In this opinion piece for the New York Times, Sandeep Jauhar, MD, says that on the surface pay for performance seems like a good idea, but the initiative may be having untoward consequences. Under P4P, there is pressure to treat even when the diagnosis isn't firm, so, for example, more and more antibiotics are being used in emergency rooms despite all-too-evident dangers like antibiotic-resistant bacteria and antibiotic-associated infections, Jauhar says.