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Comment & Response
June 7, 2016

Consequences of Influencing Physician Behavior—Reply

Author Affiliations
  • 1Department of Medicine, University of California-San Francisco
  • 2LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
  • 3Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2016;315(21):2351. doi:10.1001/jama.2016.1226

In Reply In response to our Viewpoint on extrinsic and intrinsic motivations to change physician behavior, Dr Meador states that incentives should be assessed for intended and unintended consequences, and we agree.

However, Meador argues that the rise of financial motivators has directly caused a decrease in clinical research and teaching. This argument is difficult to make conclusively, since so many factors have changed in academic medicine over this period. Our thesis in the Viewpoint was that a careful balance of extrinsic and intrinsic motivators, thoughtfully customized to one’s own organization, is key to promoting efficiency and drive. It is unlikely that any single financial motivator is decreasing the time spent on research and teaching. Instead, it is the balance of motivators and shifts in that balance that may affect how physicians spend their time.