The purpose of this qualitative descriptive study was to explore physician descriptions of the influence of pay for performance (P4P) programs on their medical decision-making for the delivery of health care through three antecedents of behavior intention—attitude toward program compliance, perceived behavioral control, and subjective norms. The Theory of Planned Behavior served as the theoretical framework for the research questions, which captured physician descriptions of the influence of their attitude toward pay for performance program compliance, perceived behavioral control, and subjective norms on their medical decision-making. This study employed non-probabilistic convenience and purposive snowball sampling to select 16 physician informants. Thirteen physicians participated in individual semi-structured interviews, and separately, three physicians participated in a semi-structured focus group. Thematic analysis was used to produce four main themes: (a) program compliance and beliefs of physicians in delivering patient care, (b) design, control, and performance motivation, (c) physician performance measurements and the opinions of others, and (d) patient care and compensation program considerations. The findings suggest that physician involvement in the design, implementation, and on-going evaluation of P4P models may influence physician participation and behavior change. As a practical implication, payors and policymakers may use the findings of this study to create future P4P models, which influence physician behavior change to control the rising cost of health care and variability of outcomes in the United States.