<p>Since the COVID-19 pandemic, attention to elective (or planned) surgery waiting lists has been increasingly urgent and sustained. While the ethical challenge of prioritising patients for planned surgeries is extensively discussed at a policy or system level, little attention has been paid to ethical practice at the individual clinician level. We argue that surgical resource allocation should be reconceptualised as an ethical issue that spans the macro and the micro, to acknowledge and begin to address the experiences of individual clinicians working in this area. This project explored the ethical challenges faced by surgeons, surgical liaison nurses and surgical leadership practising in one network of hospitals in metropolitan Melbourne, Australia. The project was conducted by one hospital’s clinical ethics unit and involved qualitative ethicist-led conversations with eighteen key staff members. These revealed that clinicians experience ethical challenges throughout the surgical patient journey, from referral to the scheduling of the procedure, many of which centre on perceived inequities. The map of challenges includes some patients bypassing public outpatient clinics via the private system, inconsistencies in use of urgency categories, and managing patient deterioration between consent for surgery and the procedure itself. Mapping clinicians’ ethical challenges shows that clinicians administer “the system” and bear witness to its failings; they navigate their moral obligations to individual patients in personal, but quite variable, ways with acute awareness of the broader resource-constrained system. Making these on-the-ground ethical challenges visible is important for clinicians’ and teams’ own reflective practice at the micro level and for informing systemic change at the macro level.</p>