Moral Distress in Radiology: Frequency, Root Causes, and Countermeasures-Results of a National Survey.

Background: A major cause of burnout is moral distress: when one knows the right course of action, but institutional constraints make the right course impossible to pursue. Objective: To assess the frequency and severity with which radiologists experience moral distress, and to explore root causes and countermeasures. Methods: This study entailed a national survey evaluating moral distress in radiology. The survey incorporated the validated Moral Distress Scale for Health Care Professionals (along with additional questions). After modification for applicability to radiology, respondents were asked to assess 16 clinical scenarios in terms of frequency and moral distress severity. The survey was sent by email on May 10, 2022 to 425 members of radiology practices, based on a national radiology society's quality-and-safety list serve. Measure of Moral Distress for Health Care Professionals (MMD-HP) was calculated for each respondent as a summary measure of distress across scenarios (maximum possible score, 256). Results: After excluding 12 surveys (incomplete data), final analysis included 93/425 (22%) respondents. A total of 91/93 (98%) respondents experienced at least some moral distress for at least one scenario. A total of 17/93 (18%) respondents had left a clinical position due to moral distress; 26/93 (28%) had considered leaving a clinical position due to moral distress but did not leave. Mean MMD-HP was 73±51 for those who had left, 89±47 for those who had considered leaving, and 39±35 for those who had never considered leaving (p<.001). A total of 41/85 (48%) respondents felt that the COVID-19 pandemic had influenced their moral distress level. The three scenarios with highest moral distress across respondents related to systemic causes (higher case volume than can be read safely; high case volume preventing resident teaching; lack of administrative action or support). The most commonly selected countermeasure to alleviate moral distress was educating leadership on moral distress sources (71%). Conclusion: Moral distress is prevalent in radiology, typically relates to systemic causes, and is a reported contributor to radiologists changing jobs. Clinical Impact: Urgent action is required by radiology practice leadership to address moral distress, as radiologists commonly practice in environments contradictory to their core values as physicians.