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Actually, I'm in Texas, and in April, I closed my office (private solo practice - walkin urgent care with some family practice for the last 6 years after 4 years in old fashioned cradle to grave family practice with OB during which I joined 6 other docs in a partnership). I'm not a good business person and the complexity just finally got too much - and my employees started changing jobs for more money but fewer benefits. When what I thought of as my "family" started leaving, I couldn't justify working so hard for so little money.

Now, I'm doing a lot of political work and volunteer testifying and visits to State agencies and hearings. I need and love to be a doctor, so I'm working as a locum tenens with a couple of docs and trying to decide "what I want to be when I grow up." My husband supported us for the last two years while my practice floundered, so I'm taking the opportunity to try to work at changing the things I've griped about for the last 10-15 years.

Those obscene salaries and benefits for the insurance company execs are a pet peeve. How can Dr's fees remain stable for years, when the CEO is making $ 2+ Million a year? (average is $1.74 million salary plus benefits)
http://www.insurancetech.com/utils/printableArticle.jhtml?doc_id=14705473

Just FYI...I live in one of the "insurance capitals" of the country. I noticed an article last week in the business section about executive movement within a particular company...a major group health provider.

Get this...the "executive vice presidents" of departments...not entire divisions...simple departments (as in marketing, advertising, etc.) are making $900,000 per year. I am particulary appalled about the V.P. of marketing...I mean, how hard is HIS job. "Buy our outrageously priced insurance, or your children may die of cancer because you have no coverage." V.P. of extortion would be more appropriate.

See my posting above regarding violations of Federal and State of California regulations.

I am distressed that the federal administration has not quickly sought to break up the HMO industry when it is so clear that the industry is part of the bust-out strategies that were occuring during the Clinton Administration.

There are direct relationships between elected officials and the various HMO insurers.

Do you understand how capitation works?

I would like to explain the process publicly in this forum so that Free Republic readers understand why they can not get adequate access to medications and physicians when necessary.

Essentially, there is more than enough money in the federal system to resolve health access problems. The biggest problem with the physician is not standing up to fight for what we do.

I am interested in cutting out the red tape and have done so.

Any individual, including hospital executives with off shore bank accounts, who interferes with our team of physicians will be identified, targetted, and smoked out.

I'm not interested in spending time arguing with bought off politicians about these issues. I already KNOW what is happening.

The question is NOT whether or not my point of view is correct. IT IS BASED ON PERSONAL EXPERIENCE IN THE INDUSTRY.

I have assembled a team of like minded physicians and any politician that crosses me will be publicly chided during this election year.

WE LOOK FORWARD TO COOPERATION but will take action against those in authority who have FAILED US.

closed my office (private solo practice)

You certainly shouldn't feel alone. I'm in California, and all of the solo practitioners I know who are in generalist fields are struggling to stay afloat. It's a real tragedy for the patient because, I strongly believe, the best medicine is practiced by one physician working with one patient with whom she or he has a long acquaintance. Until I moved recently, I was a long time patient with one of the "last of the G.P's" who would regularly make diagnostic decisions based on his knowledge of how the patient normally looked or behaved.

Sadly, the squeeze has come from multiple directions. In the eighties, my physican owned and operated his own blood testing facility. He also regularly cajoled drug reps into giving him large amounts of free samples which he then doled out to his patients, and he had long-time employees who ran the financial end in a highly professional way.... you paid the co-pay, or you went home. As a result, the patients benefited by paying less for testing, nothing for the first month or more of most prescriptions, and being able to deal with people with whom they had an ongoing relationship.

That's all changed now. He struggled with it for several years, as reimbusements decreased, he was ordered to stop doing his own blood testing, etc. Essentially, the application of the law and rules left him without any of the ancillary revenue sources that used to help underwrite the cost of the practice. The final straw came when an insurance company sent him a letter demanding that he begin printing the entries in his charts because they were having difficulty reading his handwriting.

He walked, saying he'd signed on to practice medicine, not insurance. He's probably now sitting on a tropical beach somewhere, sipping punch, and signing the chit in the same "unacceptable handwriting".

The other movement that's become common out here is for generalists to become specialists. Radiation Oncology seems to be a popular choice.