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Motivators and Hygiene Factors Among Physicians Responding to Explicit Incentives to Improve the Value of Care

Waddimba, Anthony C. MD, MS, DSc; Burgess, James F. Jr PhD; Young, Gary J. JD, PhD; Beckman, Howard B. MD, FACP, FAACH; Meterko, Mark PhD

doi: 10.1097/QMH.0000000000000006
Original Articles

Background: Physician's dissatisfaction is reported to be increasing, especially in primary care. The transition from fee-for-service to outcome-based reimbursements may make matters worse.

Purpose/Objective: To investigate influences of provider attitudes and practice settings on job satisfaction/dissatisfaction during transition to quality-based payment models, we assessed self-reported satisfaction/dissatisfaction with practice in a Rochester (New York)-area physician practice association in the process of implementing pay-for-performance.

Subjects/Methods: We linked cross-sectional data for 215 survey respondents on satisfaction ratings and behavioral attitudes with medical record data on their clinical behavior and practices, and census data on their catchment population. Factors associated with the odds of being satisfied or dissatisfied were determined via predictive multivariable logistic regression modeling.

Results/Conclusions: Dissatisfied physicians were more likely to have larger-than-average patient panels, lower autonomy and/or control, and beliefs that quality incentives were hindering patient care. Satisfied physicians were more likely to have a higher sense of autonomy and control, smaller patient volumes, and a less complex patient mix. Efforts to maintain or improve satisfaction among physicians should focus on encouraging professional autonomy during transitions from volume-based to quality/outcomes-based payment systems. An optimum balance between accountability and autonomy/control might maximize both health care quality and job satisfaction.

Bassett Healthcare Network Research Institute, Cooperstown, New York (Dr Waddimba); Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Boston Healthcare System, Boston, Massachusetts (Drs Burgess, Young, and Meterko); Department of Health Policy & Management, Boston University School of Public Health, Boston, Massachusetts (Drs Burgess and Meterko); Center for Health Policy and Healthcare Research, D'Amore-McKim School of Business and Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts (Dr Young); Focused Medical Analytics, Pittsford, New York (Dr Beckman); and Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York (Dr Beckman).

Correspondence: Anthony C. Waddimba, MD, MS, DSc, Bassett Healthcare Network Research Institute, One Atwell Road, Building 6, 4th Floor, Cooperstown, NY 13326 (

The arguments and conclusions that are expressed in this manuscript are entirely those of the authors and are not in any way intended to represent the official views of the institutions to which the authors are individually or severally affiliated.

This study was partially supported by grant 1R36 HS016832-01A1 (PI: Waddimba) from the Agency for Healthcare Research and Quality (AHRQ) and Robert Wood Johnson (RWJ) Foundation's Health Policy Investigator Award (PI: Young).

The authors are grateful to Greg Partridge for facilitating access to the administrative data used in this study. The authors thank Dr Bert White for his assistance with the administrative management of this project. They appreciate the generosity of the primary care physicians of RIPA who responded to and returned the survey questionnaires. The authors Drs Waddimba and Young are grateful for the financial support that they received from the Agency for Healthcare Research and Quality (AHRQ) and Robert Wood Johnson (RWJ) Foundation, respectively.

No potential conflicts of interest are reported by the authors.

© 2013Wolters Kluwer Health | Lippincott Williams & Wilkins