Is private-practice urology becoming a thing of the past?

"Most definitely, yes. I think private practice will cease to exist in the next decade.

Physicians account for just 12% to 15% of medical expenditures, but we're poorly represented, and as a result, other organizations, such as the American Hospital Association, have taken advantage of us. Doctors are faced with a 7% reimbursement cut this year, while hospitals are immune to cuts until 2018.

Hal Scherz, MD
Atlanta

"I think 5 years from now, there will be private medicine. Maybe it's 'Pollyannic,' but I hope the federal government isn't going to consume private medicine. I plan to be practicing, and I'm 63 years of age.

Pressures are a lot worse on doctors now than they were 30 years ago. Financial rewards are not as great, government oversight and Medicare almost dare you to make a miscalculation on a charge, but tort reform in Texas has helped a bit.

I think at least a portion of the public will continue to want private medicine. They're not going to want to fall under the guidelines of the federal government, and that will keep private practice going."

Gordon B. Healey, MD
Port Arthur, TX

There are millions of people in the United States, and if someone is very skillful, there will be people who are willing to pay for their care.

For someone who wants to get involved in a specialty and really excel, you do need to promote yourself. You need Web presence; you need to develop relationships with other physicians, so when they see someone who needs a certain expertise, they will send them to you.

It won't work for all doctors, but if you develop unique skills few doctors have, you will be able maintain your independence."

Harold Reed, MD
Miami

"I stopped practicing a few years ago for medical reasons, although I had planned to practice many more years.

We have always been a volume-centered business; the more patients we saw, the more money we made. But with the proposed changes, physicians are going to reach a point where they are more than happy to sell their practices to a large organization, take a reasonable salary, and not have to deal with all the aggravation and problems of running a business.

The newer models may be more people-centered than economically centered. But I am worried that because it doesn't have that same independence and upward mobility potential, medicine won't attract the same kind of brilliant minds it has traditionally attracted."

Harley Wishner, MD
Calabasas, CA