The perfect storm in medicine


Now is the time for all physicians to come to the aid of themselves, their professions, and their patients.

Now is the time for all physicians to come to the aid of themselves, their professions, and their patients.

You’ve been experiencing and reading in Medical Economics about all of the forces acting on you, your colleagues, and your patients, issues that potentially are changing or eliminating our practice of medicine, including:

  • government involvement in all processes and care since Medicare began in 1965 and intensifying with the passage of the Affordable Care Act (ACA);

  • involvement of health insurance companies in all processes and care, which has been increasing since employer-sponsored benefits were encouraged by the government during World War II;

  • electronic health record systems and required participation in digital data entry and manipulation to obtain payment under the Health Information Technology for Clinical and Economic Health Act;

  • the shift in care from patient-oriented care to that of the population medicine of Europe and Canada or that of the ACA, in which medicine is run by private entities but ruled by the government;

  • the fact that medical care is the only business/service in the United States that is not paid for directly by the one receiving the service at the time of the service; instead, it is beholden to third-party insurers for payment or denial at a later date;

  • more and more medical care being delivered by nurse practitioners and physician assistants as a less expensive substitute for postgraduate residency-trained physicians; and

  • telemedicine as a substitute for office visits.

As physicians, we are-or should be-occupied every minute with patient care. We have become overrun with insurance processes, government compliance and unrealistic costs, time demands to complete arbitrary tasks for MOC and OCC. If the government succeeds in its quest for regulatory capture, we must fight just to maintain a medical license to legally practice medicine in our state(s) of choice.

I present a call to action on all the aforementioned issues, lest we lose our right to practice and thousands of years of the independent, individual patient care philosophy on which we swore an oath when we entered this profession. I advocate for making a plan for a direct-pay patient practice, disenrolling from health insurance network contracts, and resisting any additional board or licensure testing or data submission. We must restore the vibrant and private patient-physician relationship.

The game is on, as is the power struggle to control costs by controlling your practice of medicine and your patients’ care needs and wants. Among the organizations fighting change are Independent Physicians for Patient Independence, the Association of American Physicians and Surgeons, Doctors for Patient Care, the Benjamin Rush Society, and Change Board Recertification.

The author practices family medicine in Mullica Hill, New Jersey, and is a Medical Economics editorial board member. Editorials reflect the opinions of the authors and are independent of Medical Economics. Send your feedback to


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