Original Article

CME Article: Moral Controversy and Working with Colleagues with a Shared Ethical/Moral Outlook: A National Survey of US Primary Care Physicians

Authors: Kwang Jin Choi, MD, Hyo Jung Tak, PhD, Richard Dwyer, MD, Peter Mousa, MD, Nicholas Barreras, MD, Wafa Dawahir, MD, Theodore Christou, MD, John D. Yoon, MD


Objectives: This study assesses physicians’ attitudes on the importance of working with colleagues who share the same ethical or moral outlook regarding morally controversial healthcare practices and examines the association of physicians’ religious and spiritual characteristics with these attitudes.

Methods: We conducted a secondary data analysis of a 2009 national survey that was administered to a stratified random sample of 1504 US primary care physicians (PCPs). In that dataset, physicians were asked: “For you personally, how important is it to work with colleagues who share your ethical/moral outlook regarding morally controversial health care practices?” We examined associations between physicians’ religious/spiritual characteristics and their attitudes toward having a shared ethical/moral outlook with colleagues.

Results: Among eligible respondents, the response rate was 63% (896/1427). Overall, 69% of PCPs indicated that working with colleagues who share their ethical/moral outlook regarding morally controversial healthcare practices was either very important (23%) or somewhat important (46%). Physicians who were more religious were more likely than nonreligious physicians to report that a shared ethical/moral outlook was somewhat/very important to them (P < 0.001 for all measures of religiosity, including religious affiliation, attendance at religious services, intrinsic religiosity, and importance of religion as well as spirituality). Physicians with a high sense of calling were more likely than those with a low sense of calling to report a high importance of having a shared ethical/moral outlook with colleagues regarding morally controversial healthcare practices (multivariate odds ratio 2.5, 95% confidence interval 1.5–4.1).

Conclusions: In this national study of PCPs, physicians who identified as religious, spiritual, or having a high sense of calling were found to place a stronger emphasis on the importance of shared ethical/moral outlook with work colleagues regarding morally controversial healthcare practices. Moral controversy in health care may pose a particular challenge for physicians with lower commitments to theological pluralism.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Huber MT, Ham SA, Qayyum M, et al. Association between job factors, burnout, and preference for a new job: a nationally representative physician survey. J Gen Intern Med 2018;33:789-791.
2. Yoon JD, Rasinski KA, Curlin FA. Moral controversy, directive counsel, and the doctor' role: findings from a national survey of obstetrician-gynecologists. Acad Med 2010;85:1475-1481.
3. Curlin FA. Commentary: a case for studying the relationship between religion and the practice of medicine. Acad Med 2008;83:1118-1120.
4. Curlin FA. Religion and spirituality in medical ethics. In: Balboni M, Peteet J, , eds. Spirituality and Religion Within the Culture of Medicine: From Evidence to Practice. New York: Oxford University Press; 2017.
5. University of Chicago Program on Medicine and Religion. Physician responses to common mental behavioral health concerns. http://pmr.uchicago.edu/page/physician-responses-common-mental-and-behavioral-health-concerns. Published 2019. Accessed April 8, 2019.
6. Yoon JD, Shin JH, Nian AL, et al. Religion, sense of calling, and the practice of medicine: findings from a national survey of primary care physicians and psychiatrists. South Med J 2015;108:189-195.
7. Hoge DR. Validated intrinsic religious motivation scale. J Sci Study Relig 1972;11:369-376.
8. Hatch RL, Burg MA, Naberhaus DS, et al. The Spiritual Involvement and Beliefs Scale. Development and testing of a new instrument. J Fam Pract 1998;46:476-486.
9. Ammerman NT. Spiritual but not religious? Beyond binary choices in the study of religion. J Sci Study Relig 2013;52:258-278.
10. Curlin FA, Odell SV, Lawrence RE, et al. The relationship between psychiatry and religion among U.S. physicians. Psychiatr Serv 2007;58:1193-1198.
11. Stulberg DB, Lawrence RE, Shattuck J, et al. Religious hospitals and primary care physicians: conflicts over policies for patient care. J Gen Intern Med 2010;25:725-730.
12. Curlin FA, Serrano KD, Baker MG, et al. Following the call: how providers make sense of their decisions to work in faith-based and secular urban community health centers. J Health Care Poor Underserved 2006;17:944-957.
13. Yoon JD, Rasinski KA, Curlin FA. Conflict and emotional exhaustion in obstetrician-gynaecologists: a national survey. J Med Ethics 2010;36:731-735.
14. Kinghorn WA, McEvoy MD, Michel A, et al. Professionalism in modern medicine: does the emperor have any clothes? Acad Med 2007;82:40-45.
15. Tilburt J, Geller G. Viewpoint: the importance of worldviews for medical education. Acad Med 2007;82:819-822.
16. Balboni M, Balboni T. Hostility to Hospitality: Spirituality and Professional Socialization within Medicine. New York: Oxford University Press; 2018.