I was a bright, enthusiastic, and hopeful child full of dreams to help others. I fantasized about performing the most challenging and complex surgical techniques and then walking into a room with a humble smile while people greeted me with appreciation, hope, and respect for saving lives. I was offered a full scholarship to MIT for Computer Science and I passed it up to accrue hundreds of thousands of dollars in medical school debt in order to become a surgeon. MIT will you take me back? Please? Is it too late?

OK….. I was a dreamer. I genuinely believed–from the bottom of my heart–that all the brutal physical, mental, and financial sacrifices of training to become a physician would lead to a comfortable and tremendously fulfilling life—financially and emotionally.

Unfortunately, rather than enjoying the fruits of a hard-earned career this year, I noticed an alarming change in the dynamic of my career and where my surgical practice is headed. I tried to convince myself that I was just feeling pessimistic, and that nothing had really changed significantly. However, when I saw that every month my earnings have been declining, I decided that I needed to sit down and evaluate what has been happening to my practice. I focused exclusively on the last 6 months—the exact period since the inception of Obamacare. I sat down and looked at the numbers and trends in detail and I was horrified by the new reality of my private practice. I want to share with you what has been happening around me as a private practice physician since Obamacare was enforced.

The Electronic Medical Records requirement will lead to a 5% increase in my overhead costs. My surgical practice has spent hours looking for an Electronic Medical Records System to avoid penalization by the government. The costs of this new system (even taking into account incentive payments by the government) will raise our operating overhead by at least 5% a year. That will translate to tens of thousands of dollars in lost revenue for each doctor in our office. E-prescribing now leads to 2 extra hours of work per day for our office.

The number of my Medicaid patients has risen by 12% and the number of private insurance patients has declined by 22%. I must see three to four Medicaid patients to earn the same amount as one of my patients with private insurance

Referring doctor supply is shrinking rapidly. 20% of my referring doctors have left private practice completely! This was the most astonishing and disappointing discovery for me. Several doctors who used to refer me 10 patients a week, on average, have already quit medicine completely. One of my greatest referral sources is now earning 3X as much working as an HMO administrator, and many of my most loyal referring docs have moved to work for hospitals, large medical groups, or HMOs like Kaiser. Referrals of new patients have consequently plummeted dramatically.

Doctors retiring much earlier than before . 5% of my referring doctors retired from medicine in the last six months alone. They were young by retirement standards (in their 50s early 60s)

Concierge practices on the rise . 10% of my referring doctors have decided not to take insurance at all or have decided to practice “concierge medicine” and charge yearly retainers ranging from $500/patient to $20,000/patient. They are seeing fewer patients now and that means fewer surgical referrals. As a surgeon, the concierge model is not a viable option because we don’t usually treat chronic patients.

Emergency Rooms far busier with more (not fewer) uninsured patients. Another shocker. My emergency room on-call work hours at my local hospital have quadrupled and the number of uninsured patients that I have seen on-call has quadrupled as well. I am not sure why, but I am working four times as hard and collecting 75% less from the patients I see through the Emergency Room Panel.

I cannot provide a great education for my kids. I applied for private schools for my son for Kindergarten, because our local public school is not very good. The gifted track at our school system is even behind most regular public schools in other districts. When interviewing for the private schools, my friend who works for one of the admissions offices told me that I should try to hide the fact that I am a doctor. She said, “They rarely accept doctors’ kids (unless they are legacies) because doctors can’t afford the tuition anymore and are pulling their kids out.” She was right–we weren’t accepted to any private schools for my son. One of my patients who is a successful TV producer got his kid into three amazing private schools. My son is 5 years old and reads third grade level books. As a doctor, I cannot even provide my kid with the education he needs?

Increased patient morbidity due to transferring medical care from Physicians to Nurse Practitioners and Physician Assistants. I have seen a dramatic increase in Nurse Practitioners and Physician Assistants taking over the jobs of physicians to cut down costs. I have utmost respect for NPs and PAs. However, I have discovered GRAVE problems due to this rapid transfer in medical decision making and treatment to healthcare providers without medical school and residency training. In the last six months, I have seen one Nurse Practitioner misdiagnose a complex toe fracture as “cellulitis.” I have seen a Physician Assistant fail to recognize a patient who was having classic stroke symptoms. I operated urgently on a child who had appendicitis that was misdiagnosed by a Nurse Practitioner as a stomach flu and given Pepto-Bismol. I had two cases where I had to re-suture complex wounds that should have been referred to a surgeon but were repaired by Physician Assistants, and I had a patient who had Stage III breast cancer repeatedly missed by two different Nurse Practitioners who were hired by the hospital to perform breast cancer screenings and the list goes on.

If the California Anti-MICRA Law passes on the November Ballot, I will be forced to shut down my practice. The California Anti-MICRA measure—which raises the pain and suffering cap on malpractice cases exponentially—somehow landed on the November ballot. lf this deceptive law (hiding large financial incentives for frivolous and subjective malpractice lawsuits under the guise of physician safety measures) passes, it will surely force me out of business. I will no longer be able to practice medicine as the rising liability from this law and the rising medical malpractice premiums will completely wipe out my practice.

My revenue as a private practice surgeon is plummeting. This demise in the profitability of my surgical practice due to Obamacare is not a gradual process. These economic and personal losses are RAPID and DRAMATIC. My referral pool is rapidly dwindling. I am no longer able to provide a great education for my own children. My liability costs will skyrocket if this new California liability provision encouraging large payouts for “pain and suffering” lawsuits takes effect.

Doctors:

I sincerely hope that you are not experiencing any of these difficulties and that my personal situation is entirely unique. I hope that I am still a dreamer and that this is just one very long bad dream.

Sincerely,

Once Hopeful Surgeon