Why Performance Bonuses Aren’t Making Physician Jobs Better

Does your job involve regular performance reviews that play heavily into your total compensation? If so, know that you are in good company. Even physicians undergo performance reviews. And in many cases, they receive bonus pay based on how such reviews go.

A recently published article from The Hospitalist contributor Leigh Page suggests that performance reviews and bonus pay are not having the desired effect. She contends they are not making physician jobs any better, nor are they contributing to physician happiness or fulfillment. The question is, why?

Page cited data from an annual Merritt Hawkins review to establish a simple premise: performance reviews and bonus pay are tied to employer goals rather than physician goals. And because the two do not always line up, the resulting conflict creates a problem seen in other industries.

A Disengaged Workforce

The annual performance review pits manager against employee. On the one hand, the manager is tasked with making sure that employees achieve company goals. Those goals obviously come first. On the other hand, employees have goals of their own. When their goals differ from those of their employer, it is easy for them to become disengaged.

What happens then? Disengaged employees simply go through the motions. They do just enough to get a good performance review and earn that bonus. They do not invest themselves in their jobs like they otherwise could because they feel like their only purpose is to achieve a set of arbitrary goals that mean nothing.

If this sounds familiar, it might be your experience. Page says the data suggests that far too many physicians are in this very situation. Doctors are simply not excited about the goals they are tasked with achieving. They do not share the same vision with their employers.

A Quality of Care Issue

All of this matters when you look at healthcare as a vital service rather than just a business opportunity. In the end, it is all about quality of care. Doctors can find all sorts of jobs on internet boards like Health Jobs Nationwide. But how many of those jobs give them the opportunity to provide the quality of care they truly seek to offer?

Also in play is the idea of outcome-based medicine. If you remember all of the discussions that accompanied the passage of the Affordable Care Act a decade ago, you probably remember that one of the stated goals of the legislation was to transition healthcare delivery from the fee-for-service model to a patient outcome model.

The transition is largely based in the idea that patients are also customers. They deserve to receive the kind of quality service they would get from any other industry. As the thinking goes, more positive outcomes make for more satisfied customers. Thus, outcomes and quality of care become intrinsically linked.

If physicians do not think their jobs give them the opportunity to provide the level of care they want to provide, it stands to reason they probably lack confidence in their ability to create positive outcomes. The end result is a never-ending cycle in which their employers are trying to produce better outcomes but asking doctors to do so in a way that just doesn’t work.

So what’s the solution? Retooling physician jobs so that they are more in line with the goals of the doctors themselves. Yes, there is a business side to medicine that cannot be ignored. But the most profitable medicine will ultimately be that which provides the best quality of care in a patient-centered setting. Doctors know how to do it better than anyone else.

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