Intended for healthcare professionals

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When financial incentives do more good than harm: a checklist

BMJ 2012; 345 doi: (Published 14 August 2012) Cite this as: BMJ 2012;345:e5047

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Re: When financial incentives do more good than harm: a checklist

Glasziou and colleagues[1] suggest that financial incentives can sometimes improve the quality of clinical practice, but can also have unintended consequences such as loss of motivation.

We recently conducted a study exploring the barriers and facilitators to older general practitioners’ decisions around continuing to stay working in rural areas in Australia. Thematic analysis of our in-depth interviews with general practitioners (GPs) confirms that intrinsic motivation is an important factor for GPs to keep working in rural general practice. Financial remuneration was one factor but not the most important for continuing to work in general practice. There was a general perception of somewhat inadequate remuneration, however this was in comparison to their specialist colleagues, and was almost exclusively discussed in the context of other more salient factors (e.g. job control and wanting to improve patient’s health outcomes). Most GPs alluded to the fact that factors relating to job satisfaction and burnout outweighed the barriers relating to remuneration.

The admirable Checklist provided by Glasziou and colleagues focuses mainly on changing clinical behaviour [1]. We see an additional application in non-clinical health system issues such as the introduction of interventions designed to recruit or retain GPs in rural and remote areas.

1. Glasziou P., et al. When financial incentives do more good than harm: a checklist. BMJ 2012;345:e5047 (Published 14 August 2012)

Competing interests: Sabrina Pit owns a consultancy firm that looks at sustainable employability. Peter Honeyman and Vibeke Hansen are listed as consultants

28 August 2012
Sabrina Pit
Senior Research Fellow
Vibeke Hansen, Peter Honeyman, Lesley Barclay, Deborah Donoghue
University Centre for Rural Health, North Coast, University of Sydney
62 Uralba Street, Lismore NSW 2480, Australia