What motivates today's radiologists?

Workplace satisfaction among radiologists is propelled more by intrinsic motivators such as purpose and autonomy than extrinsic motivators such as salary and other financial incentives, according to an article published in the Journal of the American College of Radiology.

“Incentive plans are a core component of many radiology positions and are often considered a major factor in the ability to recruit and retain high-performing radiologists,” wrote lead author Jason N. Itri, MD, PhD, Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, and colleagues. “Financial incentives are widely thought to be effective at motivating individuals, but there is considerable evidence to the contrary.”

Itri and colleagues assessed basic assumptions about financial incentives and the potential negative effect such incentives can have on radiology practices.

“Traditional financial incentive programs in radiology are based on the theory of behaviorism, with incentives designed to alter the behaviors of radiologists through positive and negative reinforcement,” the researchers wrote. “This notion has become dogma: a clever manager need only design the ‘right incentives,’ and his or her job is essentially done.”

Practice and hospital leaders hold seven assumptions that validate the implementation of financial incentives.

  1. Radiologists will not work effectively if they are not financially rewarded for their individual efforts.
  2. Radiologists’ objectives differ from department and hospital leadership and incentives must be redirected so that the objectives of the leadership are met.
  3. Financial incentives improve performance.
  4. Financial incentives encourage innovation and problem solving.
  5. Financial incentives enhance recruitment/retention rates of high performing radiologists, because financial incentives are more important to this group of people.
  6. Financial incentives ensure equitable pay.
  7. High performance should be rewarded using financial incentives.

Though providing traditional financial incentives is what practice and hospital leaders think motivates radiologists, these rewards can cause harm and have various unintended consequences.

For instance, when radiologists see that financial rewards are directly correlated with work relative value units (wRVU), they may specifically pick higher wRVU exams to those that are “normal” or “less complicated.” In return, the more complicated exams go unreported. The same holds true for peer reviews—radiologists may skip complicated CT and MRI exams and focus on less complex exams to get more done.

In the book “Drive: The Surprising Truth About What Motivates Us,” the researchers wrote, authors Daniel Pink said a sense of purpose, mastery, and autonomy were the three main intrinsic motivators of workplace performance and employee satisfaction.

“Smart and creative people want to have autonomy and control over their work,” the authors wrote. “They should be given ownership of their work and latitude in how to meet goals.”

Some intrinsic motivators that can drive success include a high degree of employment security, self-managed teams and decentralized decision making, extensive training and investment in employees and an emphasis on the company's mission.

Leaders must also develop relationships with their employees to determine which intrinsic motivators drive the employees, the authors explained. A strong organizational structure is key. And radiologists should also self-reflect and determine what intrinsic motivators are important to them. 

“Leaders and employees should work together to achieve a workplace that values intrinsic motivators over financial incentives,” the researchers concluded. “The message is the same regardless of whether we are considering academic or private practice radiologists: ‘If we design workplaces that permit people to do work they value, we will be designing a human nature that values work.’”