Some pundits want all physicians on a strict salary. If that happens, productivity will likely go into the tank, affecting access and increasing waiting times. Shadowfax opines further in this great piece:
. . . what does compensation methodology have to do with efficient operation of the ER? I include this here because I strongly believe that in order to optimize the processes in your ED, it is important to have medical staff who are motivated to be as effective as possible. I have worked in settings in which pay was hourly and those which were 100% incentivized. The difference is remarkable. In environments in which a person’s individual compensation is not at risk, the motivation to give 100% effort is attenuated. Some docs will do their best because they are altruistic, or for Press-Ganey scores, or just because they are energetic ““ they are usually the top 25% of docs in any group, either way. But the average doc does about 10% less work, and the bottom quartile really dog it when there is no disincentive against phoning it in. The cumulative effect of this productivity decrement is significant and can really impact the smooth operation of the ER, not to mention the bottom line of the group.
