Hall and Berenson [1] maintain that financial incentives in managed care are acceptable as long as they "cause physicians to think about what is necessary for their patients' health care ... not what will increase their own income."

Practically speaking, I suspect it is very hard for most physicians to make this moral decision as easily as it is for the authors to declare it. And even though the authors qualify themselves by stating that "... ethical rules are aspirational, not regulatory," why expose physicians to the temptations for personal gain that financial incentives so clearly offer? Are physicians free from the human frailties that affect everyone else?

Financial incentives are open to wide personal interpretation in daily practice. They make it too easy to hide our personal desire for gain and represent a conflict of interest that no amount of rationalization will ever eliminate.

Furthermore, in a malpractice claim, a lawyer can allege that a test or a consultation was not ordered because it would have decreased a physician's year-end bonus. Physicians have enough insecurities to deal with every day; why burden them with yet another, one with such devastating potential?

Financial incentives are an appropriate tool for the business world but not for medicine. Physicians do not need them to deliver cost-effective medicine. They can do that with outcomes studies and clinical guidelines.