績效薪資的使用越來越廣泛普及，支持者認為績效薪資可以激勵員工追求更好的表現，反對者則是認為金錢激勵永遠不可能增加一個人對工作的熱愛。根據認知評價理論的說法，金錢激勵會降低內在動機，但這是以學校的兒童作為實驗對象而得到的結果，在以金錢給付為常態的組織中，績效薪資對於內在動機之影響，仍有待驗證。
本研究以醫師為研究對象，發現主治醫師的內在動機顯著大於住院醫師，亦即工作本身的激勵性影響內在動機甚巨。此外，公辦民營或公民合營醫院之醫師內在動機顯著高於公立醫院。影響主治醫師內在動機之因素包括醫院是否依其治療服務量及組織表現計算其績效薪資及他人的肯定尊敬，證照加給的薪資的給付方式對內在動機則是有不良的影響。在住院醫師方面，升遷發展的機會及是否有教學研究工作之績效薪資，對其內在動機影響最大。
在理論驗證方面，績效性的薪資雖然會帶來控制效果，但是卻未降低內在動機。組織中的工作者似乎能夠將內在獎酬與外在獎酬分離，外在獎酬影響外在動機，內在獎酬影響內在動機。這樣的結果與Fisher(1978)的結論相同：影響工作者內在動機的是工作本身之激勵性，亦即工作是否具有多樣性、完整性、重要性、自主性、回饋性。個人差異對於外在獎酬的解讀則是未產生顯著的干擾效果，原因可能是醫師群體同質性過高，因而需要擴大研究群體至其他工作者，做進一步之驗證。

Pay for performance programs are being used more and more extensively nowadays. The proponents of incentives claim that money is an important motivator for better performance, while the opponents insist that incentives can never bring lasting performance improvement, which is driven by intrinsic motivation. It has been born out that monetary reward has detrimental effects on intrinsic motivation. However, the results come mostly from experiments on school children, whether the result can be replicated in work settings is still a question needs to be examined.
This study examined whether performance based pay has detrimental effect on physicians’ intrinsic motivation and what effects other non-monetary rewards may have on intrinsic motivation. It is found that the intrinsic motivation of Attending Physician is significantly higher than Resident Physician, which implies that the motivational property of the work itself is a very important factor of intrinsic motivation. Physicians from privatized public hospitals have higher intrinsic motivation than those from public hospitals, of which the causes may need to be further explored.
In terms of different positions, productivity-based pay, organizational performance based pay and recognition are found to have positive influence on Attending Physicians’ intrinsic motivation, while career development opportunities and research-teaching based pay are found to have positive influence on Resident Physicians’ intrinsic motivation.
As to the effects of performance-based pay, it is found that physicians having performance-based pay do feel more controlled by pay; however, their intrinsic motivation is not negatively affected. It seems to imply that organizational workers are able to separate intrinsic reward and extrinsic reward and thus their intrinsic motivation is not affected by extrinsic rewards. This result is similar to what Fisher found in 1978. The moderating effect of individual difference is not significant in this study due to the homogeneity of physicians.

第一章 緒論 4
第一節 研究動機 4
第二節 內在動機 6
第三節 外在獎酬與內在動機 9
第四節 醫師的薪資制度與內在動機 18
第五節 研究目的 22
第二章 研究方法 23
第一節 研究架構 23
第二節 研究工具 24
第三節 研究對象 34
第三章 實證研究分析結果與討論 40
第一節 內在動機之前導變項 40
第二節 訊息及控制效果與工作偏好之互動效果 46
第三節 薪資制度的中介效果 50
第四節 薪資計算基礎與非財務性獎酬 53
第五節 薪資組合與內在動機 58
第四章 討論與建議 61
第一節 結果與討論 61
第二節 研究限制、貢獻及後續研究建議 65
參考文獻 66
附錄一：總變數相關係數表 71
附錄二：題目敘述統計分析 72
附錄三：問卷 74
附錄四：研究說明 78

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趙秀雄，1996，「不同工不同酬與醫師獎勵制度之運用—公立醫院實施醫師費面臨之問題」，公立醫院經營效率問題探討研討會論文集：43-44。


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