As those old guys said, "Life, Liberty and the pursuit of the Kardashians".

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I am paid 1/2 of what the hospital based system and 75% of what the corporate owned practices are by our government mandated fee system. The hospital employs 75% of the doctors in my county now (because of the economics set up by the ACA) and has instructed their employed doctors to only refer to other hospital employed doctors. I don't even get notified when my patients end up in the ER. My name is often "mistakenly" left off the list of physicians on staff given to new doctors, or my training program is incorrect on the website they have andcreplaced with a less prestigious one I did not train at, or my office contact is "mistakenly" listed as THEIR number.

The hospital has also acquired all the ancillary services here-radiology, radiation, outpatient surgical centers. I am restricted from having ownership in my own ancillaries by provisions in the ACA which fortified the Stark regulations so I can't create my own. Everytime my patients get a scan or have a procedure they are identified, then contacted by a hospital employed "nurse navigator" who trues to convince them to switch their care to the hospital.

I survive because of my reputation in a small town...but the new doctor I brought in 2 years ago does not have a reputation yet. She told me she may leave when her contract runs out which means when she leaves and my other partner retires, I will have no one to cover me so I could take off. And I will have no one to share overhead expenses with...

There is no competition in healthcare. The government dictates everything, from fees, to how we write our notes, to what computers/software/ chairs etc we can have in our office. Every year it gets worse because, once passed, no rule or regulation ever goes away. They just get added to.