The Tyranny of Metrics

by Jerry Z. Muller

Add to this the psychic costs of treating medicine as if it were primarily a profit-making enterprise. Berwick captured this brilliantly in his article, “The Toxicity of Pay for Performance”: “Pay for performance” reduces intrinsic motivation. Many tasks, especially in health care, are potentially intrinsically satisfying. Relieving pain, answering questions, exercising manual dexterity, being confided in, working on a professional team, solving puzzles, and experiencing the role of a trusted authority—these are not at all bad ways to spend part of one’s day at work. Pride and joy in the work of caring is among the many motivations that do result in “performance” among health care professionals. In the rancorous debates about compensation, fees, and reimbursement that so occupy the time of health care leaders and clinicians today, it is all too easy to neglect, or even to doubt, the fact that nonfinancial and intrinsic rewards are important in the work of medical care. Unfortunately, neglecting intrinsic satisfiers in work can inadvertently diminish them.