Because cost containment is a priority in our rapidly changing American health care system, the prestigious Pew Health Professions Commission (1995) has predicted a greater role for nurse practitioners (NPs) in the delivery of primary care. Factors favoring a broadened scope of NP responsibility for primary care include: (a) the pressing need to contain the nation's ever-escalating health care costs, (b) the present window of opportunity for advanced nursing practice, and (c) the need to use fewer resources more effectively. Because ours is a market-driven health care system with a growing surplus of physicians, NPs increasingly find themselves in direct competition with physcians for the same primary care jobs. Hence, market-driven (rather than identical) pricing of services is necessary if NPs are to compete successfully with medically trained providers of primary care. The brain has two functions: One is to be right and the other is to survive and sometimes we give up the latter. (Old Chinese proverb)

As health care workers enter the twenty-first century, they must understand the relationships among market-driven forces, the health care workforce, and financial compensation. This understanding can be facilitated by a grasp of utilitarian ethical theory and by ethical tenets of justice such as distributive justice, material principles of justice, and justice as fairness. Health care workers also need to understand how unfair financial compensation can demoralize them and compromise their values. However, professional associations and health care managers can take a proactive stance to ensure that organizations are ethical in their approach to financial compensation.