Turning doctors into patients' enemy.

• Position: ObamaCare - Impact of Patient Protection and Affordable Care Act on the independence of physicians and autonomy of patients

In years past, you could count on an independent physician to look out for patients inside and outside of the hospital. Times change and, today, things are quite different, according to Lawrence R. Huntoon, editor-in-chief of the Journal of American Physicians and Surgeons and a board-certified neurologist who runs a third-party free practice in Derby, N.Y.

Thanks to the Patient Protection and Affordable Care Act (ObamaCare), independent physicians are being squeezed out and, in some cases, deliberately driven out of business nationwide, charges Huntoon.

Hospitals and large physician groups are combining to form accountable care organizations (ACOs), designed to cut health care spending. In some cases, hospitals are combining with insurance companies to form exclusive provider organizations (EPOs) that limit choice to a small panel of physicians in an effort to maximize profits by controlling the care they provide.

Some doctors, beleaguered with increasing and costly administrative burdens imposed by government and insurers, have sought refuge in these new care models, perhaps not fully realizing what the loss of autonomy means for their patients, warns Huntoon. The developing culture in these ACO, EPO, and employed physician models is that doctors quickly learn to do as they are told and not criticize or speak out when the system is not working for their patients.

Physicians, for example, who previously referred patients to specific specialists based on years of trust and experience in the specialists' skills and abilities increasingly are being told to stop...