In the context of improving quality of the medical practice, pay for performance (PFP) programs have been developed to reward best medical practices, but currently they have not been implemented in surgical specialties. In spite of some improvements reported in the quality of health care, there is no evidence in the literature on the cost effectiveness of PFP programs, and some unexpected adverse results have been published. It is our responsibility as clinicians to develop specific process or outcome measures to facilitate the parameters to be evaluated as thoracic surgeons in the near future.