Why Money Alone Can’t (Always) “Nudge” Physicians: The Role of Behavioral Economics in the Design of Physician Incentives

Abstract

Behavioral economics seeks to define how humans respond to incentives, how to maximize desired behavioral change, and how to avoid perverse negative impacts on work effort. Relatively new in their application to physician behavior, behavioral economic principles have primarily been used to construct optimized financial incentives. This review introduces and evaluates the essential components of building successful financial incentive programs for physicians, adhering to the principles of behavioral economics. Referencing conceptual publications, observational studies, and the relatively sparse controlled studies, the authors offer physician leaders, healthcare administrators, and practicing anesthesiologists the issues to consider when designing physician incentive programs to maximize effectiveness and minimize unintended consequences.

Five-year follow-up to assess long-term sustainability of changing clinical practice regarding anesthesia and regional analgesia for lower extremity arthroplasty

“…Even when they become routine, clinical pathways and protocols will require ongoing maintenance, review, and reinforcement. Understanding what motivates physicians may also be helpful [ 15 ]. Taking pride in providing the best evidence-based care or following international recommendations [ 1 ] is an example of an intrinsic motivation [ 15 ].…”

“…Understanding what motivates physicians may also be helpful [ 15 ]. Taking pride in providing the best evidence-based care or following international recommendations [ 1 ] is an example of an intrinsic motivation [ 15 ]. Extrinsic motivations may relate to payment, and there is now a national quality measure in the United States related to utilization of regional anesthesia for TKA [ 16 ].…”

Behavioral economics in neonatology—balancing provider wellness and departmental finances

“…Motivation to meet (or exceed) productivity targets can be intrinsic (personal workplace satisfaction, recognition of individual contributions by division chief or chair) or extrinsic (financial incentives or penalties or non-financial awards such as “top-doctor” recognitions) [ 9 , 10 ] Behavioral economists have studied how individuals can be “nudged” to make desirable choices [ 11 ]. There are no controlled studies evaluating financial incentives to achieve a sustainable increase in productivity in Pediatrics.…”

“…An observer might be able to notice a difference between a 10 g weight and a 15 g weight. However, it is difficult to notice a difference between 1000 g and 1005 g. Similarly, the magnitude of the incentive should be proportional to the base pay to be noticeable (at least 10%) and motivate positive behavior [ 10 ]. Immediacy: In academic NICUs, census and acuity can be variable and not under the control of a neonatologist.…”

<p>Increased frequency of urine drug testing in chronic opioid therapy: rationale for strategies for enhancing patient adherence and safety</p>

“…This lack of recent literature perhaps relates to dramatic changes in attitudes toward opioid analgesia for chronic pain over the past several years. Furthermore, the financial burden associated with frequency of testing largely remains largely unaddressed, and its importance cannot be overstated at this time in which “behavioral economics” in medicine are under greater scrutiny than in the past 13. Thus, the purpose of the current study was to gain insight into the broad implications of more frequent compared to less frequent UDT in regard to uncovering aberrant behavior associated with COT, utilizing data reflective of the current opioid zeitgeist as opposed to that of the period in which previous studies were conducted.…”