Moral Injury Among Physicians Caring for Immigrant Patients Amid Anti-Immigrant Policies.

Abstract

Beginning in January 2025, the sociopolitical context in which immigrant patients seek and receive health care has changed significantly. To explore the perspectives of primary care physicians regarding their own well-being and the health and well-being of their immigrant patients after anti-immigrant policy changes in January 2025. This qualitative study used virtual semistructured interviews with primary care physicians across the US (recruited using purposive and snowball sampling) who were providing health care to immigrant patients. The study was conducted between July and September 2025. The audio from the physician interviews was recorded, transcribed, and analyzed using thematic analysis. Themes and subthemes derived from interviews. There were 38 participants interviewed (mean age, 40.3 [SD, 10.8] years; 27 women [71.1%]; by specialty: 24 [63.2%] internal medicine, 13 family medicine [34.2%], and 1 internal medicine-pediatrics [2.6%]). The identified themes and subthemes were (1) drivers of physician moral injury (ethical and professional values conflict, compounded burden on immigrant identities, workforce strain, powerlessness, navigating dynamic policies, altering clinical decision-making); (2) patient vulnerability and health consequences (complex decision-making within mixed-status families, ripple effects on US citizens and broader communities, pervasive fear and hesitancy of accessing care, physical and mental health deterioration); (3) contrasting responses from health care systems (restricting health care, institutional silence and suppression of immigration-specific support, adapting through flexibility in care delivery, guiding through proactive communication and partnerships); and (4) physician empowerment (engaging in multilevel advocacy, leveraging trust, role modeling for trainees and peers, protecting patient privacy). In this qualitative study, physicians experienced moral injury stemming from anti-immigrant policies starting in January 2025, which was compounded for those with immigrant identities and because of health care systems' varying responses to these policies. Physicians perceived that changes in immigration policy had adversely affected immigrant and US citizens. Despite these challenges, physicians and health care systems have adapted to support patients and staff, which has mitigated moral injury.