We will give up our hospital privileges and perform our exams and procedures at our clinic or at the outpatient surgical centers. It’s already happening. Many opthalmologists, ENT’s, plastic surgeons, OMFS, orthopedic surgeons, urologists, dermatologists, and general surgeons no longer come to the hospital at all. If a case is too complex or the patient too critical, they get sent to the ER for the on call folks to take care of. EMTALA is an unfunded mandate and it’s about to get worse.