The three D's of physician performance appraisal

In relation to Performance Appraisals (PA) in general, one can explain the experience as the three D¿s - DESIRABLE , DIFFICULT, DREADED (by manager even more than the subordinate). PA¿s are conducted in nearly all industries in some shape or form. There have been many critics of PA¿s over the years, even Edward Deming (the guru of Quality Management) labeling them as one of the 7 deadly sins of management. Because of the consequences of morbidity and even mortality that ensue as a result of poor performance of physicians, in the Healthcare Industry it is not a question of if we should conduct PA¿s, but a question of how. Almost across the board in Healthcare the Annual PA is used. We would like to look at whether annual PA¿s suffice, and if not we would like to know if there is a suitable system leading to effective performance appraisals