I feel sad for the doctors

I’ve been super hard on the doctors, but this DOJ complaint makes me feel really sad for them. Some of them write to the government for help in very genuine and heartfelt ways.

Comment ID

ATR-2025-0001-0110

Tracking Number

mar-3mvh-ixk6

Why I’m Ready to Leave Medicine — A Physician’s Honest Confession

I’m a board-certified internal medicine physician who completed residency in 2016. And despite years of sacrifice, training, and a deep desire to serve my community, I’m on the verge of leaving medicine altogether.

As a married mother of three, I gave over a decade of my life to pursue this dream. I commuted four hours daily to attend an out-of-state medical school, then three hours daily for residency — a total of seven grueling years, riddled with abuse, exhaustion, and humiliation, all for the goal of becoming a compassionate primary care physician. I wanted to serve the underserved, particularly the elderly — a population I deeply respect and believe deserves dignity and high-quality care.

In 2019, I joined a private practice that had been rooted in the community for 40 years. I was hopeful. They were independent and I thought I had finally found a place to practice ethically. But I quickly discovered it was just a façade. The focus was not care — it was profit. That became especially clear during the pandemic when I was asked to “supervise” nurse practitioners on paper — essentially committing insurance fraud — without any involvement or oversight on my part.

The pressure wasn’t to help people, but to increase RVUs. Eventually, the practice sold out to a large health system in Connecticut. Despite being offered partnership, I couldn’t participate in what had become a rigged system — one that exploits both patients and physicians.

I tried to build something better. I opened a practice with the goal of providing ethical, personalized care. But getting credentialed with insurance was a nightmare. UnitedHealthcare offered me less than 70% of Medicare rates — and refused to negotiate. They could do this because they control the market. Other insurers like Aetna, Anthem, and Cigna delay approvals, deny claims, and intentionally obstruct care because they know there are no real consequences.

I initially chose to accept traditional Medicare in order to serve the elderly population fairly and transparently. However, it became clear that private insurers had infiltrated that space, often delaying payments and denying necessary care. This exploitation has been enabled, in part, by the government’s aggressive push for Medicare DISAdvantage — a program that increasingly limits patient choice and physician autonomy.

Given these challenges, I made the difficult decision to opt out of Medicare entirely. Compounding the issue, CMS — the agency tasked with oversight — has failed to prevent widespread abuse, including upcoding and fraudulent billing practices that have been ongoing since at least 2011. Despite repeated warnings from the Office of Inspector General (OIG), little meaningful action has been taken.

UnitedHealthcare led this charge, but they are not alone. All major insurers engage in similar tactics and are rarely held accountable. Today, more than 70,000 physicians are directly employed by UHC, raising serious concerns about conflicts of interest and the erosion of independent medical judgment. What happened to enforcement of the Stark Law?

The vertical integration of insurers, healthcare systems, and physician networks has been allowed to flourish — not despite regulation, but because it serves the interests of those in power, including the government itself. It’s a system built not on patient care, but on profit — and it’s failing the people it claims to serve.

I’ve become deeply disillusioned. Medicine today is a corporate machine — one that uses both physicians and patients as pawns for profit. Hospital systems have consolidated to force compliance and silence dissent. Insurance companies dominate entire regions, denying care and underpaying providers, all while enriching shareholders. Even lab giants like Quest exploit the system — charging cash patients $4.32 for a CBC while billing insurance $47 for the same test.

It’s legalized exploitation.

The system rewards volume over value, profit over ethics, and secrecy over transparency. And the government has allowed this to flourish — through inaction, deregulation, and entanglement. How can we expect fairness when politicians are allowed to invest in insurance and healthcare stocks?

I hope this administration is serious about dismantling the monopolies that previous ones allowed to grow. Because the current system is broken — not just for physicians like me, but for every patient who trusts it to deliver care.

Enough is enough.

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You can browse all the public comments on antitrust in healthcare here: Regulations.gov

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The “funny money” insurance vs no insurance lab charges were really bad when I had no health insurance (pre-existing condition) for a couple decades.

My favorite doctor of all time - I saw him for about 12 years and no other doctor ever cared so much and tried so hard - retired from the healthcare profession circa 2018 to become a forest ranger. Yes he was so frustrated with dealing with insurance companies clamping down on care, that he became a forest ranger.

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In the early 1960s when I was having my children, health insurance was in its infancy. Doctors made house calls. They made arrangements for people who did not have a lot of money. They decided which hospitals they wanted to bring patients into. It was completely different then, before both hospitals and doctors were owned by health insurance companies, by management companies, and by the pharmaceuticals. And pharmaceutical companies did just that… produced safe and effective products that had been fully researched and tested, plus vaccines that were truly vaccines (the two polio vaccines) that were disseminated for free to the public. Today, greed and bureaucracy have taken over.

