Bravo for the "Point of View" sent in by Dr. Stuart Copperman. He has crystallized almost everything that I have felt regarding the way my own practice has veered. I have not been at it quite as long as he has, but I have seen the changes that have come about since fee-for-service has turned into HMO medicine. We have lost all control.

I am especially dismayed that the Academy stands on the sidelines when nothing short of the "rape of American medicine" is being perpetrated by today's medical conglomerates. My patients are decidedly not better off and the patient-physician relationship has suffered — an irreversible blow.

There is no such thing as loyalty, as parents and their employers continue to seek the elusive bottom line. We are PCPs and not physicians, and we come and go on a whim. We are by no means suffering economically, but it seems a sin that the patients' costs are increasing, our reimbursements are decreasing and the high echelon functionaries of the insurance companies are making a killing.

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