Dr. Lake used to be a businessman. His books were clean and orderly. His staff was efficient and kind. He steered his ship agilely through troubled waters and still managed to provide the highest quality care. His was not only physician but small business owner. He was proud.

As the political climate changed, Dr. Lake became more distressed concerning his situation. His overhead was increasing and the regulatory culture was expanding. Laboring under the strain of advanced technology, the time for patient care diminished.

Looking in the mirror one morning, Dr. Lake decided that this wasn’t the job that he trained for. He shuttered his doors, and signed a contract with the hospital owned medical group. At least now he would be able to ply his trade and leave the regulations to someone else.

Dr. Lake used to be a hospitalist. Trained in the care of the complex ailing individual, he enjoyed rounding at the hospital between appointments in the office. The bonds formed with each patient were strengthened by being available in times of greatest need. He took pleasure in seeing the nurses and consulting physicians on a daily basis. It was a community.

So when the administrators started to enforce the rule about using the medical groups hospitalist program, Dr. Lake felt a certain sense of loss. It was true, however, that unencumbered by those troublesome phone calls and travel time, he could see many more patients in the office.

Dr. Lake used to be a kind of emergency room. Often the sickest patients would walk through the door needing immediate treatment or triage. The phone lines were always open, and there was always enough space to fit someone into the schedule.

But as the onslaught of physicals, well patient visits, and followups increased, Dr. Lake found it easier to refer to the emergency room. After all, he couldn’t just sit on the patient with abdominal pain for 24 hours while he tried to find a space in his schedule. And what if they needed a CT scan?

Similarly, the patients who wanted to be seen for colds and flu had to be scheduled a week in advance. Dr. Lake occasionally resorted to suggesting pharmacy clinics to lighten his load.

Dr. Lake used to be a master diagnostician. His skill was honed over years of experience and reading. Unlike his specialist friends, he was able to see the patient as a whole. While his knowledge was not as deep, his range was far greater. There was nothing more satisfying than making a difficult diagnosis.

If only there was enough time to use his clinical acumen. Dr. Lake was to busy with an overbooked schedule, and checklists and boxes to fill on his brand new electronic medical record. If he worked up each patient appropriately, he would have to keep his office open till midnight. A good thing his specialist friends were salivating to take his referrals.

Dr. Lake used to be a physician. But one day an administrator from the medical group called to say his position was being filled by a nurse practitioner, PA, or a medical assistant. A person of his pay grade and education was no longer appropriate for the job.

As he packed up his office, he wondered what the future would hold. His best employment opportunity was to work as a consultant for a pharmaceutical company.

In a moment of clarity, Dr. Lake divined that he had been sold down the river.

He also realized, that he had done quite a bit of paddling on his own.

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion.

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