International Journal of Public Leadership

Employee motivation factors: A comparative study of the perceptions between

physicians and physician leaders
David Conrad Amit Ghosh Marc Isaacson

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IJPL
11,2

Employee motivation factors

92

A comparative study of the

perceptions between physicians and
physician leaders

Received 30 January 2015

Revised 7 May 2015
Accepted 7 July 2015

David Conrad
Department of Business Administration/MIS, Augsburg College,
Minneapolis, Minnesota, USA

Amit Ghosh
Downloaded by 36.77.162.88 At 08:21 19 September 2016 (PT)

Department of General Internal Medicine, Mayo Clinic College of Medicine,

Rochester, Minnesota, USA, and

Marc Isaacson
Department of Business Administration/MIS, Augsburg College,
Minneapolis, Minnesota, USA

Abstract

International Journal of Public

Leadership
Vol. 11 No. 2, 2015
pp. 92-106
Emerald Group Publishing Limited
2056-4929
DOI 10.1108/IJPL-01-2015-0005

Purpose Motivation is a widely explored topic and numerous studies have been done to determine
motivation importance and implementation. However, no studies have been identified that investigate
what motivators are most important to physicians and if physician leaders agree with the importance
physicians place on specific motivational aspects. The purpose of this paper is to investigate this
missed management learning opportunity.
Design/methodology/approach A fully inclusive sampling of all (n 2,547) public-practice
physicians and physician leaders (clinic and hospital employed, non-private practice) in Minneapolis
and St. Paul Minnesota was conducted in the summer and fall of 2013. The surveys were sent in a link
via a web survey software program by the study researchers. The surveys were anonymous and
minimally intrusive, asking only for perspectives regarding the most important motivational elements
by physicians and physician leaders.
Findings Generally, the responses were surprisingly similar between physicians and physician
leaders. The two statistically different motivators interesting work and job security were ranked
as more important by physicians than the physician leaders. This suggests that leaders should be
more attentive to ensuring variety, challenge, and engagement is an active part of the physicians
work. This also suggests that managers should emphasize and reinforce the fact that if it is the
case jobs are secure and that staffing stability is a key goal for management. As Kovach (1987)
suggests, as employees income increases, money becomes less of a motivator and as employees get
older, interesting work becomes more of a motivator.
Research limitations/implications Conclusions and generalizations can be made about the
population sampled.
Practical implications The two statistically different motivators interesting work and job security
were ranked as more important by physicians than the physician leaders. This suggests that leaders
should be more attentive to ensuring variety, challenge, and engagement is an active part of the
physicians work. This also suggests that managers should emphasize and reinforce the fact that if it is
the case jobs are secure and that staffing stability is a key goal for management.
Social implications As this study reveals, physicians have clear preferences when it comes to
workplace motivation. It is not unreasonable then to determine that the more satisfied the employee, the
better he or she will perform. Accordingly, the environment that managers create for their employees
must be one that is constructive to positive energy. If employees feel happy when they are working, then
they will be naturally encouraged to work, thus producing improved quality healthcare for patients.

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Originality/value What are the most important motivators for physicians and do physician leaders
understand what motivators are to enhance physician productivity, well-being, and morale? Answers to
this question may be beneficial to designing leadership education that enhances the understanding of the
impact effectively identified and effectively applied motivation techniques may have on employee
behavior and attitudes. Insights will also benefit the design of motivational structures and methods in the
healthcare workplace.
Keywords Importance, Leadership, Motivation, Physicians
Paper type Research paper

