Running a small business is hard, and that’s especially true for doctors running private practices. Like any small business owners, they’re navigating payroll, expenses and overhead. Add on the bureaucratic red tape and chronic underpayments that come with billing Medicare and it’s a wonder that doctors have the time and resources to see patients at all.
If we want to improve the health of Americans and make it easier to access care, not harder, it’s time for Congress to prioritize protecting private practice. Instead, we’ve seen the government picking winners and losers. These market distortions only contribute to our nationwide healthcare shortage, and the problems in Texas are especially worrying.
According to the Texas Public Policy Foundation, a conservative think tank, the state “is projected to be short 10,330 doctors by 2032.” It estimates that more than six million Texans live in areas with shortages of health providers and notes that “37 counties lack a single primary care doctor.” Also: “To make matters worse, 15 percent of Texas’ primary care physicians are 65 years old or older and getting ready to retire.”
Part of the blame must rightly fall on Medicare’s flawed physician payment system — known as the Medicare Physician Fee Schedule, or MPFS. Unless addressed, the structural problems inherent in the fees that Medicare will pay could force local, independent community doctors to stop accepting Medicare patients or even go out of business altogether.
At the heart of the issue is the fact that Medicare drastically underpays independent physicians for the care they provide. According to data from the American Medical Association, payments to physicians through the MPFS have been on a slow and steady decline for decades. Since 2001, Medicare payments to physician practices have fallen by 33% (adjusted for inflation). By failing to tie physician payments to the inflation in the cost of running a practice, the federal Centers for Medicare and Medicaid Services is forcing smaller physician practices to do more with less.
As Medicare payments become increasingly inadequate to sustain independent physician practices, many are being forced to reduce their staff or the range of services they provide, turn away Medicare patients or exit the profession entirely. The other alternative is to accept a buyout from a large health system or hospital. But those tend to be farther away from home, feel less personal and charge patients and taxpayers more.
In any case, limited payment is driving physicians out of private practice en masse. In 2024, only 42% of physicians worked in the private setting, a nearly 20 percentage point decrease from 2012. With fewer options for care, the strain on existing physician practices and wait times for patients continue to grow. According to a recent survey, patients must wait an average of 31 days for a physician appointment in major metropolitan areas such as Dallas-Fort Worth and Houston. That’s an increase of 19% since 2022 and 48% since 2004. These long waits can undermine patient outcomes and lead to even worse health complications.
Congress must address these concerns and put the fee schedule back on a sustainable, stable path forward to strengthen and protect local physician practices as well as access to care for patients.
After five straight years of cuts, lawmakers recently approved a slight increase for doctors in 2026, but it doesn’t address the cuts physicians are facing this year. Nor does it ensure reimbursements in future years will adequately reflect the rising cost of care.
Moving forward, lawmakers must pass legislation that ties payments through the MPFS to inflation — as with other Medicare provider payment systems. By doing so, Congress can provide the support and resources physicians need to keep their doors open and continue serving their patients and communities. Fortunately, Texas Sen. John Cornyn recently said that he hopes doing so is “high on the agenda.”
With the clock ticking, Texas’ leaders in Washington should help level the playing field for physicians throughout the Lone Star State and across the country. The sooner they fix this broken Medicare payment system, the better off we will all be.