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“Physician practices are different from almost any other small businesses,” said Dr. Jerry Kennett, chairman of the American College of Cardiology Advocacy Steering Committee. “The payment for services performed is not controlled by free-market dynamics, but instead payment is tightly regulated by Medicare and Medicaid and private payers.”

Doctors also have to deal with more paperwork than previously. For physicians with small private practices, this means more administrative work, about which they often are untrained or unsavvy, and less time with their patients. Not content with that reality, many are leaving their businesses to join hospitals that take care of the paperwork for them.

Mr. Smith said doctors spend an average of 15 hours a week doing paperwork. It’s “alien to the mindset and makeup of many physicians,” who have never had business training, he said.

“It has been reported that the U.S. federal tax code runs to some 75,000 pages,” Mr. Smith explained, “whereas the Medicare regulatory code by which physicians must abide runs to 130,000 pages.”