European Journal of Gynaecological Oncology (EJGO) is published by IMR Press from Volume 40 Issue 1 (2019). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with S.O.G.
Does shifting a physician payment system shift physician priorities? A multi-site evaluation of an alternative payment plan (APP) for gynecologic oncologists in Ontario
Objective: The objective of this study was to attempt to understand how changing the mode of reimbursement alters physician behavior from the physician's perspective. Method: Individual interviews were conducted with 14 Ontario gynecologic oncologists. Each interview was analyzed using grounded theory. Results: The move to an alternative payment plan (APP) significantly shifted physician clinical and personal priorities. This resulted in improvements in recruitment and retention. A model was developed to explain the link between the shift in the payment system and physician perceptions of their behavior. The model is comprised of two themes: (a) need for change: site similarities and differences, (b) effects of change: shifting priorities and time management. Even when the same compensation package was offered to four sites, the interpretations and motivations differed from site to site. We identified two types of situations: sites that were operating in 'survival mode' and those that were 'meeting core clinical and academic requirements'. They experienced the APP very differently. Conclusion: This study presents a model that depicts how and why a funding shift has variable effects on physician behaviors, depending on the individual physician, site, and multi-site perspectives. It offers one of the few qualitative evaluations of a funding change.