desperately needed in the primary care environment.
Keywords: moral distress, primary care, primary care provider