We would like to commend Armour et al1 for delving into such a complicated issue in the practice of medicine. While the authors' research of the literature was inconclusive, we agree that more emphasis on the quality of care2 and patient satisfaction is needed. Also, we offer the following comments.
Currently, physicians face an enormous challenge to deliver high-quality, comprehensive primary care services to their patients.3 As we embrace capitalism, our economy is constantly being driven by incentives, whether it is the rebate of the federal income tax or not having to pay any interest on the next luxury car. Therefore, it is naive to think that incentives may not play a role in physicians' care of their patients. Perhaps the results have been inconclusive to date, because the role of such incentives is extremely difficult to demonstrate in a study, and the variables, which include the physician, are numerous.