In my opinion, most otolaryngologists treat most of their patients with good quality medicine most of the time; there are few “bad apples,” but they do exist. However, all of us can improve our practices if we assess what it is we do, determine why we do it, and implement ways of doing it better. Will pay-for-performance work? Will physicians respond to a financial incentive in the way it is intended? Only time will tell. Those who promote the pay-for-performance approach have an obligation to monitor the results of this experiment. It may turn out, for all of the reasons cited above as well as others, that what is intuitive does not work. It certainly has happened before in many areas of our lives. Indeed, it may turn out that the unintended consequences of pay-for-performance may result in totally undesirable effects that are unknown at this time. In the end, we are professionals, and I believe that the biggest stimulus is to do the right thing for our patients is our professionalism, our desire to help people in need, and our inherent need to do the right thing.
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February 2007©2007 The Triological Society