The introduction of “pay for performance” for French surgeons, and its probable extension to all public sector physicians, represents a major change in the health care system in France. In this paper, we will firstly go back over the theoretical foundations of this mode of remuneration, which is linked to Agency Theory, and then, we propose both an overview of the practical difficulties of implementing such a system and a detailed analysis of the limits inherent to this individualized management of remuneration.