Family physicians' reactions to performance assessment feedback

OBJECTIVE: To explore and describe family physicians' personal and professional responses to performance assessment feedback. DESIGN: Qualitative study using one-on-one semistructured interviews after feedback on performance. SETTING: Fee-for-service family practices in eastern Ontario. PARTICIPANTS: Eight physicians out of 25 physicians in the control group of a previous randomized controlled trial who received performance assessment feedback were purposefully selected using maximum variation sampling to represent various levels of performance. Five female physicians (2 part-time and 3 full-time) and 3 male physicians (all full-time) were interviewed. These physicians had practised family medicine for an average of 18.5 years (range 9 to 32 years). METHOD: Semistructured one-on-one interviews were conducted to determine what physicians thought and felt about their private feedback sessions and to solicit their opinions on performance assessment in general. Information was analyzed using an open coding style and a constant comparative method of analysis. MAIN FINDINGS: Two major findings were central to the core elements of medical professionalism and perceived accountability. Physicians indicated that the private feedback they received was a valuable and necessary part of medical professionalism; however, they were reluctant to share this feedback with patients. Physicians described various layers of accountability from the most important inner layer, patients, to the least important outer layer, those funding the system. CONCLUSION: Performance feedback was viewed as important to family physicians for maintaining medical professionalism and accountability.