As the science and study of medicine has continued to evolve over the last 30 years, the concept of physician performance has not only taken shape, but risen to the forefront of our daily practice. "Pay-for-performance," "quality," "audit" and "computerized-care" are terms we recognize and use ever more frequently. Yet, as we strive to improve our care, we have failed to identify a single or best method for translating the growing body of knowledge into regular practice. Multiple methods exist, including evidence-based guidelines, continuing medical education conferences, academic detailing, opinion leaders, audit and feedback, public reporting, pay-for-performance, and computer-based reminder systems. Each method holds potential to improve performance. As attempts are continually made to change the care provided, we should be mindful to ensure that these measures actually improve our performance and our patients' lives. © Copyright Clinical and Experimental Rheumatology 2007.