My wife is a university doc. She's looking at a reduction in salary... not because of doing less work, but because of lower "collection"... the university is also the hospital of the indigent and much of their patient load is of the Medicaid and other government-like sponsored insurance. Even when they get paid, it's usually $.30 (or less) on the dollar from government insurance sources... barely covers the hospital's out-of-pocket cost to provide the care.