The Ringelmann effect, or Has family medicine lost its élan vital?

A French agricultural engineer named Maximilien Ringelmann performed a classic experiment over a century ago that you could replicate in your own backyard, playground or office.

He measured people pulling on a rope connected to a strain gauge, both as individuals and as part of a group tug-of-war. Result: People pull harder as individuals.  

Ringelmann called this “social loafing.” We all remember it from group projects in school. Since as physicians we are overachievers, chances are you remember carrying the load for the deadbeats, as I do. Teachers think this is great. I think it’s nuts.

What happens to per-doctor productivity when a hospital buys a private practice and everybody goes on salary? Yep. Productivity plummets. That’s Ringelmann for you.

As the Dare to Slack poster says, “When birds fly in the right formation, they need only exert half the effort. Even in nature, teamwork results in collective laziness.”

On the other hand, teamwork is essential in the business of medicine. Without loyal, intelligent and hard-working (not to mention beautiful and handsome) colleagues, life would be a nightmare anywhere except a micropractice. So what are the laws of productive teamwork?

First, the team has to have a good Captain, and the lines of authority and responsibility must be clear. The buck has to stop somewhere; that would be the boss. Some bosses can’t make decisions, or they fear responsibility. Their teams won’t be productive.

Second, productivity must be rewarded. I’ve dealt with this at length elsewhere. In a solo practice, this happens by default. In a group, the compensation formula must be simple, fair and transparent. There is no shame in not wanting to work as hard as the next guy. The shame is in wanting to be compensated as if you were.

When I first came to Topeka in 1980, I intended to join a group practice run by a man I respected greatly. But I also wanted to start a private school for my kids. So I negotiated a half-time job. I didn’t want to be paid 75 percent of what the others made; 50 percent would have been just fine. There was nothing immoral about that. One member of the group just couldn’t believe I wasn’t going to be ripping them off, so I withdrew and went to work in the emergency room. But there’s no problem in principle for wanting an honest half-day’s pay for an honest half-day’s work.

What’s immoral is expecting the other members of a group to financially support your desire to carry on leisurely chit-chat with 15 patients per day.

The profession changes with the culture. When I was a resident, taking call every third or fourth night, old-timers thought I was a slacker. They had spent 120 hours a week in the hospital. But their mentors thought they were slackers, because they were allowed to be married. Not so very long ago, you see, only single men were admitted to medical school.

So I don’t want to play that game. You won’t find me looking down on someone because they want to enjoy spouse and family, as well as the medical profession. That’s what I wanted, and that’s what I got.

My disquiet comes from a suspicion that fledgling family physicians want their jobs microwave-ready; that maybe their mentors weren’t all that successful in private practice and found academic medicine a haven from its demands; that, perhaps, the specialty has lost the dynamism, creativity and entrepreneurial zeal it had in 1975.

Teamwork has its uses, but it is not the font of dynamism, creativity and entrepreneurial zeal. So when I hear the “leaders” of family medicine talk too much about teamwork, I want to ask: Quo vadis, Captain?

Posted at 12:01PM Jul 30, 2009 by Doug Iliff  |  Comments[4]