Oct 1, 2026 · 35 min · 11 segments
As we've noted on *Raise the Line from Elsevier* before, the system Americans rely on to keep vaccine recommendations grounded in science has changed in ways that many in the medical community find…
Jason GoldmanGuest
Lindsey SmithHost
I'd imagine over time, though, that day-to-day realities of practice looks different now than what it did when you first started.
So you've been a practicing internist for nearly three decades, and you've been sounding the alarm about the pressures that are impacting primary care from the administrative burden, shrinking reimbursements, all of it.
You know, I've been referred to as a dinosaur because I still have a private solo practice.
I see all my patients, make the phone calls, talk to all my patients, and really have hands-on approach.
Sadly, that is exceedingly rare in this day and age because the shift has gone to corporatization, private equity, ownership by a health care system as opposed to individual practices.
As long as I've been in practice, we've been facing Medicare payment cuts, which are an ongoing annual problem.
why they ever decided to first tie our reimbursements to a gross domestic product and something called the sustainable growth rate, which they then changed to a MACRA and MIPS program for quality improvement without any data validation as to what they consider quality improvement.
and then issues of budget neutrality, where they have a fixed pool of money for physician services that have to remain neutral, and we're the only field in healthcare that has to face this.
So if they create new procedures or codes that, for example, will increase payment to primary care, They're going to have to decrease it from someone else, like surgery or radiology.
It's inherently unfair because you do the work that you need to do, and it shouldn't be based on whether someone else is doing more or less work.
The hospitals don't face that, ambulance companies, nursing homes, only the physicians.
So that pressure of decreased reimbursement, and we're paid less now than we were 30 years ago, when you adjust for inflation, has driven people out of private practice because it's somewhat unsustainable.
I'd imagine over time, though, that day-to-day realities of practice looks different now than what it did when you first started.
So you've been a practicing internist for nearly three decades, and you've been sounding the alarm about the pressures that are impacting primary care from the administrative burden, shrinking reimbursements, all of it.
You know, I've been referred to as a dinosaur because I still have a private solo practice.
I see all my patients, make the phone calls, talk to all my patients, and really have hands-on approach.
Sadly, that is exceedingly rare in this day and age because the shift has gone to corporatization, private equity, ownership by a health care system as opposed to individual practices.
As long as I've been in practice, we've been facing Medicare payment cuts, which are an ongoing annual problem.
why they ever decided to first tie our reimbursements to a gross domestic product and something called the sustainable growth rate, which they then changed to a MACRA and MIPS program for quality improvement without any data validation as to what they consider quality improvement.
and then issues of budget neutrality, where they have a fixed pool of money for physician services that have to remain neutral, and we're the only field in healthcare that has to face this.
So if they create new procedures or codes that, for example, will increase payment to primary care, They're going to have to decrease it from someone else, like surgery or radiology.
It's inherently unfair because you do the work that you need to do, and it shouldn't be based on whether someone else is doing more or less work.
The hospitals don't face that, ambulance companies, nursing homes, only the physicians.
So that pressure of decreased reimbursement, and we're paid less now than we were 30 years ago, when you adjust for inflation, has driven people out of private practice because it's somewhat unsustainable.
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