The Physicians Foundation made shockwaves last month when it released its 2014 Survey of America’s Physicians. The survey’s top-line finding: Of the 20,000 doctors surveyed, almost 50 percent stated that Obamacare deserves either a “D” or an “F.” Only a quarter of physicians graded it as either an “A” or a “B.”

Count me among the discontented. Obamacare has harmed too many of my patients.

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It has done so by disrupting the doctor-patient relationship and thereby worsening the quality of patients’ care. This is the heart and soul of medicine, as I have learned in in my 33 years as a practicing physician. The doctor-patient relationship is critical for positive health outcomes because it allows both parties to work together to identify and ultimately treat medical problems. Simply put, a relationship of trust and continuity is essential to our professional mission.

Obamacare’s assault on the doctor-patient relationship first manifested this time last year, when my patients began receiving cancellation letters indicating that their plans didn’t meet the law’s minimum requirements.

Some of my patients were transferred to plans that did not include me in the physician network. In some cases this meant they had to find another surgeon to assume care while they were recovering from the first stage of a multistage surgical course. Others were enrolled in one of the Medicaid plans in which I participate. These plans make it difficult for me to coordinate with other specialists when treating cancer and other complex surgical patients because of the scarcity and distance of other specialists in the plan. And some could only afford plans that significantly limited their health care options.

No matter which option they chose, Obamacare forced my patients to make trade-offs between pricing, access, and quality of care.

Obamacare’s Medicaid expansion exacerbated this patient crisis. Arizona, the state in which I practice, expanded Medicaid in 2013 under the assumption that it would give the poor better access to medical care. Yet many of the new Medicaid enrollees—perhaps as many as 80 percent of them, according to one recent study—were merely forced off their private insurance plans and into Medicaid.

Several of my patients experienced this first-hand. They have found that Medicaid offers sub-standard health care compared to the private insurance they used to have. Their choice of doctors has been severely curtailed, even more so when it comes to specialists. Often they resort to the local emergency room rather than waiting weeks to get medical attention in a doctor’s office. An Oregon study revealed a 40 percent increase in ER visits among new Medicaid enrollees.

Unsurprisingly, patient health suffers when illnesses and diseases remain untreated, hence Medicaid’s persistently poor ratings on patient health. Unfortunately, my patients were forced into this broken system without a second thought.

Nor does it appear that any thought was given to the regulatory burden that Obamacare has imposed on physicians. In their zeal to regulate and standardize health care, the law’s authors empowered bureaucrats in Washington to drown doctors like me in a deluge of paperwork and reporting requirements.

This has only forced doctors like me to spend less time treating patients. Compared to when Obamacare was passed, I now spend roughly half my time on data entry and administrative work. I feel more like a data entry clerk than a doctor. Surely this time would be better spent in the treatment room or on the phone with patients conducting follow-ups.

I could keep going. Obamacare was passed on the promise that it would expand and improve medical care—indeed, that it would make quality health care universal. For too many of my patients, this promise has been broken. This is precisely why doctors disapprove of Obamacare by nearly a two to one margin. Until the law stops failing our patients, we won’t stop giving it a failing grade.

Singer practices general surgery in Phoenix, Arizona and is an adjunct scholar at the Cato Institute.