Providers are people too…

I have an FQHC client, a pretty well run organization, who had a Family Nurse Practitioner that would only see twelve patients in an eight hour day.  She claimed that she felt she could not possibly provide quality medical care seeing more than twelve patients a day.  Management felt she was, well, to be frank, lazy.  As it happens, several of her colleagues (those who had to pick up all the patients she didn’t have time for) were somewhat irritated and felt the same way.  I asked if they had talked to her about it, and they responded that yes, she had been counseled on several occasions and told that this level of productivity was unacceptable.   I asked if they were having any trouble recruiting mid-level providers and the answer was “no,”  so it wasn’t that they had to have her as a “warm body.”  I listened a little longer and asked “so why haven’t you fired her?”  The answer I got was a look of utter astonishment.

Six months later a 100% productivity plan was introduced.  There were a lot of good reasons for doing so, but there were a couple of assumptions that were flawed.  One of them was that the introduction of the plan would improve the productivity of low performers.  The second was that even if it didn’t improve their productivity, at least low performers wouldn’t earn as much, so it wouldn’t irk the other providers.  Finally, there was the feeling that these poor performers would leave since they couldn’t earn as much.  In any event, it was felt that managing performance through compensation was a lot easier than actually managing performance.

Two years later, and we’re working on how to convert from the 100% productivity plan back to a salary plus incentive system.  I asked about our favorite low productivity provider, who, it turns out, was still there, still seeing 12 patients maximum a day, quite content with the compensation she was earning, and still irritating her colleagues who were picking up the slack.   The problem they were sure would go away as a result of the new compensation system was still there.

Providers are people too.  Some are mission driven and don’t even care about pay.  Some will work exactly as much as you make them, and won’t lift a finger further.  Some will see a productivity plan as a way to earn more, and they’ll work harder.  Others will be content with exactly what they earn working at the level they want to work.  There is no reason to believe that providers are any different than any other employee when it comes to performance.  For some reason, many believe that they can be treated like piece-rate workers … or maybe, that it’s easier to do that than actually treat them like any other employee.

Moral of the story?  When you design a compensation program for your providers, first ask what you’re trying to accomplish.  If any of your premises are based on improving the performance of poor performers, be realistic and don’t really expect change.  Much better to simply hire better performers, and reward good performance.

About Edmund B. Ura

Edmund B. Ura, MAIR, JD, works with governing boards, executives and human resources staff to develop methodologies for ensuring fair and equitable compensation programs that support achievement of organizations' missions. Contact Ed at
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