Introduction
Motivation theories
Motivation is a widely explored topic and numerous articles have been written and
a wide array of studies have been done to determine motivation importance and
implementation. Therefore, it is important to define just what theorists believe
motivation is and how it is applied in the workplace.
Certo (2000) defines motivation as, the inner state that causes an individual to behave
in a way that ensures the accomplishment of some goal (p. 354). Lewis et al. (2001) relate
effort to output by defining motivation as, the forces and expenditure of effort acting
on or within a person that cause that person to behave in a specific, goal-directed manner
(p. 468). Daft (2003) adds the dimension of enthusiasm to the definition of motivation by
referring to motivation as the forces either within or external to a person that stimulates
enthusiasm and causes a person to persist in the pursuit of a particular course of action.
Many authors have also defined the concept of motivation. Motivation has been defined
as: the psychological process that gives behavior purpose and direction (Kreitner, 1995);
a predisposition to behave in a purposive manner to achieve specific, unmet needs (Buford
et al., 1995); an internal drive to satisfy an unsatisfied need (Higgins, 1994); and the will
to achieve (Bedeian, 1993). For this paper, motivation is operationally defined as the inner
force that drives individuals to accomplish personal and organizational goals.
Arguably, the leading motivation theories come from the work of Herzberg (1966),
Maslow (1954), Alderfer (1972), and McClelland (1985), who discuss the basic needs model
of motivation, referred to as content theory of motivation, highlighting the specific factors
that motivate an individual. Some are primary needs, such as those for food, sleep, and
water needs that deal with the physical aspects of behavior and are considered
unlearned. On the other hand, needs are often psychological, which means that they are
learned primarily through experience. These secondary needs consist of internal states,
such as the desire for power, achievement, and relationships. Secondary needs are
responsible for most of the behavior that a manager deals and is concerned with, and for
the rewards that most motivate employees within the organization.
Pink (2009) argues that human motivation is largely intrinsic, and that the aspects of
this motivation can be divided into autonomy, mastery, and purpose. He argues against
old models of motivation driven by rewards and fear of punishment, dominated by
extrinsic factors such as money. Pink concludes that these three motivation aspects
must be present to create productive and engaging work environments. Pink notes that
the carrot and the stick has been replaced by satisfaction of the higher level needs of
empowered independence, skill development, and a sense of mission and advancement
toward meaningful outcomes.
Lindner (1998) writes that understanding what motivated employees and how they
were motivated was the focus of many researchers following the publication of
the Hawthorne study results. Lindner concludes that five major approaches that have

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94

led to our understanding of motivation are Maslows need-hierarchy theory, Herzbergs

two-factor theory, Vrooms expectancy theory, Adams equity theory, and Skinners
reinforcement theory.
According to Maslow, employees have five levels of needs (Maslow, 1943):
physiological, safety, social, ego, and self-actualizing. Maslow proposed that lower level
needs had to be satisfied before the next higher level need would motivate employees.
Herzbergs work categorized motivation into two factors: motivators and
hygienes (Herzberg et al., 1959). Motivator or intrinsic factors, such as achievement
and recognition, produce job satisfaction. Hygiene or extrinsic factors, such as pay
and job security, produce job dissatisfaction and become demotivators if not met to the
expectations of workers.
Vrooms theory is based on the belief that employee effort will lead to performance
and performance will lead to rewards (Vroom, 1964). Rewards may be either positive or
negative. The more positive the reward the more likely the employee will be highly
motivated. Conversely, the more negative the reward the less likely the employee
will be motivated.
Adams theory states that employees strive for equity between themselves and other
workers. Equity is achieved when the ratio of employee outcomes over inputs is equal
to other employee outcomes over inputs (Adams, 1965). If inequity is sensed, employees
will retaliate through various means including slowing down their work output,
sabotaging the organization, or leaving the organization.
Skinners theory simply states those employees behaviors that lead to positive
outcomes will be repeated and behaviors that lead to negative outcomes will not be
repeated (Skinner, 1953). To this end, managers should positively reinforce employee
behaviors that lead to positive outcomes and they should negatively reinforce
employee behavior that leads to negative outcomes.
Ramlall (2004), in his synthesis of employee motivation adds the job design model to
the inventory of the most common and popular motivation theories. This approach is
similar to Herzbergs model in that it proposes that specific features be added to the job
itself to make it more motivating and enjoyable. Essentially, employees will be
motivated if the feel they are responsible for their work, if the work is perceived to
be meaningful, and if the employee believes their contributions add to the overall
effectiveness of the organization.
Motivation and job satisfaction
There is a very large and impressive body of work proving that employee enthusiasm
translates into stronger business performance. Pfeffer (1998) in his comprehensive review
of the motivation and staff morale research concludes that companies with enthusiastic
employees are 30-40 percent more productive. Certo (2000) adds the dimension of
management control as a factor of employee morale by stating that worker morale will be
low when management exerts excessive control. Certo continues that excessive control
causes employees to feel pressured to perform and increases frustration by stifling
individual freedom, thus, decreasing motivation. As Pink noted, a sense of autonomy is a
driver of performance.
Dewhurst et al. (2009) cite a McKinsey Quarterly study from June, 2009 that obtained
responses from 1,047 executives, managers, and employees around the world to
determine what they perceived to be the most crucial employee motivators.
The respondents view three non-cash motivators praise from immediate managers,
leadership attention (e.g. one-on-one conversations), and a chance to lead projects or

