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In Reply: I appreciate Dr Stapczynski’s comments and do not discount the perverse impact that poorly designed patient satisfaction surveys linked to "pay for performance" plans may have on physician behavior. He states that the 14% absolute difference in satisfaction "may appear small to an academic physician." Perhaps, but while I have an academic appointment at Michigan State University, I see patients 3 days a week in a small private practice, where my income depends completely on how many patients I see and whether they pay their bills. To paraphrase a recent president, I feel his pain.

Should I excise that mole because I will make more money than by simply reassuring the patient? Should I order an x-ray, because we have this expensive machine in our office and I can get paid well for (over) using it? Should I prescribe an antibiotic to boost my satisfaction ratings and therefore . . . [Full Text of this Article]

Mark H. Ebell, MD, MS
ebell@msu.edu
Department of Family Medicine
Michigan State University
East Lansing

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