INTRODUCTION: Physicians are continually encouraged to be more productive while providing higher levels of patient satisfaction. It is a common presumption that the two goals are somewhat exclusive-that higher productivity must entail a sacrifice in patient satisfaction or vice versa. Moreover, physicians seeking tested, evidence-based approaches to improving satisfaction have had relatively little to go on, and they commonly have justifiable concerns about how ineffective changes may hurt their productivity for no benefit. METHODS: For our large specialty practice, we plotted physicians into quadrants on a scattergram: strong performers on productivity and patient satisfaction, those who are weak in both areas, and those who are strong in one and weak in the other. We performed an observational study to investigate behaviors and work processes associated with a range of performance levels in productivity and patient satisfaction. RESULTS: The observation yielded clear, discrete sets of common characteristics for physicians and staff in each quadrant. In our organization, these findings have provided practical assistance for physicians performing at any level to assess their own situation and chart a path, on their own or with coaching, that leads to improvement. CONCLUSIONS: The findings help dispel commonly held myths about the exclusivity of productivity and patient satisfaction, suggesting that 1) there are many physicians who excel in both areas simultaneously, and 2) there are different characteristics associated with varying levels of performance. The study encourages the further development of evidence-based methods for improving the patient experience while enhancing-not sacrificing-productivity.