I speak from the experience of three decades inside the medical establishment:  What many people don't realize or remember is that the Republican assault against physicians began in full force during the Reagan administration.  Two closely related things happened: first, corporations began refusing to pay the kind of health insurance premiums required for physicians to keep earning their salaries/fees; and (2) Medicare began freezing, sometimes even reducing, physician fees.  Of course, for the first 20-25 years since then, it never occurred to physicians that they were simply being regarded as hired help by the "real" Republicans, i.e. corporate executives.  They never imagined that when Republicans see a payment to a worker--whether janitor or physician--all they can ever see is an opportunity to cut it and thereby improve their profit margins.  They certainly never realized that all the social conservatism of that generation of physicians gained them absolutely no respect from "real" Republicans (who dont care a thing about social conservatism).  What they did realize is that in very many large and small communities across America, absolute income of physicians has been going down--albeit slowly. And whaddya know, after a quarter century, physicians have finally waked up to realize what the Republicans have been doing to them, which is no different from what they always do to hired help. And then of course the profound demographic change in medicine has taken hold, too: whereas in 1975-1980 most medical school classrooms anywhere in the country were at most 5 percent women, now they are typically 50% and often more.