The Super Committee's abject failure to compile a plan that reduces spending by $1.2 trillion over 10 years was no surprise. But now, some healthcare leaders are looking with dread at the "sequester," a process by which hospitals and physicians will see automatic Medicare reimbursement cuts of 2% starting in 2013 through 2021.

Independent physician practices are slowly fading away, and with the advent of healthcare reform, the pace may be about to get much quicker. It's only one of a few troubling signs about the physician labor pool, which seems increasingly dissatisfied with their career choice and the direction of the healthcare industry.

When it all becomes too much-the falling revenue, the long hours, the hassle of working with third-party payers, the uncertainty of what the healthcare system will look like five years from now-many physicians dream of getting out. But there is another option that might appeal to them.

The AMA's House of Delegates' vote in November 2011 to "vigorously work to stop" the "onerous" implementation of ICD-10, due in just 22.5 months, caught some healthcare leaders by surprise.

When physician practices merge or integrate with hospitals or health systems, healthcare leaders say integration of practice teams and compensation are the biggest challenges. Trust ranks well down the list, according to a recently released HealthLeaders Media Intelligence Report. In reality, though, trust is at the heart of successful mergers of physician practices-and lack of trust contributes greatly to failure.

Diamantoni & Associates of Lancaster, PA, attested to Stage 1 of meaningful use recently, resulting in the five-office practice and 18-provider group receiving more than $300,000 in federal incentive payments. Along the way they learned a few lessons that might help other practices, says health information technology consultant Christine Kelly of CMK Consulting, who helped Diamantoni with its EMR implementation.