Dr. Marcus Conant, among the first AIDS specialists in San Francisco, who for decades had one of the world’s largest private practices for patients with AIDS and HIV, has left town and moved to Manhattan.

He has been a physician for nearly 50 years, but like many doctors, in the past decade he has become increasingly frustrated with insurance challenges that made running a private practice unnecessarily complicated and a financial nightmare, he said. He tried to run his practice part time, using his personal savings to keep the clinic open. “The bottom line is, you cannot make a living practicing medicine unless you work at least 50 to 60 hours a week,” he said. “I’m not the only doctor who’s getting to the point where it’s not worth it.”

This is what happens when the business model of a doctor’s practice is determined by bureaucrats in Washington with very little clue about how the practice of medicine really works.

They’ve decided for doctors that we’ll get paid for strictly office visits and procedures when, in fact, being a good doctor is much, much more about good communication and solid relationships than the maximum volume of patients you can see in a given day.

Last year, I wrote a piece showing how Medicare is systematically devaluing primary care in collaboration with the specialists.

Under today’s business model of medical care, it is financially impossible for doctors to be good doctors. And, remember, every month you hand over your insurance premiums to the insurance companies, you are propagating this broken system with your own money. Things will not change until people, like you and me, demand change with our wallets.

Jay Parkinson is a pediatrician and preventive medicine specialist and founder of The Future Well. He blogs at his self-titled site, Jay Parkinson + MD + MPH.

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