As a board-certified neurologist in independent practice for three decades, I’ve watched the soul of medicine slowly erode, not due to a lack of compassion, skill, or science, but from a suffocating bureaucracy that has infiltrated every corner of patient care. Private practice doctors across America are being regulated, pre-certified, audited, and administratively strangled out of existence.
Each week in my office, my staff and I spend countless hours fighting with insurance companies, not to get paid more, but simply to get permission to order basic tests or prescribe FDA-approved medications. Pre-authorizations for brain MRIs, denials for life-altering seizure medications, or repeat appeals for medications that a patient has already been stable on for years have become the norm.
It is not medicine; it is a slow administrative death spiral.
The pre-authorization process has ballooned into an industry of its own, with third-party companies profiting off delays in patient care. The average physician now spends 13 hours a week on prior authorizations, according to the AMA. For a solo or small group practice, that is the equivalent of hiring a full-time employee just to beg for permission to treat.
Worse yet, these denials are often made by non-physicians or doctors in unrelated fields who never examine the patient. I recently had a patient with low back pain and radicular symptoms. I could not get her MRI of the lumbar spine approved. She had to go to the emergency room to get the MRI of the lumbar spine, was admitted to the hospital, and had her surgery the next day.
At every level—federal, state, and insurance—regulations grow while physician autonomy shrinks. MACRA, MIPS, “value-based care,” quality measures, electronic documentation mandates, surprise billing laws, good faith estimates, and billing audits now dominate our daily work. The irony: None of this has improved care for the average patient. It has simply redirected resources away from the bedside and toward screens, checkboxes, and compliance consultants.
Private practices, once the backbone of American medicine, are being squeezed out. More physicians are selling to hospital systems or retiring early, not because they want to, but because they can’t function under the weight of non-clinical interference. What is left behind are fewer choices for patients, longer wait times, and less continuity of care.
This is not just my story. It is a national crisis hiding in plain sight, and it demands a unified voice from both physicians and patients.
To that end, I have launched a petition to call for the restoration and protection of private practice medicine in America. The petition calls on policymakers to roll back excessive regulations, reform pre-certification abuse, and defend the independent physician’s ability to treat patients directly, without interference from corporate middlemen.
If you believe that your doctor—not an algorithm or a distant clerk—should be making your medical decisions, I urge you to read and share it.
Once independent medical practices are gone, they won’t come back. When you replace trusted, long-term physicians with corporate protocols and revolving door providers, medicine becomes something colder, flatter, and far less human.
If we do not act now, the next time you need care, your doctor may not be a doctor at all—just someone reading off a screen, waiting for an insurance approval that might never come.
Scott Tzorfas is a neurologist.
