People don’t realize how much physicians sacrifice for our careers. The dedication to medicine is all consuming; financial, emotional, physical, personal; medicine is our life. We love what we do, sometimes to our own detriment. Those of us in primary care have/had large educational debts and knew this was part of it, but historically physicians earned enough income to pay student loans back in about 10 years. Now the cost is higher for undergraduate and medical school tuition and income is lower relative to inflation and the cost of living; our income has remained essentially unchanged over 20 years. The healthcare insurance companies are making billions in profit while ‘pimping’ out physicians. We have lost our power to them. They control the reimbursement schedules and contracts. They do not take into consideration the costs to run a medical practice, especially a solo/private practice. We are gradually being snuffed out, absorbed by big corporate healthcare businesses, against whom we can not compete. Pharmacuetical companies are next, driving up the cost of healthcare, making billions in profits, if not trillions. But physicians get blamed for the rising cost of healthcare, when it’s those two metropolis’s who are driving up the cost. Many people think physicians make a large income too, some do, but pediatricians and family practitioners do not. And we are the ones in the trenches, doing all of the foot work. We are responsible for preventive care, screenings, making differential diagnosis’s, treatment interventions, referrals to specialists, hospital inpatient and out patient care, office follow up, coordinating care between all other physicians and ancillary medical entities, documenting all of these encounters plus telephone triage, and finally 24/7 call coverage. We do this because we are the patient’s medical home; it is part of practicing primary care medicine and we are trained to do all of this, this is our expertise, but over the last 30 years we have lost control over our discipline. We now have to almost beg, spending hours in appeals to justify the standard of care we trained 11+ years to determine, for permission to order a test or procedure. Now with all of the new rules from the federal government and medicine becoming more technical, we are required to have electronic medical records (EMR) so more and more documentation is required, to the point of impossible requirements, making unreasonable unrealistic non sustainable demands on small practices. We choose our specialties because we are passionate about helping people and love what we do, not for the pay although we desire a lifestyle comparable to someone with our level of esteemed training, medical legal risk and responsibility taken, near all time consuming administrative as well as clinical practice demanded, and not to mention the personal and business financial investments made. Small practices are going to become obsolete if things don’t change. We, physicians, are beginning to fight back. We refuse to go quietly into the night..