Motivating Physicians

By J&C Research Associates

Physicians are motivated by a variety of factors and driving forces.  What provides them meaning and professional satisfaction, as studies show, is not exclusively correlated with monetary rewards. 

What motivates individuals to take up the practice of medicine? Self-interest and financial concerns undeniably play a role, as the practice of medicine can be quite lucrative. Of course, this still doesn’t account for physicians in countries with lower compensation levels for doctors, such as the former Iron Curtain countries, that have entered the medical field in levels exceeding demand, or the large number of doctors in the U.S. that continue to serve in fields or geographic areas where the same long hours would net higher pay in a different industry. Nor does such logic explain the countless hours donated by physicians here and abroad to charitable causes. The facts suggest that physicians are driven to the field not primarily out of financial interest, but rather by a desire to help patients.[1]

Still, the question of motivation is essential both for individual achievement and physician management. What’s more, it is essential for maintaining a robust health care delivery system. The evidence suggests that physicians are increasingly dissatisfied and decreasingly motivated in their career. Recent studies have found that physician burnout and stress levels have steadily increased over the last twenty years. Whereas in 1973, 15% of physicians reported doubts about their career choice, surveys over the last ten years put the number between 30% and 40%, with greater numbers indicating they would not encourage their children to enter the medical profession.

These numbers make plain a level of job dissatisfaction that can prove harmful to the health care system overall, as physician job satisfaction is linked to patient satisfaction, trust, and confidence in doctors.[2] If physicians are not overwhelmingly motivated by financial concerns, then an understanding of the root causes of physician motivation is a key to drawing out the best from one’s employees, colleagues, and even oneself. The following report examines some of the major motivational factors found to drive people to become physicians and excel in the field.

Human Motivation 101: Internal Factors

Research in the field of human motivation is widespread, as organizations of all sorts seek to draw the best efforts out of students, citizens, employees, and others.

Analysis in the field of human motivation has led researchers to posit that humans operate largely based on four essential drives:[3]

• Drive to acquire—Humans are driven to acquire goods. This drive comes into effect not only with material goods such as food and clothing, but also with intangible “goods” such as experiences, ideas, and social status.

• The drive to bond—Humans are social animals, and tendencies common to social animals show forth in uniquely human activities. Humans seek to bond to larger collectives like teams, companies, and nations. Humans become attached to their closest cohorts and generally subsume themselves to some degree within the larger organization.

• The drive to comprehend—Humans need to make sense of the world around them, accounting for phenomena with scientific, religious, and cultural explanations. In organizations, this leads to a desire to fulfill a purpose within the larger group.

• The drive to defend—The drive to defend oneself, one’s property, or one’s social circle is an outgrowth of the basic fight-or-flight response at the root of most animal actions. With humans, this drive manifests in the form of justice-promoting institutions and the sense of fair play.

These drives—which form the basis for human motivation—are each independent and essential. Fully satisfying one drive will not account for insufficiently addressing another. These drives also take a number of forms in practice. A 2004 survey, for example, found that locum tenens providers were commonly motivated by either the desire for a more flexible work schedule—which could signal the drive to acquire a more personally satisfying lifestyle—or the desire to continue practicing medicine part time—which, while also related to the acquisition or maintenance of a comfortable lifestyle, also fits with the drive to comprehend, as the continuing practice of medicine allows for older physicians to maintain some constants in their lives.[4]

Research has also shown that there are varying sorts of motivational goals. The desire to be a physician falls into the category of an “identity goal,” which may be expressed in the idea, “I want to be a doctor.” For individuals with identity goals, progress toward these goals—say, getting into medical school or starting one’s residency—does not result in lessened pursuit of these goals. Generally, increased competence and accomplishment within a field tends to result in a widening of one’s horizons.[5] That is, for the successful physician, there is always something else to chase.

