By Joanne Conroy, MD
I attended the AAMC Chief Medical Officers (CMO) meeting in Nashville last month. There were excellent speakers and lots of participant engagement. Many of the sessions focused on new payment models and lessons learned by some academic medical centers that have successfully navigated these pilot programs. One of their keys to success was figuring out how to motivate and reward physicians in their organizations.
Physicians, like anyone else, can be easily motivated. There are few physicians whose motivation is purely material. Most are driven by a combination of a search for mastery and a sense of purpose. Jackson and Coker published an industry report in 2009 about motivating physicians.
Key considerations for physicians are for careers that are personally and professionally rewarding. The report also describes the “higher order needs” essential for career satisfaction: inherent and performance dimensions. The inherent dimension is the most powerful determinant in overall career satisfaction among respondents. It centers on the “doctor–patient relationship that is derived from provision of patient care but also includes interactions with other physicians, and career advancement.” The performance dimension refers to how a physician is doing professionally, including success in meeting the needs of patients and the ability to maintain mastery in a specialty.
So how do we leverage these higher order needs when we try to motivate and reward physicians through the dramatic changes in healthcare delivery?
Massachusetts General Hospital (MGH) rewards its physicians in a number of ways. As an institution, it has made a commitment to meeting all of the national quality and safety standards. However, every physician also has three personal clinical goals to meet every year. The maximum incentive that they can earn from meeting these goals ranges from $1,500 to $2,500.
Although this does not represent a significant portion of a doctor’s total compensation, MGH’s personal goal-setting process is very motivational; the clinical staff is laser-focused on meeting these goals. At the end of the year, there’s a dinner to recognize clinicians who take care of the sickest patients; care for the greatest number of uninsured; or have the largest, most difficult patient panel. The CMO speaker referred to these docs as the real heroes in the clinical arena, physicians who take on professional and personal challenges that are rarely recognized.
It really makes you think about examining who we currently recognize and why.
Washington Hospital Center also had an interesting approach to recognizing staff. They wanted to accumulate testimonials from employees about the institution. Instead of staging the testimonials with scripts and professional photographers, they just set up cameras in several locations across the hospital where the staff could record their testimonials whenever they wanted. There were some fabulous, heartfelt contributions. There was even a camera in the OR, and the CMO arrived one morning to see a line of surgeons in their scrubs queuing up to record their testimonials. They even did team testimonials! The clips were so good that they were broadcast them throughout the hospital and used for TV ads across the DC metro area. Even physicians like to see themselves on the big screen, but it also gave them an opportunity to talk about the professional relationships that make their work so rewarding.
As we re-engineer care delivery, we need to think about how we recognize and reward people. The value might not be in the number of your publications, but the impact of your research. The clinical rewards will not be for the high volumes you generate, but for the difficult patient care challenges you embrace. Rewards will be based on the quality of the students and physicians produced from educational programs, rather than the number of your degrees or specialty honors you hold.
We have to think about how to appeal to our love of purpose and performance: the higher order needs that drive all of us.
—Joanne Conroy, MD, is Chief Health Care Officer at the Association of American Medical Colleges. She can be reached at firstname.lastname@example.org. Follow her on Twitter @joanneconroymd.