On the Multiple Motivations of Physicians: Lessons from Reforms

This article presents findings from an empirical investigation of the motivations of Russian physicians and how they have been changing during the reform of the Russian healthcare system. The data were collected in 2015 via in-depth interviews with managing and practicing physicians (N = 37) working in three types of medical organizations in Moscow - a Federal Institute, two clinical emergency hospitals and two urban polyclinics. The analysis of physicians' motivational hierarchies shows that their motivations have a complex and flexible structure, which we define as multiple motivations. Financial incentives play an important, but not dominant role in this structure, which is explicitly expressed by nearly all physicians ("we're here not just for the money"). The healthcare reforms currently being carried out in Moscow partly recognize this fact. However, for these reforms to have a greater effect, it is not only necessary to raise wages, but to improve the equipment and organizational aspects of physicians' work, and to abandon the currently chaotic system of professional development and training in favor of more consistent practices. The results of the study show that professional development can be a long-term motivational factor, which, unlike money, does not become addictive.