Medicare’s excessive regulatory infrastructure is accelerating physician burnout, driving consolidation, and worsening access to care for America’s seniors, particularly in rural and underserved communities. Having just testified before the U.S. Senate on physician workforce challenges, I can attest that physicians are not quitting because they want to, but because the economics of running a sustainable medical practice have become nearly impossible.
Independent physician practices have long served as the backbone of American medicine. They deliver continuity, accountability, and relationship-centered care that is especially critical for older adults managing chronic illness. That foundation is rapidly disappearing in favor of unaccountable healthcare giants.
Across the country, independent practices are closing or being absorbed by hospitals, private equity firms, and large corporate health systems. This shift is not being driven by patient preferences, quality concerns, or clinical outcomes. It is driven by federal payment structures and regulatory requirements that impose administrative costs unrelated to patient care and largely independent of practice size.
Medicare regulations now permeate nearly every aspect of clinical practice. Importantly, many commercial insurers follow Medicare’s regulatory lead, importing the same documentation rules, coding requirements, and quality programs into private contracts. As a result, physicians experience these burdens as pervasive, regardless of payer.
Physicians, regardless of practice size, must comply with complex coding systems, documentation rules, multiple quality reporting programs, audit exposure, and continuously evolving compliance requirements. Each program may appear reasonable in isolation. Taken together, they consume an extraordinary share of physician time and resources that would otherwise be devoted to patient care. These compliance costs do not scale with patient volume, imposing similar burdens on a two-physician rural practice as on a multi-hundred-provider health system.
These pressures have intensified in recent years, accelerating early retirement, part-time practice, and physician exit, even as many who remain report profound moral injury from practicing under constant administrative strain.
This dynamic all but guarantees consolidation. Large hospital systems are better positioned to absorb compliance costs and are paid more for the same services due to flawed site-of-service payment policies. Independent practices, by contrast, are squeezed from every direction. Many physicians have responded by leaving traditional insurance-based practice models altogether. One alternative that has emerged is Direct Primary Care (DPC), often mistaken for concierge medicine, but structurally distinct.
Under DPC, practices do not bill insurance and are not subject to Medicare documentation, coding, or quality reporting programs. As a result, administrative overhead is dramatically reduced, allowing practices to remain financially viable with smaller patient panels and greater clinical capacity per patient. The rapid growth of DPC reflects substantial patient demand for this model.
DPC is not offered as a policy prescription, but as a real-world observational contrast. It demonstrates how primary care functions when administrative design is fundamentally altered.
Today, Medicare guarantees coverage, not care; a physician burdened by unsustainable administrative load may still show up, but attention is divided between patients and paperwork, while a physician who leaves practice delivers none. If Congress wishes to preserve access for older Americans, particularly in rural and underserved communities, administrative simplification must be treated as necessary policy. Without reform, consolidation will continue and the doctor-patient relationship will fracture beyond repair.
Dr. Lee Gross is a family physician who has practiced full time in Southwest Florida for more than twenty years. He is founder of Epiphany Health, one of the earliest Direct Primary Care practices in the United States.
