job satisfaction. A discussion that only focuses on cutbacks of Christmas and vacation benefits will not lead to any significant outcomes. Rather, the focus should be on performance (quality) orientation of payments and on getting rid of hierarchical structures. A proactive management of human resources (instead of an administration of personnel) has to find its place into health care management in order to keep a highly educated workforce from leaving the country or working in other non-medical professions. Instead of relying on the intrinsic motivation of physicians, strategies have to be developed to employ the physician factor efficiently and effectively in health care delivery.