Family physician Jonathan Bushman discusses his article, "The hidden moral injury behind value-based health care." He shares the story of a young physician who was told to remove her most complex patients from her panel to protect the health system's performance metrics. Jonathan uses this powerful example to explain moral injury: a deep, ethical wound that is fundamentally different from burnout. The conversation exposes how value-based payment models, even in not-for-profit systems, can incentivize data manipulation and force doctors to choose between their patients' well-being and their employer's bottom line. He argues that this crisis of integrity is a primary reason many physicians are leaving employed positions for independent models like direct primary care (DPC), where they can answer directly to their patients instead of a spreadsheet. His core message is an urgent call to confront the reality that when "value" becomes code for "profitable," the entire system's moral compass is at risk.

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