In a national survey of more than 1,200 practicing physicians, 47% said they often or always lacked the time to give patients optimal care, and 27% said they had already left a job because of moral distress. Rebecca Schoon, Ph.D., one of the authors of the Physicians for a National Health Program report behind those numbers, says the patients her team heard from in Oregon could see what was happening to their doctors and did not blame them for it.

Medical Economics Senior Editor Richard Payerchin sat down with Schoon, an associate professor of public health at Pacific University and a board member of Health Care for All Oregon, a nonprofit that advocates for universal health care. Schoon helped lead the report's Oregon case study.

Schoon walks through the acquisitions of Oregon practices by Optum, Amazon and private equity firms, the noncompete clauses and visit quotas she says drove physicians out of the Eugene area, and the 2025 state law that restricts corporate control of medical practices. She also explains how moral injury reaches physicians in independent practice through prior authorization, denials and paperwork. Then she turns to Oregon's effort to design a statewide universal health care plan and to what patients told researchers about longer waits and the toll of fighting their insurers.

The full report, "Moral Injury in Medicine: The Human Costs of Practicing in a Profit-Driven System," is available from Physicians for a National Health Program, and the Universal Health Plan Governance Board posts its meetings and materials online. This conversation was recorded before the board voted in August to push the deadline for its plan from Sept. 15 to Dec. 1.

Music Credits:
Cup of Coffee by Ionics - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.

0:00 – 0:29 | Cold open. Schoon on what patients in Oregon's focus groups said about their physicians.

0:29 – 1:52 | Introduction. Austin Littrell introduces the episode and the guest, with an update on the Universal Health Plan Governance Board's deadline.

1:52 – 3:12 | Meet Rebecca Schoon. Richard Payerchin welcomes Schoon, who teaches health policy and health systems at Pacific University and works on policy reform with Health Care for All Oregon.

3:12 – 5:38 | How the study came together. Physicians for a National Health Program paired a national physician survey and focus groups with an Oregon case study and patient focus groups run by Health Care for All Oregon, with funding from the Robert Wood Johnson Foundation. Schoon defines moral injury as the tension between clinicians' ethical obligations and the for-profit constraints of the current system.

5:38 – 8:24 | Financialization comes to Oregon. Optum's acquisitions of Oregon Medical Group in Eugene and The Corvallis Clinic, the physician resignations and two-year noncompete clauses that followed, and deals by Amazon and private equity firms for clinics in Portland, Bend and Redmond.

8:24 – 12:22 | How Oregon pushed back. Oregon's corporate practice of medicine ban dates to a 1947 state Supreme Court ruling, but corporate owners found ways around it, most recently through management services organizations. Schoon describes how Health Care for All Oregon worked with state Rep. Ben Bowman (D-Oregon) on the 2025 law that has been called the strictest in the nation, which also limits noncompete clauses.

12:22 – 15:04 | Moral injury in independent practice. Physicians in corporate settings are bound by limits set by management services organizations. In independent practices, Schoon says moral injury comes more from prior authorization, denials, step therapy and paperwork.

15:04 – 15:56 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

15:56 – 19:39 | Oregon's path to universal health care. A 2019 legislative task force, the 2022 ballot measure that added access to health care to the state constitution as a fundamental right and the nine-member Universal Health Plan Governance Board designing the plan. The board has since moved its September deadline to Dec. 1.

19:39 – 23:05 | Paying for it. Draft options include income, payroll and corporate taxes. Schoon argues most Oregonians would save compared with what they pay in premiums, deductibles and copays. She contrasts billing in countries with universal health care, which she says takes seconds, with the months an American practice can spend chasing a single payment.

23:05 – 28:15 | What patients told researchers. Appointments limited to one health issue, longer waits after specialists left the Eugene area, repeated denials that took a psychological toll and patients who sympathized with doctors whose hands were tied.

28:15 – End | Closing thoughts and outro. Payerchin thanks Schoon, and Littrell wraps the episode.

S1 Ep186: When physicians know the right care and can't give it, with Rebecca Schoon of Pacific University

Off the Chart: A Business of Medicine Podcast

S1 Ep186: When physicians know the right care and can't give it, with Rebecca Schoon of Pacific University