New Recommendations Address Crisis of Physician Stress


January 18, 2023 – A new set of 12 recommendations for hospitals and health care institutions addresses moral stress in clinical practice and the ways that it impedes good care. The recommendations for hospital leaders across the country come from the Study to Examine Physicians’ Pandemic Stress (STEPPS), a project of the University of North Carolina at Chapel Hill and The Hastings Center.

One of the STEPPS research insights is that many physicians felt complicit in perpetuating injustice when institutional practices reflected bias or allocated resources unfairly. The STEPPS recommendations for responding to that situation are (1) Recognize feelings of complicity in injustice to patients as corrosive to wellbeing. (2) Collaborate with Diversity, Equity, and Inclusion (DEI) administrators to incorporate DEI priorities into wellness programming.  

The full list of STEPPS research insights and their accompanying recommendations is available at

STEPPS is led by Mara Buchbinder, professor and vice chair in the UNC Department of Social Medicine with funding from The Greenwall Foundation.

“Clinicians experience moral stress when they feel like they can’t provide good care because the systems they work in are working against them. Our findings make clear that the crisis of professional wellbeing facing our healthcare workforce is not only a mental health problem but also a moral one,” Buchbinder said.

“The STEPPS findings contribute to a more nuanced understanding of the health care worker’s perspective on everyday and crisis situations arising in contemporary American hospitals,” said Hastings Center research scholar Nancy Berlinger, a co-investigator of the study.  “Often, these frontline workers — in this case, physicians- are diagnosing what’s not working in their systems, and what they need to do their jobs well and to feel they are doing right by their patients. It is crucial for clinical leadership to listen to these insights and use them to build much more supportive environments for the work of healing and the relief of suffering.”

“Extreme burnout of our healthcare workforce was present before the pandemic and has been exacerbated in a most extreme way these past few years as we continue to move through this continuous crisis,” said Nadia E. Charguia, MD, director of UNC Health’s Taking Care of Our Own Program and a member of the STEPPS advisory board.

“We have an opportunity to learn and grow from all we have been through. We cannot continue to primarily focus on helping our workforce be more resilient when we are asking them to tolerate fractured and broken systems,” Charguia said.

Additional findings from STEPPS have been published in the Journal of General Internal Medicine,  Annals of the American Thoracic Society, and Perspectives in Biology and Medicine.

The other STEPPS co-authors are Alyssa Browne, MA, and Tania Jenkins, PhD, both in the UNC Department of Sociology; and Liza Buchbinder, MD, PhD, at UCLA’s Center for Social Medicine and Humanities and Semel Institute.

For more information contact:

Tom Hughes

UNC Health
(919) 627-5510

Susan Gilbert
The Hastings Center