For Clay, the cardiologist, the final squeeze began last fall when the 22 doctors in his practice were told that their insurance carrier was dropping Pennsylvania as of Jan. 1. Researching options for new policies, the doctors found that they faced huge costs or higher risks.
And the headhunters - who are swarming all over Pennsylvania - were at the door. Clay, who is married with three sons, decided to join a practice in Wilmington, Del., remain in his house in suburban Philadelphia and make the 50-minute trip each morning.
The human cost
The effect on his income is only part of the equation, he said. "It has changed the entire way we practice medicine. We've closed offices. Meetings often are about how can we survive rather than offering new therapies or expanding services."
Now, as he looks at his patient list in the morning, he sees the faces in his mind and winces at the thought of telling them he's leaving.
Blanche Mycek, 76, was one of the tough ones. Clay has treated her since she received a diagnosis of congestive heart failure two years ago. Clay took his time trying to find the right medication to avoid an invasive procedure, said her daughter, Eileen Ryan.
"It's exactly like he was treating his own mother," Ryan said. "His bedside manner and patience and kindness were overwhelming."
Mycek cried when Clay told her. The doctor, too, had tears in his eyes.
"I filled up. It was very emotional," Ryan said.
Ryan says she would like to follow Clay and is willing to make the hour-plus drive but fears that her mother's insurance won't allow it. An initial conversation with the carrier did not leave her optimistic. Most importantly, she worries about emergencies.
"She's so distraught over it," Ryan said. "How can you force a woman who's 76 years old with a heart condition to go to somebody else when she doesn't want to go?"