Intrinsic and extrinsic motivations in primary care: An explanatory study among French general practitioners

Background: Like many other OECD nations, France has implemented a pay-for-performance (P4P) model in primary care. However, the benefits have been debated, particularly regarding the possibly undesirable effects of extrinsic motivation (EM) on intrinsic motivation (IM). Objective: To examine the relationship between French GPs' IM and EM based on an intrinsic motivation composite score (IMCS) developed for this purpose. If a negative relationship is found, P4P schemes could have side effects on GPs' IM that is a key determinant of quality of care. Method: From data on 423 GPs practicing in a region of France, IM indicators are selected using a multiple correspondence analysis and aggregated from a multilevel model. Results: Several doctors' characteristics have significant impacts on IMCS variability, especially group practice and salaried practice. Qualitative EM variables are negatively correlated with the IMCS: GPs who report not being satisfied with their income or feeling "often" constrained by patients' requests in terms of consultations length and office appointments obtain a lower mean IMCS than other GPs. Conclusion: Our results provide a cautionary message to regulators who should take into account the potential side effects of increasing EM through policies such as P4P. (C) 2012 Elsevier Ireland Ltd. All rights reserved.