Son of an OB/GYN practicing in the Pittsburgh market here.
Pic related pretty much explains things. UPMC keeps buying up hospitals and clinics and everything, and the contracts to have practicing privileges at any of their facilities effectively makes you a salaried employee for the company rather than an independent professional.
Hospital administrators (at ones still independent) also mess around with physician certifications and a lot of other stuff which are simply cumbersome for the physicians. Insurance reimbursement rates are low. HMO's are penny pinching know-it-alls that inhibit the doctor-patient relationship.
At the same time, the red tape and reimbursement rates for the government aid programs are a drag. Let's not get into the matter of tort law and ridiculous lawsuits.
So I came across this article which championed the return of medicine to a medieval setting:
>having state-chartered physicians' guilds which would own all the productive capital >provide insurance plans to people >train apprentices rather than people blowing loads on medical school for an uncertain future>would handle matters of medical malpractice in-house, instead of the slickest lawyer pursuading a jury guaranteed during selection to have no medical expertise in it>would have a legally enforced monopoly, but the charter could be revoked by the state and new one given to another emergent association should the old one grow corrupt, incompetent, etc.http://distributistreview.com/mag/2011/07/distributism-and-the-health-care-system/