Doctors suffer high rates of 'moral injury.' La Plata County patients pay the price

Grief accompanied Amanda Neidermyer's first few months as an independently practicing physician.

To become a doctor in the United States is notoriously rigorous. It can take 11 to 16 years of classroom and hands-on education to be able to practice independently. For many, it takes even longer.

None of that time in the classroom or in the hospital prepared Neidermyer for exactly how much time she would spend on administrative tasks or included how to navigate the constraints of the health insurance industry alongside providing effective medical care.

Nor was there a primer on the emotional toll of watching patients being unable to receive the most effective care because of insurance denials. It was a shock.

"I felt a very real sense of grief. Like, 'What have I done with my life? What am I doing here?,'" said Neidermyer, who is the primary care doctor for Mercy Hospital's satellite clinic in Bayfield. "(Practicing medicine) was not anything I thought it would be. It's hard, but not in the ways that I would have thought."

America's health insurance system regularly asks physicians to act in direct opposition to their Hippocratic oath. They have to rush patients in and out of appointments and are forced to prescribe less effective treatment plans to meet arbitrary insurance requirements. Everyday, healthcare providers are asked to make or witness ethical compromises.

"Moral injury" is the term coined to explain this, referring to the psychological distress that results from a person acting or witnessing something that violates their core moral beliefs and values.

Physicians have a higher likelihood of experiencing moral distress than the rest of the U.S working population, according to a 2026 study conducted by the American Medical Association. Nearly two in five physicians reported a high level of job-associated moral distress within two weeks of being surveyed, which, the study found, leads to high rates of burn out and industry exit.

This phenomenon is both a symptom of the many issues within the broader American health system and causing significant moral distress, leading some physicians to burn out or to leave the profession altogether.

"It's the one thing that makes me really hate my job and would lead me to not want to practice medicine anymore, which is something I really love doing," Neidermyer said.

It's bad for patients as well. Especially in rural Southwest Colorado.

A 'circular hell'

Durango based primary care doctor and former CommonSpirit Mercy employee Adam Owens said hearing the term "moral injury" finally gave him a word to apply to what he had been feeling.

He became a doctor to do "moral and good" work but was also a repeated witness and participant to a health insurance and broader American healthcare system that places blocks in front of doctors and their patients' care.

"At some point, you start to think, well, wait a minute, I'm the bad guy in this situation," he said. "That's where you start to really feel that injury to your sense of self and sense of purpose and sense of mission."

Several doctors interviewed for this article described having to choose less effective treatment plans because insurance constraints routinely override their clinical judgment. Others stopped practicing and some, like Owens, transitioned into private practices that don't take insurance.

Neidermyer described it as a "circular hell," of checking insurance plans, ordering medication, denials and fulfilling prior authorization requests, only to get more denials.

She's ended up in court on behalf of a family fighting with an insurance company that refused to cover their child's' life-saving medication.

"I'm like this is ridiculous. This is pointless. This is just a huge waste of everyone's time," she said. "Eventually, we'll get that medication approved, but at what cost?"

Providers spoke to the intense priority large health systems place on billing.

For Owens, it began to feel like his job was to produce as many clinic notes as possible to bill at as high a level as possible. The people he was supposed to care for became a second priority. Then a burden.

Several years into his career, a sick man was worked into Owens' schedule for a last-minute, 15-minute appointment. The patient was very ill and ended up needing much more of Owens' time than scheduled.

"My initial response was the nerve of this guy to come in like this and ruin my day," Owens said. "A few moments later (I) realized this is absolutely insane. Why would I be upset with somebody for this? This is what we're (physicians) supposed to be doing."

Clearly, there was a problem.

It continued into the COVID-19 pandemic. Owens eventually asked to take a few months off as his mental health suffered. Instead he left his supervisor's office with a prescription for antidepressants.

Bad for patients as well

"It's not just the doctors that are that are suffering," Owens said.

Rural communities like La Plata County have a shortage of healthcare providers and struggle to retain those who do relocate to work as physicians, nurse practitioners or nurses.

In the past six years, studies conducted by organizations such as the American Medical Association and Med Central have found that anywhere from 35% to 40% of surveyed healthcare providers consistently say they intend to leave the profession or retire early.

Owens said in his eight years at Mercy Hospital, he turned 24 prescribing partners over, and he himself was going to leave the profession once his debt was paid off.

He ended up finding out about direct primary care, a private practice model in which doctors sidestep the insurance industry altogether and charge a flat fee for visits.

Health systems limit the amount of time for patient visits. The providers are stressed. Successful preventive care suffers.

For years, Gigi Baty and her husband went to CommonSpirit Mercy Hospital for general preventive checkups. Baty is in her 70s and said they felt like parts on an assembly line.

"I wouldn't call that medical care," she said.

Her husband had critically high blood pressure that the overworked staff members ignored for years, she said. They called it "normal" for a man of his age. Five years ago, the couple transferred to Owen' private clinic.

The high-blood pressure and host of other potentially life-threatening health issues were prevented, Baty said.

Side-stepping a solution is becoming a more utilized option but it does not work for all doctors, nor all patients.

It requires high overhead and doctors take on significant liability. Doctors make less money.

For Neidermyer, it is not a viable option.

"What else am I gonna do?" she said. "I'm hundreds of thousands of dollars in debt for my medical education, right?"

jbowman@durangoherald.com