A physician—like other professionals—encounters different social and physical surroundings as he progresses along his career path. A physician’s surroundings, as well as his identity, changes from university training to residency and rotations to private practice. Each change in identity brings a change in the horizons of the profession, and each change in horizons brings a new avenue for success and achievement. Along the way, research has shown that successful individuals are able to generate internal reward systems to emphasize the long-term benefits and value in work that may seem pointless at the time.[6]

“Higher Order Needs”

Studies show that—once in the profession—physicians are highly motivated by their desire to provide high quality care. Physicians can also be motivated by the desire to be perceived as good doctors by patients and colleagues.[7] To this end, in 2006, Canadian researchers conducted a survey of 2,810 physicians across numerous specialties. Their findings cut to the core of what motivates doctors within the profession.[8]

The study identified two “higher order needs” essential to career satisfaction among doctors and, consequently, their motivation to perform at a high level in their jobs. The study authors classified these two higher order needs as the “inherent” and “performance” dimensions to physician employment, while other dimensions studied included “personal” and “professional.”

• Inherent dimension—The study found this dimension to be the largest determinant in overall career satisfaction among respondents. The inherent dimension, as its name implies, covers aspects of the job inherent to the profession. It centers on the doctor-patient relationship that is derived from provision of patient care. Aspects of this dimension include the diversity of patients seen, interactions with other physicians, and career advancement in medicine.

• Performance dimension—This measure covers largely how a physician is doing in his position. Aspects of this dimension include the physician’s ability to access the needed resources for treatment of patients, the physician’s role in organizing treatment programs for patients, the physician’s success in meeting the needs of his patients, and the physician’s capacity to keep up with advances in his specialty.  As the study’s authors maintain, “Physicians are achievement-oriented, seek responsibility, and desire competency in their clinical practices,” all of which are important “from a public policy perspective.”[9]

The study’s findings indicate that satisfaction of these two higher order needs goes a long way toward motivating greater clinical performance among physicians. Put plainly: doctors will be motivated to perform better at their jobs given that their jobs focus largely on the practice of medicine and are challenging and rewarding. Seeing and treating a variety of patients with which one has time to form a relationship; interacting with peer physicians; advancing one’s knowledge and practice of one’s craft--all of these are essential aspects of the professional experience for successful, motivated physicians.

The Canadian study’s findings are in keeping with the general consensus on physician motivation: physicians are motivated largely internally, and the external factors affecting motivation are largely related to the quality of the practice of medicine. Similar studies have documented the importance of intrinsic motivation, with some finding that the internal drive to succeed ranks at the top among motivating factors.[10]

Compensation and prestige are, of course, motivating factors in the practice of medicine, but factors such as a varied caseload, challenging atmosphere, and collaboration and competition with peers and colleagues appear to be more important. This, taken in combination with the aforementioned statistics regarding career dissatisfaction among physicians, perhaps suggests a clearer view of the problem facing the modern health care system, at least with regards to doctor performance and motivation.

With health care delivery becoming increasingly bureaucratized and commoditized, the modern physician is faced with an overload of administrative duties, red tape, and even patients. A 2006 survey of physicians found “loss of autonomy,” “bureaucratic red tape,” and “patient overload” to be three of the top reasons for physician discontent (“low reimbursement” and “loss of respect” were other top factors).[11] That is, doctors feel overworked and overregulated, which results in them feeling underpaid for the work they do, which results in lowered morale and decreased motivation.

Steps could be taken to increase compensation rates for doctors, but perhaps a more plausible course would be to alleviate those factors affecting what have been demonstrated to be the higher concerns among physicians. The complaints over patient load, autonomy, and bureaucracy dovetail with the aforementioned inherent and performance dimensions of practice shown to be vitally important to motivating doctors. To put it plainly: a change in the health care working environment—a change resulting in doctors spending less time doing paperwork and other non-practice business and more time dispensing care to patients—would likely motivate physicians much more effectively than would a change in the numbers on a paycheck.