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Khristinn Kellie Leitch, MD, MBA; Paul M. Walker, MD, PhD, FRCPSC

Arch Surg. 2000;135:708-712.

Hypothesis  Financial incentives are the only form of compensation that will motivate surgeons at an academic health sciences center to perform the tasks outlined in the hospital's mission statement.

Design  A questionnaire divided into 5 sections: demographics, compensation, time allocation, benefits and incentives, and motivational factors.

Setting  The Department of Surgery, The Toronto Hospital, Toronto, Ontario.

Participants  All academic surgeons (N=64) practicing at The Toronto Hospital in July 1997.

Results  Of the 64 eligible mailed surveys, there were responses for 59. Of these 59 surgeons, 48 (81%) receive compensation through a fee-for-service method. However, only 32 (54%) of the surgeons prefer the fee-for-service method, while 18 (31%) prefer salary and 9 (15%) prefer an alternative system. On average, these academic surgeons spend 44% of their time teaching or performing research, for which they receive 14% of their total income. Of the motivational factors assessed, financial bonuses are a positive motivational factor for all "surgeon tasks." In addition, task-specific motivational factors were established for research, teaching, and operating, including research facilities, mentorship and prestige, and interesting case types, respectively.

Conclusions  Surgeons are not appropriately remunerated for time spent on academic activities, and many would prefer an alternative form of compensation to the fee-for-service method. Knowledge that surgeons are receptive to tasks supporting the hospital's mission statement leads us to conclude that appropriate motivation can shape the activity of academic surgeons. Financial rewards ranked the highest as a motivational factor for all surgeon tasks; however, task-specific motivational factors were identified. Overall, multiple factors, specifically targeted to the individual, will serve to motivate. Thus, compensation packages based on individual preferences and personal motivational factors will be the most successful.

From The University Health Network, Toronto General Hospital, and the Faculty of Medicine, University of Toronto, Toronto, Ontario.