Change is hard. I’ve been practicing medicine for 30 years. I’ve seen many different changes in medicine, especially in the way physicians are reimbursed. These changes have greatly affected the way we practice and how our patients view us as a profession. I began my career with fee for service, then went to a discounted fee for service, followed by managed care with HMO’s, and back to a fee for service based on RBRVS, a relative value scale which pits doctor against doctor to split the shrinking health care dollar. Although I can long for the day when our contract was with our patients, and not with huge third party payors, we can’t force that toothpaste back into the tube.