"Primary care is dying in this country, largely because the the government which sets both the amount that doctors are reimbursed for their time as well as pattern by which private insurance reimburses, has decided that cognitive skills are less valuable than throwing a lot of procedures at the patient."
"A few years ago I realized that my bonus, based on my "quality" management of diabetes, was compromised by the poor quality of my patients. I then dismissed many of the alcoholics and non-compliant (more correctly, I maneuvered them to dismiss me -- much less hassle); and my bonus scores have greatly improved. I thought I was clever, but I've come to believe that this is exactly what the the network, the insurance companies, and the gov't, wants me to do."