A publication reports that a bipartisan healthcare resolution is working its way through Congress. It mandates no changes to how healthcare is delivered but seeks to spotlight how systemic inequities harm providers as well as patients.

The bill seeks to establish a National Physician Suicide Awareness Day.

According to the report, and supported by multiple studies and physician surveys, the constant tension between the financial realities of for-profit healthcare systems and the medical needs of patients can take a serious toll on physicians’ mental health.

Nowhere is this more apparent than in systems that put up barriers to care, such as requiring payer authorization. DaisyNews recently explored how a think tank’s recent call to end this often inhumane practice should resonate with anyone working in the California workers’ comp system, where every single treatment for an injured worker requires payer approval.

Now, lawmakers on both sides of the aisle wish to raise awareness of the “moral injury” that not being able to provide appropriate care inflicts on doctors, hundreds of whom reportedly take their own lives annually. 

Though no studies demonstrate a direct correlation between prior authorization and physician suicide, it’s worth taking a hard look at how obstacles to care can metastasize into undue stress on providers.

Moral injury in healthcare

Figures vary, but previous iterations of the resolution have cited that 300 to 400 physicians die by suicide each year, and the president of the American Academy of Emergency Medicine has claimed that one in 10 physicians report suicidal ideation. 

The stressors of delivering care, from managing high caseloads to keeping afloat financially, are varied and multifaceted. But it’s impossible not to wonder if being denied the ability to give necessary treatment by insurers (and increasingly, by vendors acting on behalf of Medicare) can play a significant part in a doctor’s mental anguish.

As the publication points out, this dynamic is perhaps best articulated by the concept of moral injury, the emotional harm originally coined to describe experiences common to warfare but increasingly applicable to healthcare. 

According to Moral Injury of Healthcare, a nonprofit that advocates for “morally centered care,” when financial necessities conflict with patients’ medical needs, providers suffer in addition to patients:

Tough, resourceful and resilient clinicians feel trapped between the patient-first values of their Hippocratic oath and the business imperatives of a broken healthcare system.

According to a 2025 American Medical Association survey of 1,000 physicians, doctors are suffering under the yoke of prior authorization, with over a quarter reporting adverse outcomes for patients and 94% reporting that it contributes to burnout (or, according to Moral Injury of Healthcare’s argument, a condition better understood as moral injury than typical burnout). 

California comp: rampant treatment delay & denial

California requires payer approval for every treatment a physician recommends for an injured worker. Payers consider those requests via the utilization review process.

As we’ve explored in detail, California UR is rife with systemic problems, most of which remain poorly understood because of a years-long failure to compile comprehensive statewide UR data, despite state law mandating that collection and analysis.

Data from daisyAuth, by which our provider clients request treatment authorization and track payer responses, show that the hundreds of payers in our system (including major insurers, third-party administrators and self-insured employers), collectively approve about 70% of requested treatments, a troubling figure made even worse by the fact that some payers approve care far less frequently than others. 

Injured workers who try to push back overwhelmingly fail; just 10.2% of appeals against UR denials in 2025 succeeded in overturning the payer’s decision. 

It should come as no surprise that doctors are fleeing comp, with major health systems like the University of California at Los Angeles and San Francisco, Cedars-Sinai and Stanford refusing to take on workers’ comp patients. That decision is undoubtedly financial; however, it’s not implausible to consider whether bowing out of the workers’ comp system can help protect a doctor’s mental health.

Between network chicanery, UR abuse and other barriers to delivering necessary treatment, workers’ comp doctors struggle against an enormous disadvantage. For many, the mental and emotional consequences can be as jarring as the financial ones.

The moral injury of treating injured workers is real; the only question is whether state leadership will address it before the system erodes even further.

Catherine Montgomery is the co-founder and CEO of daisyBill, a provider of workers' comp end-to-end revenue cycle management software. This post appears with permission.