Still early in a long game of delivery system transformation, the United States is already experiencing some of the negative consequences of pursuing quality and value measurement on professionalism in health care, specifically in the form of provider burnout. Other countries have struggled with similar endeavors, including the United Kingdom, which in 2004 launched an important experiment in value-base payment called the Quality and Outcomes Framework, or the QOF (“Qwaf”). The QOF increased primary care payments by up to 25% depending on how physician did on more than 120 measures.