Essentially, there has been a decrease in autonomy. When physicians want something, they now have to go through insurance companies, who require extensive documentation and reasoning for it, or they will only cover things that may not be in the best interest of the patient, etc. There's more of an emphasis on documentation for billing purposes, so now a lot of notes have a lot of needless fluff in them to make sure they meet the right billing code, and aren't as useful to hand off to another care provider.
Physicians are generally not their own bosses anymore, either. They often work as a part of a group practice or a hospital-owned practice, which gives them even less autonomy.
There's been a shift in the paradigm from 'physician as customer' (everything we do is for the physician) to a 'patient as customer' perspective as well, which means physicians are leaders of a team, but it is a much more team based approach.
Along with all this has come a decrease in reimbursements.