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task forces as no less or even more effective motivators than the three highest-rated
financial incentives: cash bonuses, increased base pay, and stock or stock options. The
surveys top three non-financial motivators play critical roles in making employees feel
that their companies value them, take their well-being seriously, and strive to create
opportunities for career growth. These themes recur constantly in most studies on
ways to motivate and engage employees.
Smith (1994) concludes that motivated employees are needed in our rapidly
changing workplaces, because motivated employees help organizations survive and
motivated employees are more productive. Smith states that, to be effective, managers
need to understand what motivates employees within the context of the roles they
perform. A motivated staff is a major asset in the highly competitive business and
public services environment.
Of all the functions a manager performs, motivating employees is arguably the most
complex, but the most crucial. This is due, in part, to the fact that what motivates
employees changes constantly according to Bowen and Radhakrishna (1991). For
example, research suggests that as employees income increases, money becomes less of a
motivator (Kovach, 1987). Also, as employees get older, interesting work becomes more of
a motivator. Accordingly, managers must be keenly aware of how the work itself becomes
the motivator.
Maylett and Nielsen (2012) equate motivation to engagement and report that,
although organizations can play a role in satisfaction by changing a variety of
practices, policies, and compensation factors, as well as equip and train employees
differently to ensure effectiveness, motivation stands out as the loose variable. The
authors argue that, motivation is personal and it varies from individual to individual,
and cannot be dictated for someone else. They conclude that managers must identify
the most crucial motivators in the workplace and ensure the motivators are part of the
leadership approach and system.
Cuma (2011) states that morale is a lot like motivation and you cannot just give it to
employees or an organization. Cuma posits morale is the result of ongoing positive
behaviors that are routinely demonstrated and so, while some people believe that
paying higher wages or benefits will somehow improve morale, typically, this does not
address the underlying issues. It only creates a higher paid workforce with poor
morale. In that vein, Cuma posits, key motivation aspects that produce positive morale
must be identified, practiced, and lived on a day-to-day basis by management
Kanwar et al. (2009) studied the relationship of work-life balance and job satisfaction.
They found evidence that work-life balance increased satisfaction and is related to
enhanced productivity. Job satisfaction is facilitated by work-life balance, but hindered by
burnout of the employees. A healthy balance between family and job leads to higher job
satisfaction, thereby enhancing employee well-being and performance. Accordingly,
managers must be sensitive to the needs of employees to maintain this balance in their lives.
Lisoki (1999) claims that many companies seek new and better ways to motivate
employees; many start up new or improved recognition systems which they hope will
energize their workforce, resulting in major cost savings and marked strides in quality,
and the good news is a well-designed recognition and appreciation program can do
exactly that. The bad news is a misidentified, or poorly designed, or poorly implemented
one can have just the opposite effect.
Scott (2011) concludes that fear does not work as a consistent motivator and extended
periods of fear cause stress, burnout and lower peak performance. He states that, the
opposite of fear, entitlement, also does not work, because entitlement thinking is what has

