The Effects of Peer Comparison Information on Physician Behavior and Well-being

Abstract

To modify behavior, policy makers are increasingly using nudges, or interventions that attempt to change behavior without altering economic incentives or limiting freedom of choice. Despite their widespread use, the potential negative consequences of nudges on recipients’ well-being are still largely unknown. In light of high burnout rates among US physicians, we conducted a field experiment involving 199 primary care physicians and 44,287 patients to examine the impact of peer comparison nudges on both physicians' performance and well-being. We varied whether physicians received information about how their preventive care performance compared to that of other physicians. This peer comparison nudge did not significantly improve physicians’ preventive care performance (measured by their order rates of preventive exams), but it did significantly deteriorate their well-being (including job satisfaction and burnout), even four months after the intervention was discontinued. We provide quantitative and qualitative evidence highlighting a novel mechanism underlying these unanticipated negative effects; physicians perceive peer comparison information as an inappropriate nudge in this context that signals a lack of support from their leaders. Consistent with this account, providing leaders with training on how to support physicians mitigated the negative effects of peer comparison information on physicians’ well-being. Our research uncovers an important downside of peer comparison nudges, highlights the importance of considering the consequences of nudges on recipients’ well-being, and points to how a complementary intervention—leadership support training—can mitigate these adverse effects. Note: *The first two authors contributed equally to this work. Trial Registration: clinicaltrials.gov numbers: NCT04237883