One of the most profound changes brought about by the Affordable Care Act is that it drove thousands of independent doctors to throw in the towel and join large hospital networks. This is particularly true of primary care doctors. As the rules involving medical records, billing codes, and prior authorizations have gotten more complex, physicians find they can't survive without joining large healthcare networks. And they're becoming increasingly demoralized.
Today there's a small but growing movement of doctors who are opting out of the traditional healthcare system by no longer accepting insurance. This new approach is called "direct primary care," but it's essentially a throwback to an era before insurance companies were responsible for covering routine services like ear infections or strep cultures.