Dear Patient...this is your doctor writing you today to let you know that I will no longer be able to continue your medical care due to insurance contract changes and your carrier just does not allow adequate payment for the services I provide. 

Almost sounds very similar to a "Dear John" letter...is this a continuing sign of the times for our physicians?  BD

One of the joys of being a family doctor is the relationships that I've developed with my patients over the last 10 years. It's the source of energy that keeps me going after a night up delivering babies or a day of business hassles. The sense of being needed and contributing to the fabric of the community is the best job satisfaction there is.

The relationship between physician and patient, like the family farm, is endangered. In some places, I'd say it's already extinct.  And that's unfortunate. For starters, a relationship with a doctor can help provide a safety net when you lose your job and your insurance, or become disabled.

Now primary-care doctors are pressured to churn patients through the office, to the detriment of relationship-building and possibly the health of their patients. At the same time, patients may have to switch doctors because of changes in their insurance.

Some programs have interfered more with my care of patients than I bargained for when I signed up -- referral processes and the hoops the patients and I have to jump through to get basic things done are ridiculous and can undermine patients' confidence in me. I wouldn't sign up again for such programs knowing what I do now.

As much as I hate to do it to my patients, I've had to turn insurance contracts down because of inadequate reimbursement and let some patients find a new doctor.

The Doctor's Office - WSJ.com

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