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The health care markets in which physicians practice have changed dramatically over the last 20 years. These markets continue to evolve and change, and with these changes have come many challenges for physicians. Some of these changes are positive. Advances in technology, for example, have permitted physicians to offer their patients a higher level of care. Advances in pharmaceuticals and treatment methods permit physicians to treat diseases that were once thought incurable.

Some of the changes in health care markets, however, have resulted in a steady deterioration in the ability of physicians to: (a) treat their patients in a manner they consider best, and (b) earn an appropriate level of compensation for their services. Today, physicians face very large and powerful health insurers that can simply set the level of remuneration they will pay physicians. These health insurers will also, on occasion, establish guidelines that exert significant control on how physicians practice medicine. The efforts taken by physicians to address the challenges created by large health insurers  include, for example, outright mergers of individual practices and the creation of independent practice associations. These efforts and other collaborative efforts can raise antitrust issues under certain conditions.

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