The many regulatory, reimbursement and policy changes related to the Patient Protection and Affordable Care Act are undoubtedly changing the business climate for physicians. In a feature with video, the New York Times contrasts the practices of two Kentucky primary care doctors — Sven Jonsson, M.D., and Tracy Ragland, M.D. — to illustrate the economic pressure pushing many sole practitioners into employment by large health care networks.

Dr. Jonsson was a sole practitioner who gave up his business and became an employee of the Baptist Health hospital system. Dr. Ragland is continuing with her small independent practice. Their personal stories illustrate why network employment is increasingly attractive, or put another way, why operating a small private primary care practice is increasingly difficult.