Anemia In Academia: Part 7 - Moral injury (#544)

Force #7: When values and reality diverge.

There is a kind of tiredness that sleep does not fix.

It isn’t physical. It isn’t even emotional.

It sits somewhere deeper. In the place where your values live.

I have seen it in the faces of good people.

Not burned out. Not cynical.

Just… disappointed.

As though something they once believed in has quietly let them down.

We talk a great deal about burnout in academic medicine.

Burnout sounds clinical. Manageable.

Like something you treat with a long weekend, a yoga class, or a resilience workshop.

But what I’m seeing more often now isn’t burnout. It’s something heavier. Something we don’t name easily:

Moral injury.

Burnout is being tired because you worked too hard.

Moral injury is being tired because you worked against your own values.

The difference matters.

One is exhaustion. The other is heartbreak.

Most of us didn’t enter academia for money or prestige.

We came because we believed in something.

Teaching.

Service.

Curiosity.

The idea that knowledge should be shared freely. The idea that students deserved mentorship. The idea that medicine was a calling, not merely a business.

We accepted lower pay and longer hours because those values felt real. They sustained us. They made the trade worthwhile.

But what happens when the institution you serve slowly stops reflecting those values?

When decisions feel driven less by education and more by optics?

Less by patients and more by partnerships?

Less by mentorship and more by metrics?

You begin to feel a subtle dissonance.

At first, it’s just irritation. Then frustration. Then something quieter.

Sadness.

I hear it in conversations with faculty. Not anger. Not rebellion.

Just a kind of resignation.

I didn’t think this was what the job would be.

I feel like we spend more time justifying ourselves than teaching.

I’m not sure we’re doing this for the right reasons anymore.

Those statements are the sound of moral injury.

Because when purpose erodes, something inside you erodes with it. It shows up in small, painful compromises.

Admitting more cases than you can properly teach because revenue targets demand it.

Rushing through appointments because throughput matters more than conversation.

Writing grants you don’t believe in just to keep the lights on.

Smiling through announcements about transformational gifts while wondering what invisible strings are attached.

Nodding in meetings where language like brand alignment replaces words like students or patients.

Each compromise seems minor. Practical. Necessary.

But together they add up. Death by a thousand small betrayals. Not of policy. Of self.

Veterinarians, like physicians and nurses, often carry a strong internal compass.

We want to do right by animals.

Right by students.

Right by our profession.

When systems repeatedly force you to choose between what’s expedient and what’s right, that compass starts to wobble. And living with that wobble is exhausting in a way no vacation fixes. Because you can’t rest from your own conscience.

I think back again to my early mentors.

Jim Archibald. Clive Eger. Terry Holliday. George Cardinet. Ralph Kitchell.

They were far from perfect men. But there was a coherence to their lives.

Their values and their actions lined up. They treated people with respect. They stayed late when needed. They practiced medicine the way they believed it should be practiced.

There was integrity in that alignment. They slept well at night. Not because the work was easy. Because it was honest.

When young faculty leave academia now, they rarely say, I experienced moral injury.

They say things like:

I just didn’t feel like myself anymore.

I wasn’t proud of the work we were doing.

I wanted to practice medicine the way I was trained to.

Listen closely. That’s not about hours or salary. That’s about identity. About wanting your daily actions to match your deepest beliefs.

When those two drift too far apart, leaving becomes an act of self-preservation.

The tragedy is that moral injury is largely invisible to leadership.

Spreadsheets don’t capture it. Dashboards don’t measure it. You can’t graph disappointment.

So, institutions focus on what they can see:

Salaries.

Recruitment numbers.

Productivity.

Meanwhile the real damage happens quietly, internally.

Good people slowly disengage. Not loudly. Just gently.

They stop volunteering. Stop proposing ideas. Stop believing change is possible.

And when that happens, a university doesn’t just lose staff.

It loses its soul.

Money may tempt.

Bureaucracy may exhaust.

Burnout may drain.

Loss of autonomy may frustrate.

Metrics may hollow out meaning.

Loss of mentorship may isolate.

But moral injury is different.

Moral injury is what happens when all those forces combine. When the place you once loved no longer feels aligned with who you are.

Moral injury is the most dangerous force of all, because once someone loses faith, it is very hard to win it back.

If we want to heal academia, we must do more than adjust budgets or reorganize committees.

We must restore alignment.

Put students first.

Put patients first.

Trust faculty judgment.

Value mentorship.

Reward integrity, not just output.

Make it possible again for a young clinician to say, at the end of the day: This feels like the right work, done the right way.

That simple sentence is stronger medicine than any wellness program.

Anemia happens slowly. A little loss here. A little loss there. Until strength fades.

Moral injury is the final weakness.

The point at which the body no longer believes recovery is possible.

In the final essay of this series (Part 8), I want to talk about something hopeful.

Not another force pulling us down, but what might lift us back up. How we reclaim purpose. How we rebuild trust. How we make the halls feel alive again.

The path forward.

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