Consequences of Influencing Physician Behavior

• Autores: Kimford J. Meador, Timothy J. Judson, Kevin G. Volpp, Allan S. Detsky
• Localización: JAMA: the journal of the American Medical Association, ISSN 0098-7484, Vol. 315, Nº. 21, 2016, pág. 2350
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen
  • English

    Dr Judson and colleagues1 discussed balancing extrinsic and intrinsic motivation for physician behavior. Any plan to alter physician behavior via applied motivation should have, as an intrinsic component, assessments to determine the full effect of the applied motivation. For example, Judson and colleagues provided an example of how financial incentives related to patient care revenues enhanced the delivery of patient services in an academic medical department. This approach has been successful in increasing clinical revenues across many academic departments.2 However, one untoward effect has been that time spent by academic physicians on academic activities such as clinical research and teaching has decreased by 50%.3 The effect of this change on the academic mission has been largely ignored.2

  • English

    In response to our Viewpoint on extrinsic and intrinsic motivations to change physician behavior, Dr Meador states that incentives should be assessed for intended and unintended consequences, and we agree. However, Meador argues that the rise of financial motivators has directly caused a decrease in clinical research and teaching. This argument is difficult to make conclusively, since so many factors have changed in academic medicine over this period. Our thesis in the Viewpoint was that a careful balance of extrinsic and intrinsic motivators, thoughtfully customized to one’s own organization, is key to promoting efficiency and drive. It is unlikely that any single financial motivator is decreasing the time spent on research and teaching. Instead, it is the balance of motivators and shifts in that balance that may affect how physicians spend their time.