**The Obstacles and Fortitude of Independent Physicians: Perspectives from Neurologist Scott Tzorfas**

The intricacies of the American healthcare landscape are widely acknowledged, with few grasping this reality as well as independent physicians. Neurologist Scott Tzorfas, who boasts three decades of experience in private practice, illuminates the arduous circumstances that independent doctors encounter due to overwhelming bureaucracy. In a discussion featured on the KevinMD podcast, Dr. Tzorfas elaborates on his piece, “The Crushing Bureaucracy That’s Driving Independent Physicians to Extinction.”

**The Bureaucratic Battle**

In his writing, Tzorfas outlines the effects of relentless pre-authorizations, insurance refusals, and regulatory pressures that undermine the physician-patient bond. Intrusive regulations and third-party involvement have driven many clinicians to the point of selling their practices or retiring prematurely. This transformation results in patients facing diminished options and extended delays in receiving care. As Tzorfas points out, this trend is propelled by profit-driven motives and bureaucratic hurdles rather than prioritizing patient care.

**Reduction of Independent Practices**

Recent years have seen a notable decline in the count of private practice physicians. Tzorfas notes that fifteen years ago, 75% of physicians operated independently. Currently, that figure has plummeted to merely 25%. He attributes this reduction to heightened regulations and diminished reimbursement rates designed to steer doctors toward hospital employment. Vertical integration by hospital networks, intensified during the Obama era, has financially strained private practices by favoring hospital-employed physicians.

**Administrative Strains: A Day in the Life**

For physicians like Tzorfas, managing a private practice necessitates considerable administrative skill. As much as 50% of his time is spent on the business operations of his practice and navigating ongoing administrative shifts, such as updating billing systems or overseeing communication services. The time diverted from patient care — for paperwork, audits, and system upgrades — acts as a considerable disincentive for many contemplating private practice.

**The Influence of Regulation**

Tzorfas brings attention to regulations like MIPS (Merit-based Incentive Payment System) and MACRA (Medicare Access and CHIP Reauthorization Act), which impose substantial data entry obligations on physicians, often unrelated to patient outcomes. He also references the Misvalued Code Initiative, which effectively reduced payments for certain medical procedures, compelling numerous specialists to leave private practice for hospital systems.

**Maintaining Independence and Choice**

In spite of these adversities, Tzorfas is steadfast in his commitment to private practice, highlighting the critical nature of independence and patient relationships that independent physicians provide. He advocates for a transformation in incentives to nurture entrepreneurship among emerging doctors, possibly through reduced regulations or financial benefits like tax breaks. He also emphasizes that medical schools should familiarize students with private practice frameworks, ensuring awareness of various career pathways.

**The Prospective Outlook**

Tzorfas introduces a petition intended to engage lawmakers in reducing excessive regulations, promoting a healthcare system that nurtures both the sustainability and expansion of independent practices. He believes patients should have the option to consult independent physicians, and doctors ought to have the liberty to practice beyond large corporate healthcare systems. Tzorfas’s narrative serves as both a warning regarding bureaucracy’s ramifications on healthcare and an appeal for the preservation of independent medical practices for upcoming generations.