“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.