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gotten our country into trouble. He believes there is a viable third way: Scott posits managers
can and must encourage employees to think and act like an owner, because ownership
thinking is a proven way to recruit, train, manage, and incentivize your employees.
The ability to motivate employees to improve productivity is a crucial super visional
skill according to Weiss (2011). Weiss states that, while motivation techniques are not
difficult to master, they are often neglected. But, by building and maintaining morale
along with adopting a program of applying motivation techniques, managers can
benefit. Weiss believes that, while some managers believe that when they delegate jobs,
they are empowering their employees, empowerment is more than simple delegation.
It is giving the employees the authority, training, and resources to make decisions
within defined boundaries. It is through these actions, employees gain the power and
potential to both grow and strengthen the company, and it serves as the foundation for
increasing the productivity of the workforce through motivation and empowerment.
Building on the assertion that empowerment is a crucial motivating element Lipsky (1980)
states that autonomy in decision making is actually assumed, practiced, and actualized
every day at lower levels of public organizations. The concept of street-level bureaucracy
was coined by Lipsky as the insight of professionals that they are working in a
micro-network of relations, in varying contexts, and that there is an assumed autonomy
in decision making, because every-day decisions are not made at higher levels in
organizations, but rather, made and carried out at the street level with high degrees of
discretion and a relative autonomy from organizational authority.
Sirota et al. (2011) researched what employees want from their work. They discovered
that, to maintain employees enthusiasm, managers must understand the three things
people seek from their work and then satisfy these goals: equity to be respected and
treated fairly; achievement to be proud of ones job, accomplishments, and employer; and
camaraderie to have good, productive relationships with fellow employees. They
conclude that, if just one of these factors is missing, employees are three times less
enthusiastic than workers at organizations where all elements are present.
Longenecker (2011) believes the current economic climate worldwide and in the US has
put tremendous pressure on organizations to increase efficiency regardless of industry or
market. Managers are under increasing pressure to do more with less, requiring them to
find better ways of doing business and motivating their work forces to achieve higher
levels of performance. Longeneker states that, in most books on leadership, motivation is
defined as an inner drive to satisfy a need, and this simple explanation of motivation is one
of the most powerful: people are willing to expend effort when it satisfies some need that is
important to them. And since motivation is all about need-driven behavior, it is important
for managers to understand how their actions and the culture of their organizations affect
the ability of employees to satisfy their needs at work.
Clark (2003) believes that, in any given situation, where we want to increase work
motivation, we must determine what will convince people to start doing something new
or different, increase their persistence at an important task, and invest mental effort.
People must believe that the motivator driving their enhanced performance will
directly or indirectly contribute significantly to what they need to feel successful and
effective. The challenge for management is to identify the key motivators and ensure
employees sense that what they are doing has purpose and value.
Motivation in the healthcare environment
Motivation and healthcare employee well-being and satisfaction are inextricably linked.
Boss et al. (1999) state that physician empowerment perceptions increased with

