This really nails it

Sometimes you read something that nails it so good , that condenses so many killer insights into one long sentence that you go way past wishing you had said it (the important thing someone said it) that you just want to shout it out to whoever will listen.And that is what I will do now to my tiny band of regular readers and the more readers who wander in from a Google hit on whatever.

That something (I know I have quoted this before but I want everyone to read it) is from The Covert Rationing Blog by DrRich who said this:

These reverse incentives, we’ve seen (we being readers of this site), are aimed at actively stamping out, eradicating, and punishing any self-motivated physician who tries, despite all obstacles, to deliver excellent
healthcare. Among these are the mandate that primary care doctors spend only 7.5 minutes per patient encounter; invoking the magic of P4P to determine exactly what must and must not take place during that 7.5 minutes; grabbing the right to interpret clinical science in order to formulate the “guidelines” that inform P4P; coercing doctors to agree to egregious adhesion contracts that any sane person would find unconscionable; forcing doctors to practice under a set of coding “guidelines” that prevent good patient care and serve as traps for “fraud;” and in general, making every patient encounter subject to a web of regulatory speed traps that force doctors to concentrate on keeping the OIG at bay rather than on what the patient needs. In short, in their efforts to gain control of physicians’ behavior in order to covertly ration healthcare, American Wonkonians are creating insurmountable, systematic disincentives for excellence and penalties for non-mediocrity. They have placed doctors in the untenable position of being utterly unable to fulfill their professional, traditional, legal, and ethical obligations.

The only way doctors have a realistic chance of attaining excellence under such a system, so as to service at least the rich, the connected and the quick-witted, is to abandon the system altogether.

The more I read and think about it and discuss it with colleagues (active and other retired docs) the more I agree with DrRich's analysis and his conclusion. One route to abandon the system may well be the various versions of a retainer system that are sprouting up and in that regard if you want to learn more go here to hear from Dr. Chis Ewin who does more than talk about it.