Assignment # 5 1. Highlight the difference in incentives faced by academic physicians and private practioners of MGOA?

The academic physicians cared about their prestige and knowledge; not only is the image important to the academic physician, but also to MGOA, which was considered a leader in orthopaedics. Accordingly, academic physicians were concerned about their quality of research, and to a lesser extend teaching and clinical work. They wanted to expand their understanding of their field of research and actively publish their research in medical journals. Research publication impacted significantly their professional development and was essential in order to become a full professor and achieve tenure, a process that was extremely long and challenging at MGOA. As academic physicians, they also were incentivised by certain privileges including consulting with top experts in all fields, easy access to patient referral to build their practice, and preference over the assignment of ORs. Private practitioners, on the other hand, were not full-time MGOA staff and practiced through clinical appointments. Though a few of them had active research labs at MGH, the main focus of private practitioners was clinical practice and performance. They did not benefit from some of the privileges that academic physicians had, but they received a higher salary that was on average 50% higher than that of academic doctors. As well, another incentive is the fact that unlike academic physicians, they were not required to work demanding hours to support their research and actively publish. 2. How are the different incentives faced by the two groups likely to affect the goals and performance of MGOA? The focus of academic physicians was research, which was essential to the mission and reputation of MGOA as a leader in care and cutting-edge medical research. The time that academic practitioners were devoting to research was substantial longer compared to their clinical work. Thus, the incentive of academic physicians to focus on research affected their clinical productivity, thereby contributing to MGOAs financial difficulties. The private group, instead, were more clinically productive and generated greater revenue to MGOA. This was possible because they lacked the teaching and academic commitments, as well as they were not pressured to actively publish to achieve tenure. As such, private physicians were not as dedicated to the mission of MGOA to promote orthopaedic knowledge by

embracing medical research, but they contributed significantly to the MGOAs performance. 3. What is likely the effect of the new plan on the quality of care? On the research component of MGOA? The new plan was to make each doctor financially self-sufficient, by making the surgeons salary dependent on their performance or profitability to the group. Through the adoption of this business model, the surgeon would have a new incentive to increase their performance. This could also result in an improving the quality of care, as surgeons would be encouraged to improve patient outcomes and safety and decrease medical slips in order to reduce costs and improve their standards. For instance, by increasing clinical productivity and performance, patient-waiting times would be reduced thus improving the efficiency of the practice and satisfaction of the patient. Doctors feared that the new plan would have a negative impact in their research. Dr. Howett, for example, expressed that he was worried that he would not be able to meet some specific research goals because he would have to increase his patient load to clear the benchmark. Research-oriented practitioners would have to supplant their time available for research to focus more on patient care and other revenue-generating activities. This is a concern for academic physicians that rely on conducting medical research to become permanent professors and get tenure. I think that the MGOA should adjust their standards and make this process more attainable in order to retain physicians in the academic group and maintain their mission and commitment to research. Thus, as we can see, there generated a trade-off between increasing clinical productivity and maintaining medical research. With this new plan, practitioners would be force to find a balance between these two in order to continue advancing knowledge by supporting research and education, without affecting their clinical productivity and salary.