[cassowary37]

A consideration of the economics would suggest that any doc who trained in the last two decades isn't in it for the money - the ROI on an MD is far less than most other advanced degrees. If we wanted to be wealthy, with the grades and letters required to get into med school in the US, most of us could readily have chosen other professions. (Heck, some even walk away from startups, believe it or not). My impression as someone in practice for more than a decade, who cares for a large number of docs, and has run a large clinic: It's really not the reimbursement. It's the combination of dealing with payers determined to deny treatment, massive requirements in terms of documentation and ongoing accreditation, and - in particular - constant pressure to spend less time with more patients. Then, we read posts like these which buy into conspiracy theories about how we're out to poison patients with expensive medications to line our pockets. The time problem in particular afflicts primary care docs the most, but even the surgeons complain about it. As far as ACA and its impact, there's no question it's a hack (and not a good one) - most economists not on the far right agree single payer would be optimal - but under the political circumstances, it was probably the best we could get. Regardless, we'll move to a system where the majority of care isn't delivered by docs. Then we'll complain about it. But, it will be more cost-effective.