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Peer comparison among doctors can backfire, increase burnout – UCLA study

Burnout rates among physicians are rising, often resulting in mental health problems, job turnover, and higher healthcare costs. Meanwhile, health system leaders and policymakers are concerned with motivating physicians to adhere to medical best practices.

One commonly used strategy is showing physicians how their job performance compares to that of their peers.

And yet, a recent study shows that peer comparison not only has no statistically significant impact on preventive care performance, it also decreases physicians' job satisfaction while increasing burnout.

The UCLA Department of Medicine’s Quality Team and researchers from the UCLA Anderson School of Management conducted a five-month field experiment involving 199 primary care physicians and 46,631 patients to examine the impact of a peer comparison intervention on the doctors’ job performance, job satisfaction, and burnout.

The evidence suggests that the peer comparison intervention inadvertently signalled a lack of support from leadership, thus reducing job satisfaction while increasing burnout. The study also shows that training leaders on how to best support physicians and contextualise the peer comparison intervention mitigated such negative effects on perceptions about leadership support and physician well-being.

“Behavioural interventions, like providing peer comparison information, offer attractive, cost-effective ways to promote positive behaviour change,” said Dr Justin Zhang, resident physician in internal medicine at the University of California, San Francisco, who co-led the study while a UCLA medical student.

“This research highlights the importance of assessing less visible outcomes, such as job satisfaction and burnout, when policymakers and organisational leaders implement seemingly innocuous behavioural interventions. This work also underscores the importance of attending to the way in which an intervention may inadvertently change employees’ perceptions of their managers and thus elicit negative reactions.

“To preempt negative perceptions, like reduced feelings of leadership support, this research suggests organisational leaders ought to engage employees in the design phase of an intervention, probe their feelings, and revise the design if needed. Finally, this work highlights that when leaders offer the necessary context and support to accompany a peer comparison intervention, recipients may draw more positive inferences about their leaders’ intent. This can buffer against the harmful effects of peer comparison interventions on well-being.”

The paper was published in the peer-reviewed Proceedings of the National Academy of Sciences (PNAS).

Study details

When peer comparison information harms physician well-being.

Joseph Reiff, Justin Zhang, Jana Gallus, Hengchen Dai, Nathaniel. Pedley, Sitaram Vangala, Richard Leuchter, Gregory Goshgarian, Craig Fox, Maria Han, Daniel Croymans.

Published in PNAS on 14 July 2022

Abstract

Policymakers and business leaders often use peer comparison information – showing people how their behavioUr compares to that of their peers – to motivate a range of behaviours. Despite their widespread use, the potential impact of peer comparison interventions on recipients’ well-being is largely unknown. We conducted a 5-mo field experiment involving 199 primary care physicians and 46,631 patients to examine the impact of a peer comparison intervention on physicians’ job performance, job satisfaction, and burnout. We varied whether physicians received information about their preventive care performance compared to that of other physicians in the same health system. Our analyses reveal that our implementation of peer comparison did not significantly improve physicians’ preventive care performance, but it did significantly decrease job satisfaction and increase burnout, with the effect on job satisfaction persisting for at least 4 mo after the intervention had been discontinued. Quantitative and qualitative evidence on the mechanisms underlying these unanticipated negative effects suggest that the intervention inadvertently signalled a lack of support from leadership. Consistent with this account, providing leaders with training on how to support physicians mitigated the negative effects on well-being. Our research uncovers a critical potential downside of peer comparison interventions, highlights the importance of evaluating the psychological costs of behavioural interventions, and points to how a complementary intervention – leadership support training – can mitigate these costs.

 

PNAS article – When peer comparison information harms physician well-being (Open access)

 

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Clerical burden a huge driver of burnout in medicine

 

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