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organizational rank and with leader approachability, group effectiveness, and worth of
group. Empowerment perceptions also were associated with increased job satisfaction
and work productivity/effectiveness, as well as a decreased propensity to leave the
organization. Porter and Lawler (1968) advocated structuring the work environment so
that effective performance would lead to both intrinsic and extrinsic rewards, which
would in turn produce total job satisfaction. This was to be accomplished by enlarging
jobs to make them more interesting, and thus more intrinsically rewarding, and by
making extrinsic rewards such as higher pay and promotions clearly contingent upon
effective performance. Implicit in this model is the assumption that intrinsic and
extrinsic rewards are additive, yielding total job satisfaction. To support good
performance, health care workers need clear job expectations, up-to-date knowledge
and skills, adequate equipment and supplies, constructive feedback and a caring
supervisor Luoma (2006). Workers also need motivation, especially when some of the
other factors that support good performance are lacking. Indeed, highly motivated
individuals can often overcome obstacles such as poor working conditions, personal
safety concerns and inadequate equipment. Brown (2014) posits that physician leaders
should provide physicians with the tools they need to make the changes that will benefit
their patients and to collaborate with them on coming up with solutions to solve
organizational problems, allow them to come up with solutions and have a vested interest
in organizational success. Brown suggests that leaders must narrow the chasm between
physicians and administration by appealing to the highest levels of physician motivation:
the desire to solve problems and to achieve goals and gain respect. Brown concludes that
ignoring medical staff and all of the subject matter knowledge they possess in favor of just
paying bonuses with no strategy for engagement is indeed how not to motivate physicians.
In a speech by the Royal College of General Practitioners chairperson Clare Gerada,
Reject the Language of the Market and Embrace the Language of Caring, delivered at
the October, 2011 Primary Care Conference in Liverpool, England Gerada discussed
physicians motivation for entering the medical profession, the practice of primary care
from an economic perspective, and health care inequalities. Gerada (2012) advises
physicians to remind themselves why they are in their profession in these times of
resource austerity and the possibility of increasing healthcare delivery efficiency at the
risk of effectiveness and quality. Gerada states, that We all became doctors because
we wanted to make a positive difference to peoples lives, it would be hard to devise a
better and more inspiring way of achieving this than through the provision of excellent
general practice care, and the need to come together so that we can collaborate,
co-operate and innovate not compete against each other. In this same vein, Weiss (2011),
reports that physicians have an intrinsic desire to deliver quality care, and that intrinsic
motivation is at the heart of the professional and helps build a critical connection between
physicians and patients.
Purpose of the study
Motivation is a widely explored topic and the review of motivation literature reveals
numerous studies have been done to determine motivation importance and
implementation. However, no studies have been identified that investigate what
motivators are most important to physicians and if physician leaders agree with the
importance physicians place on specific motivational aspects. This study investigates
this missed management learning opportunity.
The literature reveals that motivated employees are crucial to organizational
success. More importantly, unmotivated employees are something that leaders must

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constantly be on guard for. Accordingly, managers are most successful in

generating employee productivity and enhancing well-being if they identify the
most crucial motivators in the workplace and ensure the motivators are present,
lived, and working.
What are the most important motivators for physicians and do physician
leaders (physicians in management roles) understand what motivators are most
important to physicians to enhance physician productivity, well-being, and morale?
Answers to this question may be beneficial to designing leadership education
that enhances the understanding of the impact effectively identified and effectively
applied motivation techniques may have on employee behavior and attitudes.
Insights will also benefit the design of motivational structures and methods in the
healthcare workplace. In an effort to assist leaders in their attempts to motivate
their physician employees in Southern Minnesota, both physicians and physician
leaders were surveyed to determine their perceptions of what are the most important
employee motivators.
Research questions
RQ1. What do physicians in Southern Minnesota believe are their most important
motivators in the workplace?
RQ2. What do physician leaders in Southern Minnesota believe are the most
important motivators preferred by the physicians they manage?
RQ3. How do the perceptions compare between the two groups?
Research methodology
Participant selection
A fully inclusive sampling of all (n 2,547) public-practice physicians and physician
leaders (clinic and hospital employed, non-private practice) in Minneapolis and St. Paul
Minnesota was conducted in the summer and fall of 2013.
Survey design
In preparation for this study, the literature was researched to identify which motivators
management experts, leadership theorists, and motivation researcher writers state are
needed in business organizations. This catalogue of motivators produced the content
for the design of the survey instruments. This survey framework itself was kept
purposely simple and is based on survey development work done by Susan Herrington,
North Tennessee Private Industry Council in Clarksville, Tennessee.
The surveys were sent in a link via a web survey software program by the study
researchers. The surveys were anonymous and minimally intrusive, asking only for
perspectives regarding the most important motivational elements by physicians and
physician leaders.
There were two versions of the survey, but they were identical in content. One
survey asked staff physicians what motivates them most and the second version
asked physician leaders what they believe staff physicians chose as the most
important motivation factors. Both surveys were sent to all physicians within the
population asking the respondents to identify whether they were staff physicians or
physician leaders and complete the appropriate survey. Both groups ranked the

following motivators from 1 to 12, with 1 being most important and 12 being the
least important:
(1) feeling in on things;

