By ABBY GOODNOUGH, NYTIMES.com
MARCH 2, 2014 – TAYLORSVILLE, Ky. — Dr. Sven Jonsson, a primary care physician in this rural community, is seeing a steady tide of new patients under President Obama’s health care law, the Affordable Care Act. And so far, it is working out for him. His employer, a big hospital system, provides expensive equipment, takes care of bureaucratic chores and has buffered him from the turmoil of his rapidly changing business.
“This is just a much saner place for me right now,” said Dr. Jonsson, 52, who left private practice to work for the system, Baptist Health, in 2012. “I’m probably going to live another five years.”
About 25 miles away in the more affluent suburb of Crestwood, Dr. Tracy Ragland, 46, an independent primary care physician, is more anxious about the future of her small practice. The law is bringing new regulations and payment rates that she says squeeze self-employed doctors. She cherishes the autonomy of private practice and speaks darkly of the rush of independent physicians into hospital networks, which she sees as growing monopolies.
“The possibility of not being able to survive in a private practice, especially primary care, is very real,” she said.
Dr. Jonsson and Dr. Ragland represent two poles of that primary care system. Both live and work on the outskirts of Louisville, with the patience required of family practitioners who spend long days troubleshooting routine problems like back pain and acid reflux. But the similarities in their practices end there.