Idealogically, I disagree. I believe there is fair evidence that internal motivation (the desire to do a good job) is generally superior to external motivation (the desire to get paid), and I recall some evidence that providing the latter actually causes problems with the former. I also believe that it is impossible to know for sure, when you are on commission, that your sales recommendations are not being influenced by the kickback that you are getting. In my experience, commissioned practitioners are more likely to choose to believe things that support their belief that a more expensive hearing aid is superior for their patient, despite no evidence to support this or even in the face of evidence to the contrary. In an ideal world, I don’t think that any healthcare provider should be on commission, nor should they accept any gifts/benefits/kickbacks from manufacturers.
In the real world, there are a lot of variables that play into what makes a good and bad provider. For an employer, it’s wonderful to find employees that are internally motivated, but it can be pretty hard (though I do think that there is a slightly higher ratio of these sorts of people in healthcare fields). At the end of the day, you need to keep the clinic open and that requires you to think about the money involved–you can’t just do everything pro bono. For the employee, you may have to make a number of sacrifices to avoid a commissioned position in terms of your own compensation, where you choose to live, and the type of practice you work at. So at the end of the day, you can find all sorts of people in all sorts of different positions because they have all sorts of other pressures acting on them.
That doesn’t mean that I don’t think we should strive generally to build systems that promote a high level of ethical behaviour.
If I were picking a clinic without foreknowledge, just as I feel that “all else being equal” I would prefer to see someone with more education, “all else being equal” I would prefer to see someone whose compensation was not tied to their medical recommendations for me. That goes for all of my healthcare professionals.