Employee
motivation
factors

(2) appreciation of work done;

(3) empowerment and autonomy;
(4) interesting work;
(5) good wages;
(6) relationship with management;
(7) good working conditions;

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(8) promotion/growth;
(9) fair treatment;
(10) job security;
(11) work-life balance; and
(12) clear goals and roles.
Survey internal instrument validity
To ensure this form of content-related validity, the instrument was shown to
individuals familiar with instrument design for their assessment of the instruments
format clarity and layout appropriateness. The aforementioned academic professionals
concluded that the survey format was appropriate and purposeful.
The role of the review of motivation literature was to provide the distinct construct
and inventory of motivators. The surveys were designed to question subjects only
regarding the motivators cited by motivation experts and not research their
perceptions of other business-related domains.
Finally, the survey was pilot tested with a group of physicians in Southern
Minnesota to ensure instrument clarity and eliminate any confusion about survey
completion. The surveys were completed in a timely manner by the physicians with no
evidence of confusion and misunderstanding.
Results
A total of 114 physician and 24 physician leader surveys were completed. The following
tables show the results of the physician and the physician leader surveys (Table I).
For physicians the top four motivators (mean value) in their workplace included:
interesting work (2.88), appreciation of work done (3.97), empowerment and autonomy
(4.54) and work-life balance. The bottom three motivators in this group included
promotion and growth, relationship with management, and clear goals and roles (Table II).
For physician leaders the top four motivators (mean value) in their workplace
included, empowerment and autonomy (4.42), appreciation of work done (4.63), good
wages (5.04), and interesting work (5.17). The bottom three motivators were,
relationship with management, promotion and growth, and clear goals and roles.
A Mann-Whitneys U-test was run to evaluate the difference in the responses.
Table III shows the correlation of responses, by median values, between the physicians
and the physician leaders.

99

Table I.
Physician survey
results

Min.
value
Max.
value
Mean
Variable
SD
Total

12
3.97
7.85
2.8
114

12
7.18
13.31
3.65
114

12
4.54
8.59
2.93
114

1
10
2.88
3.88
1.97
114

1
12
5.96
7.64
2.76
114

1
12
8.65
6
2.45
114

Relationship
with
Appreciation Empowerment Interesting Good
of work done and autonomy
work
wages management

12
6.22
7.23
2.69
114

12
8.61
6.68
2.58
114

12
7.1
6.8
2.61
114

12
8.51
8.77
2.96
114

12
5.54
13.61
3.69
114

12
8.85
9.4
3.07
114

Clear
Promotion
Good
and
Fair
Job
Work-life goals and
working
roles
growth treatment security balance
conditions

100

Stats

Feeling
in on
things

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Min.
value
Max.
value
Mean
Variable
SD
Total

Stats

10
4.63
6.59
2.57
24

12
7.75
11.07
3.33
24

11
4.42
9.04
3.01
24

1
10
5.17
7.88
2.81
24

1
9
5.04
5.09
2.26
24

1
12
8.21
10.17
3.19
24

Relationship
with
Appreciation Empowerment Interesting Good
of work done and Autonomy
work
wages management

Feeling
in on
things

12
5.96
13.87
3.72
24

1
12
8.83
9.1
3.02
24

12
6.79
11.48
3.39
24

12
6.04
14.65
3.83
24

3
12
9.42
9.82
3.13
24

1
10
5.75
7.76
2.79
24

Clear
Promotion
Good
and
Fair
Job
Work-life goals and
working
roles
growth treatment security balance
conditions

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Table II.
Physician leader
survey results

