Pay for performance and medical education: strategies for preparing physicians of the future

Performance-based reimbursement has become an increasingly important topic in the field of medicine and one that has met with significant legislative support. Small- and large-scale pilot programs in the United States and more comprehensive programs implemented abroad have yielded preliminary findings that raise several interesting questions regarding the form that pay-for-performance programs will take and concerns about the unintended and unforeseen consequences of this new reimbursement approach. One important area that has not been explored, however, is the potential implications of pay for performance to "clinician educators"-individuals from diverse health-related disciplines who both provide health care and are responsible for training the next generation of health care professionals. Because the effect of pay for performance is likely to vary by health care discipline, we focus here on potential implications for physician educators. Our objective is to analyze the experience to date with pay for performance, make predictions from these experiences about the potential impact of pay for performance on the education of resident physicians, and propose educational strategies that might be useful in positioning physician trainees for success as they enter the workforce.