"I have increased stress, high blood pressure," he says. He's so wound up by the time he gets home from the office that his wife won't talk to him for an hour afterward. He's watched a couple of physician friends undergo open-heart surgery. Still, he's reluctant. His income dropped 25 percent in one recent year." "Doctors have lost ground. Insurance companies have ganged up on them. "I have anxiety about staying in business," says an internist who's put his own money toward payroll. The trouble isn't just financial. Perks, privileges, esteem (self-esteem too) have all been hit. Many physicians work longer hours. And now, it seems, all kinds of people -- including clerks! -- are telling them what to do." "many American doctors are unhappy with the quality of their professional lives." The literature on this reads like the intake form at a depression clinic: "increasing marginalization," "discontent," "confused," "angry," "insulted." "Lately, lots of doctors have to pick up work on the side. Horowitz works as a medical consultant at Juilliard. One doctor got involved with a dot-com for a few years -- which was the last time he flew business-class. Some physicians augment their incomes by selling herbs, food supplements, cosmetics, even household cleaners in their offices. Schayes sells vitamins. "I buy wholesale and sell retail," he says. "It was kind of embarrassing at first. But at the end of the year it makes a big difference." Last year, Schayes, an M.D. approaching the height of his earning power, earned about $120,000 -- which doesn't come close to buying what people once thought of as the M.D. lifestyle. Soon, Schayes figures, his wife will have to go back to work. She hasn't worked in five years while the kids grow up. "She doesn't want to, but I'm making her," says Schayes. "Besides, she's a lawyer. Her earning potential is greater than mine." "As Fox explains, "I don't have any clout." Insurance companies have clout, institutions have clout, even patients have some. And so, just like any disgruntled worker, doctors -- doctors! -- are turning to unions." "The insurance industry has created a slave workforce out of the doctor," says Moshe Rubin, a gastroenterologist at Columbia." http://nymag.com/nymetro/health/features/5044/ This is today, just imagine what it will look like ten years from now .