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Table III.
Response
comparisons
between groups

Question
1. Feeling in on things
2. Appreciation of work done
3. Empowerment and autonomy
4. Interesting work
5. Good wages
6. Relationship with management
7. Good working conditions
8. Promotion and growth
9. Fair treatment
10. Job security
11. Work-life balance
12. Clear goals and roles
Note: *Statistical difference at o0.05 level

Leaders
median

Physicians
median

p-Value

8.00
4.50
4.00
4.00
5.00
9.50
6.00
9.00
7.00
7.00
6.00
11.00

8.00
3.00
4.00
2.00
5.00
9.00
6.00
9.00
7.00
9.00
5.00
10.00

0.72
0.21
0.78
0.00*
0.19
0.72
0.72
0.49
0.69
0.00*
0.58
0.28

There were two motivational elements that showed a statistically significant difference
between physicians and physician leaders at the o 0.05 level. Physician perceived
interesting work higher than physician leaders, while job security was more important
to physician leaders compared to physicians. The bottom three motivators were similar
in both groups. The remaining motivators were ranked similarly among the two groups.
Discussion
Physician responses
Physicians chose interesting work, appreciation of work done, empowerment and
autonomy, and work-life balance as the most important motivation elements. Interestingly,
good wages (pay) was not seen as one of the most compelling motivational elements.
Further, the most important motivators are all intrinsic motivators, which could mean
that physicians are most driven by an interest or enjoyment in the work itself, rather than
relying on external pressures, or a desire for a tangible reward. However, it appears that
physicians want balance in their life and a separation from their work so as to maintain an
ample work-life balance.
Physician leader responses
Physician leaders chose empowerment and autonomy, appreciation of work done, good
wages, and interesting work as the most important motivation elements they believe
their employees want in their work. It is interesting to note that good wages (pay) made
the top four list and may mean that the managers see pay as being a key motivator for
physicians. Absent from the top four list is work-life balance, which physicians selected
as the fourth most important motivator. This suggests that leaders should be more
sensitive to this need when seeking to motivate their employees.
Response comparison
Generally, the responses were surprisingly similar between physicians and physician
leaders. This may be because the physician leaders were once staff physicians
themselves and they understand what staff physicians value in workplace motivation
elements. The two statistically different motivators interesting work and job
security were ranked as more important by physicians than the physician leaders.

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This suggests that leaders should be more attentive to ensuring variety, challenge, and
engagement is an active part of the physicians work. This also suggests that managers
should emphasize and reinforce the fact that if it is the case jobs are secure and that
staffing stability is a key goal for management. As Kovach (1987) suggests, as employees
income increases, money becomes less of a motivator and, as employees get older,
interesting work becomes more of a motivator.
Implications
In terms of helping employees maintain an effective work-life balance, physician
leaders can express and maintain a genuine interest in their employees work-life
balance. Kanwar et al. (2009) state that, being more flexible as a leader, to the extent
that leaders can offer some flexibility in scheduling and be understanding about family
commitments, will increase the job satisfaction and well-being of the physicians. Such
sensitivity can be greatly appreciated by employees. These small gestures could make
a big difference as it would alter the mental attitude of the employee, and the workplace
would be seen as one that is purely interested in the employees well-being.
Clearly, motivation is essential in the healthcare environment and physicians are no
different from employees in other industries and fields in that how one feels about the
purpose and value of their work, the level of interest they have in performing their jobs,
and the level of appreciation they receive from their leaders will dictate the level of
satisfaction they have in their roles. As noted by Smith (1994), motivation also has
several effects on the retention of excellent employees and is one of the most important
challenges in organizations today. Maintaining excellent staff is a major focus for
healthcare organizations and the costs of losing valuable staff is often incalculable.
Motivation increases the amount of effort and energy that people expend in
activities directly related to their needs and goals. As noted by Sirota et al. (2011), the
level of motivation present determines whether people pursue a task enthusiastically
and wholeheartedly, or with disengagement and apathy. To this end, motivation will
not result through pay alone, but rather, results from the continuous monitoring of
motivation needs and demands and implementation of motivation measures and means
that satisfy employees and compel them to commit to excellent work.
As Certo (2000) points out, leaders must be willing to recognize employee
accomplishments and hard work; this is undoubtedly the simplest and least costly
methods of employee motivation. There are many ways for leaders to convey this to
their employees including public and private recognition gestures. Accordingly, a sense
of pride and accomplishment emerges when physician leaders observe physicians
doing admirable work and recognize them for it. As Pink (2009) indicates, as managers
increase their employees sense of pride and accomplishment, he or she feels better
about their job and, in the end, are more productive.
Sirota et al. (2011) posit that motivation is dependent on the systemic application of
and satisfaction of many motivational elements. Clearly a focus only on money as a
motivator will not bring about the satisfaction demands physicians have indicated are
important in their jobs and lives. Being sensitive to all motivational needs of physician
staff is a start, but fulfillment of these needs constantly and continuously is the true
mission of management.
Conclusion
As this study reveals, physicians have clear preferences when it comes to workplace
motivation. It is not unreasonable then to determine that the more satisfied the