:sweat_smile:

That’s funny. My locals are trying to find places to hide me (deep in the forest) where the insurers can’t get me. Those times you mention were bad times. I forgot all about that.

I would NEVER know those times existed if you all hadn’t told me.

I got Doctors in uprisings. They might control DOJ now. FTC belongs to the diabetics and the pharmacists. It’s still too early to say, but I think I’m seeing movement. People said it was impossible and the Docs would never move. But they say everything is impossible until it happens.

We have built a triad of trouble if the docs move.

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Here’s another doctor comment to DOJ that they say is good:
Certificate_Of_Need.docx (17.4 KB)

Comment ID ATR-2025-0001-0053 Tracking Number m9p-z3vl-9fp5

Link to this Public Comment: https://www.regulations.gov/comment/ATR-2025-0001-0053

As a physician and surgeon with 35 years experience both in private practice and in developing and operating an ambulatory surgery center (ASC), I am writing to comment on the anticompetitive legislation still in force in many states known as certificate of need (CON). My perspective is especially relevant with regards to combating the unsustainable increase in the cost of health care.

An industry trend that is widespread in health care is the massive consolidation manifested as mergers and acquisitions by hospital systems, which has resulted in the purchase of physician owned practices by hospitals. This is driven by hospitals’ efforts to control their referral streams, by acquiring both primary care and specialist physician practices. This has directly led to cost increases for identical outpatient services that were previously rendered in physician offices under a “site of service” differential payment system that pays much higher rates for care provided in physician clinics re-designated as “HOPDs” (Hospital OutPatient Departments).

In my field of expertise, that of ambulatory surgery centers, it has been well documented that the reimbursement for identical surgical procedures in the ASC setting is approximately 40% lower than in the HOPD setting. This is despite costs being the same for staffing, equipment, and supplies. In addition, there is consistent data that shows surgical outcomes, infection rates, complication rates, readmission rates, and patient satisfaction all strongly favor ASCs.

The federal National Health Planning and Resources Development Act of 1974 required states to implement CON laws to receive federal funding, leading to nearly all states adopting some form of CON program by 1982. These laws, initially intended to control healthcare costs and improve access to care, were later found to be ineffective and even detrimental to patient care. In 1986, the federal government repealed the mandate. As of this writing, 35 states still carry these laws on their books. The effect of CON laws amounts to a competitor’s veto.

Depending on the state, providers apply for permission through state health agencies or departments, or special boards or commissions whose members are appointed by governors or state legislatures. This is where the term “certificate of need” comes from — if you want to build a new hospital wing, an ASC, care center or even buy more hospital beds, you need to prove to state health administrators that these new services are needed by the community. But that’s not all; incumbent providers also get a say in the matter. It’s like McDonald’s needing permission from Wendy’s before it could open a new store.

There is no credible evidence that abolishing CON laws will lead to widespread hospital closures, especially in rural areas. This fear-mongering has frightened many state legislators away from CON reform or repeal, since hospitals are all too quick to raise the specter of hospital closures, especially in communities where hospitals are large employers. This argument does not hold water, especially in communities with so-called non-profit hospitals that are tax exempt. In fact the preponderance of economic research on CON laws has consistently shown that access to care, hospital beds, imaging equipment (CT, MRI, etc), per unit population and clinical quality of care is actually INFERIOR in CON states than in non-CON states.

At the Georgia Advanced Surgery Center For Women in Cartersville, GA, we have documented in the past 15 years the safety and superior outcomes of essentially ALL non-cancer gynecologic procedures encompassing thousands of surgeries. These include procedures such as hysterectomy which are still performed in HOPDs in well over 95% of cases.

A strong incentive for driving care to the ASC setting, in addition to eliminating CON, would be to abolish Medicare’s inpatient-only (IPO) list which excludes certain procedures from Medicare payment when performed outside of inpatient settings. The IPO list overrides the clinical expertise of doctors and desires of patients. Medicare will also not pay for surgical procedures in ASCs unless they meet the regulatory standards for inclusion on the ASC covered procedures list (CPL). Similar to the IPO list, the ASC CPL’s intent of protecting patient safety prevents doctors from exercising their own judgment to deliver services in lower-acuity and less expensive settings.

It is a known fact that CMS policy lags, sometimes by years, technological advances in anesthesia and surgical techniques which have allowed surgeons to perform much more complex and higher acuity procedures in an outpatient setting with high quality outcomes. Examples include not just hysterectomy, but major orthopedic procedures such as total joint replacements. The opportunities for cost savings without compromising outcomes when applied across the board to all eligible surgical specialties is staggering.

My paternal grandparents had 4 children with all birth assisted by the same GP. 3 were born at home and the menopause baby in hospital.

This same doctor ran a free clinic twice a week in a poor working class area. He funded this out of his pocket.

In those days his office staff consisted of him and his wife. Low overhead plus steady income allowed him to help those who were unable to pay.

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