I’ve found that if I cut back on my hours everyone who works in my office gets paid except for me. Medicare has decided I deserve a 9 percent pay cut over two years, and if I accept that, private insurers will assume I am willing to do the work for less and cut their payment by that percentage or more. If malpractice rates also increase more, it would likely cause me to close my office and take an hourly job in an urgent care or emergency department.