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employee, the better he or she will perform. Motivation, then, is not a result of one
preferred one size fits all management approach, but rather, a systemic discovery
and assessment by management of motivation needs and wants and a fulfillment of
these crucial motivation elements. At the end of the day, motivation is intrinsic,
personalized, and individualized. Accordingly, the environment that managers create
for their employees must be one that is constructive to positive energy. If employees
feel happy when they are working, then they will be naturally encouraged to work.
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About the authors
Dr David Conrad is an Assistant Professor of Business and Associate Director for the Augsburg
College MBA program. He is also an Independent Business Consultant working with companies
in the areas of sales and marketing, management, and leadership development. Dave was successful
in sales and marketing management for public and private companies in the wine and spirits,
industrial, and medical supply industries. David has an EdD in Leadership (organizational) from the
Saint Marys University of Minnesota (2003). He has a Masters Degree in Management from Saint
Marys (1997) and a BA in Psychology from the Winona State University (1976). Research interests
include business and leadership communications and development. Dr David Conrad is the
corresponding author and can be contacted at: conradd@augsburg.edu

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Dr Amit Ghosh is a Professor of Medicine, College of Medicine, Mayo Clinic and Director of
International Program in the division of General Internal Medicine, Mayo Clinic Rochester,
Minnesota. Dr Ghosh completed his Medical at JIPMER, Pondicherry, India, followed by
a residency in Internal Medicine and a Fellowship in Nephrology in the Post Graduate Institute,
Chandigarh, India and at the University of Minnesota. Dr Ghosh has practiced medicine for
23 years and has been at the Mayo Clinic, Rochester since 2000. He has served in numerous
education and practice leadership roles at Mayo Clinic, namely, Editor-in-Chief of three books,
Mayo Clinic Internal Medicine Board Review book, Mayo Clinic Internal Medicine: Concise
Textbook, Course Director Mayo Clinic Internal Medicine Board Review Course and Course
Director of Mayo Clinic Internal Medicine Maintenance of Certification Program (ABIM
knowledge modules). Dr Ghosh has received numerous awards in his career including 2010 Mayo
Distinguished Educator and 2012 Laureate of American College of Physicians.
Marc Isaacson is an Assistant professor of Business Administration/MIS at the Augsburg
College in Minneapolis, Minnesota. Teaching at the college level since 1998, he currently focusses on
a variety of MIS and Statistics courses at both the undergraduate and graduate (MBA) levels. Marc
has an MS in Manufacturing Systems Engineering from Rensselaer Polytechnic Institute (1996) and
a BA in Economics/Statistics from St Olaf College (1994). Currently, he is President of the Twin Cities
Chapter of the American Statistical Association. Over the last few years, he has authored three
papers and given numerous presentations on quantitative literacy and statistical education.

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