That’s the format of a joke I often told about calling up state regulators when I was in private practice. They go off duty at 5 p.m., so the phone stops being answered at a few minutes before because a conversation started at 4:57 p.m. might go beyond 5 p.m., and they don’t get paid for that.

It’s coming to a doctor near you because Obamacare regulations are pushing doctors to become employees rather than owners, as Scott Gottlieb writes in The Wall Street Journal, The Doctor Won’t See You Now. He’s Clocked Out:

Big government likes big providers. That’s why ObamaCare is gradually making the local doctor-owned medical practice a relic. In the not too distant future, most physicians will be hourly wage earners, likely employed by a hospital chain….

ObamaCare’s main vehicle for ending the autonomous, private delivery of medicine is the hospital-owned “accountable care organization.” The idea is to turn doctors into hospital employees and pay them flat rates that uncouple their income from how much care they deliver. (Ending the fee-for-service payment model is supposed to eliminate doctors’ financial incentives to perform extraneous procedures.)The Obama administration also imposes new costs on physicians who remain independent—for example, mandating that all medical offices install expensive information-technology systems.

The result? It is estimated that by next year, about 50% of U.S. doctors will be working for a hospital or hospital-owned health system. A recent survey by the Medical Group Management Association shows a nearly 75% increase in the number of active doctors employed by hospitals or hospital systems since 2000, reflecting a trend that sharply accelerated around the time that ObamaCare was enacted. The biggest shifts are in specialties such as cardiology and oncology.

Read the whole thing. It explains how this structure alters physician behaviors, and how the esoteric and complicated billing structure exacerbates the situation.

I had dinner this weekend with a physician in private practice, who bemoaned the changes taking place and how much time he has to spend on “all that crap” other than practicing medicine. He doesn’t know how much longer he can take it, a feeling he says is common among his peers. They’re planning their exit strategies.