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Are peer comparison information studies good for physicians?

A new study has found that peer comparison information decreases a physician's job satisfaction and increases burnout

The peer comparison intervention caused doctors to feel less supported by their leaders (Photo by Jafar Ahmed, Unsplash)

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Peer comparison information can have both pros and cons, especially when it comes to the well-being of a physician.

As per a new study published in the journal Proceedings of the National Academy of Sciences (PNAS), a commonly used behavioural intervention--informing physicians about how their performance compares to that of their peers--has no statistically significant impact on performance. However, it does decrease physicians' job satisfaction and increase burnout.

Daniel Croymans and colleagues conducted a 5-month field experiment involving 199 primary care physicians and 46,631 patients in the primary care network of a large, university-affiliated healthcare system in the United States. The department leadership sent monthly emails to all physicians to provide feedback about their preventive care performance. In the control condition, physicians received information about their own personal scores.

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The remaining physicians received emails that contained information about the recipient's performance relative to that of their peers. A subset of these physicians received emails containing peer comparison information from leaders who had participated in training workshops focused on how to support preventive care performance.

The peer comparison intervention was associated with reduced job satisfaction and increased burnout, but only when the information was provided by leaders who had not received support training. Together, the results highlight the potentially harmful impact of peer comparison information on physicians' well-being as well as the potential mitigating effect of leadership support training. According to the authors, accounting for the psychological costs of behavioural interventions could improve their design.

Several PCPs explicitly stated that they felt that the peer comparison emails should be accompanied by greater leadership and organizational support. For instance, one PCP cited a lack of "support from upper management to help"; another noted that "completion of health maintenance items should be a 'system' effort, not at the individual PCP level." The leadership support training provided participants (physician leads and non-clinical managers) with information on how completing HM measures would benefit patients, which they were encouraged to share with the nonparticipating PCPs in their clinics. Researchers conjecture that such information may have helped PCPs--regardless of whether they participated in the training--contextualize the peer comparison emails, making them more amenable to accepting the HM completion metric as a marker of performance or showing them that management realized that this metric was not the only important measure of job performance.

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Using a field experiment involving 199 physicians and 46,631 patients, researchers examined the effects of a peer comparison intervention, administered alone or in conjunction with leadership support training, on physicians' preventive care performance and work-related well-being. In this setting, the peer comparison intervention did not significantly improve physicians' performance (measured as order rates for preventive measures). But it did unexpectedly harm job satisfaction and increase burnout, with the effect on job satisfaction persisting for at least 4 months. Importantly, this negative effect of the peer comparison intervention on physician well-being was substantially attenuated by leadership support training. Researchers find evidence that perceived leadership support may help explain both effects. The peer comparison intervention caused doctors to feel less supported by their leaders, but leadership training buffered against that negative effect.

Psychological outcomes need to be accounted for to estimate the aggregate impacts of policies and to improve their design and implementation. 

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