title: The Moderating Effect of Job Satisfaction on Physicians' Motivation to Adhere to Financially Incentivized Clinical Practice Guidelines.
abstract: We examined moderating effects of professional satisfaction on physicians' motivation to adhere to diabetes guidelines associated with pay-for-performance incentives. We merged cross-sectional survey data on attitudes, from 156 primary physicians, with prospective medical record-sourced data on guideline adherence and census data on ambulatory-care population characteristics. We examined moderating effects by testing theory-driven models for satisfied versus discontented physicians, using partial least squares structural equation modeling. Results show that attitudes motivated, while norms suppressed, adherence to guidelines among discontented physicians. Separate models for satisfied versus discontented physicians revealed motivational differences. Satisfied physicians disregarded intrinsic and extrinsic influences and biases. Discontented physicians, alienated by social pressure, favored personal inclinations. To improve adherence to guidelines among discontented physicians, incentives should align with personal attitudes and incorporate promotional campaigns countering resentment of peer and organizational pressure.
authors: 1 Bassett Healthcare Network Research Institute, Cooperstown, NY, USA.|2 Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors: Anthony C
authors: AC
authors: Waddimba
authors: 3 EagleDream Health, Inc., Rochester, NY, USA.|4 University of Rochester Medical Center/University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors: Howard B
authors: HB
authors: Beckman
authors: 4 University of Rochester Medical Center/University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.|5 Finger Lakes Health Systems Agency, Rochester, NY, USA.
authors: Thomas L
authors: TL
authors: Mahoney
authors: 6 Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, MA, USA.|7 Boston University School of Public Health, Boston, MA, USA.
authors: James F
authors: JF
authors: Burgess
mesh_terms: D001291:Attitude of Health Personnel; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D009042:Motivation; D058007:Physicians, Primary Care / Q000592:standards / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012052:Reimbursement, Incentive / Q000191:economics*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
keywords: adherence to clinical guidelines; health care quality; job satisfaction; motivation theory; primary care physicians; value-based pay for performance