The key to retaining physicians: understanding the interplay of motivation, commitment and performance
Ömer Ceylan, Edibe Asuman AtillaPurpose
This study examines work motivation's effect on turnover intention and the mediating roles of job performance and organizational commitment under the pay-for-performance (P4P) model implemented in Turkish public healthcare settings. It specifically questions if high performance guarantees retention, testing the Jackofsky Paradox.
Design/methodology/approach
Cross-sectional data were collected from 477 physicians in Turkish public hospitals. The research model was analyzed using partial least squares structural equation modeling (PLS-SEM).
Findings
Motivation was significantly associated with higher commitment and performance. However, no direct link appeared between performance and turnover intention, supporting the Jackofsky Paradox; high performers are at risk of leaving. Crucially, performance was positively related to turnover intention when fully mediated by organizational commitment, indicating that metric-driven performance pressures can erode institutional belonging, thereby indirectly increasing turnover intention.
Research limitations/implications
Financial incentives alone are insufficient to retain physicians. Since result-oriented P4P pressures may erode institutional belonging, managers must prioritize strategies strengthening the “psychological contract” to transform performance into commitment, rather than assuming high performers will stay.
Practical implications
Healthcare administrators must move away from seeing physicians as mere “point-producing units.” Since high performers are most likely to leave due to “ease of movement,” managers should stop assuming high productivity equals satisfaction. Strategies should prioritize strengthening the “psychological contract” through inclusive leadership and clinical autonomy. The P4P system should be revised to reward “qualitative contributions” – such as patient safety and peer support – rather than just quantitative production. Fostering an emotional bond is essential to prevent brain drain in competitive healthcare ecosystems.
Social implications
Retaining physicians is a vital social promise. When a physician leaves the public system, the community loses more than a specialist; it loses institutional memory and trusted patient-doctor relationships. This study suggests that over-mechanized performance systems may fuel brain drain, ultimately threatening the public's access to stable and compassionate healthcare. By emphasizing organizational commitment over mere quantitative production, policymakers can ensure the sustainability of high-quality healthcare services. Strengthening the emotional bond between physicians and institutions is not just an administrative task but a social necessity to protect public health and maintain a resilient healthcare workforce.
Originality/value
This study contributes by highlighting “performance-commitment tension.” It offers a nuanced perspective on traditional assumptions by demonstrating that without the buffer of organizational commitment, high performance may not effectively prevent turnover in P4P environments.