Original scientific paper
https://doi.org/10.5281/zenodo.22017726
Say ‘No’ to ‘Yes’ Men: The Mandate Against Tying Physician Compensation to Patient Satisfaction Scores
Nathaniel A. Mattera
; The University of Illinois College of Medicine
*
* Corresponding author.
Abstract
Basing physician compensation on Patient Satisfaction Scores (PSSs) violates the four foundational principles of clinical ethics and leads to demonstrable, real-world harms to patients. The pressure to secure a high score incentivizes physicians to prioritize patient desires over objective medical truth, undermining shared decision making and informed consent (violation of autonomy). It also encourages acquiescence to patient demands, resulting in unnecessary care such as unwarranted opioid prescriptions, excessive diagnostic testing, and procedures, low-value care that increases the risk of side effects, addiction, and harm (violation of beneficence and non-maleficence). Tying compensation to subjective scores further leads to unjust distribution of resources by encouraging over-utilization of costly services for non-clinical reasons, and empirical studies show PSSs contain systemic patient bias against female and racially underrepresented physicians, translating prejudice directly into pay inequity (violation of justice). These ethical breaches produce concrete clinical harms: up to 70% of providers change their initial treatment plan due to PSS concerns, and almost half report that PSS pressure promotes inappropriate care, including unnecessary prescriptions and tests, driving up healthcare costs and contributing to physician burnout and attrition. Basing compensation on patient satisfaction transforms the fiduciary patient-physician relationship into a transactional customer service model. PSSs are a flawed and harmful metric for compensation and ought to be reduced to safeguard evidence-based care, uphold the duty to do no harm, and ensure justice and equity in healthcare.
Keywords
patient satisfaction; epistemology; lived experience; knowledge; principlism; Kant; medical ethics; medicinska etika
Hrčak ID:
350249
URI
Publication date:
31.8.2026.
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