Those of us around for 2 or 3 decades inadvertently helped create this debacle by giving small discounts to insurance plans that turned into unsustainable reimbursements. It is young doctors who think private practice is impossible who need to be encouraged and supported in networks demonstrating that fee for service private practice can rise again and flourish. Physicians ultimately hold the best hands and our patients deserve the kind of care we were trained to give. Where there are big groups owned by hospitals, there should be many openings for practitioners who provide better service to blossom.

Businesses get leaner in periods of stress. How about a 10 percent cut in the budgets of all Departments other than intelligence and the military? There would be no decrease in service, only the necessary increasted productivity of the remaining workers. Redistribution of income will not benefit those to whom the income is distributed, because it will assure they don't have jobs.

Dr Sowell,

Your column exactly hits the mark.

Gratification in medical practice comes from direct patient interactions. More time meeting federal guidelines for quality, many of which have nothing to do with quality, figuring out exactly what code is needed to bill Medicare, and asking for and appealing denials for authorizations for needed procedures and tests occupy an obscene amount of time.

I wonder who sets these guidelines and how distant they are from good medical practice.

I also wonder why we physicians don't reclaim our authority over patient care, taken away by non-physicians in government and in hospital administrations.

Medicine can't be practiced without us. Patients deserve to have their...