Kathy, you make some good points, but I think reimbursement is a critical issue.  At one point there were five full-time orthopods on the Big Island including a classmate of mine.  That went down to one full-time and one half-time [I don't know the current status].  I stopped participating with te 800 lb gorilla aka HMSA in 1993 when they had frozen my hourly at $135 for four years yet had increase my premium FIFTY PERCENT.  Twenty years later I myself went into therapy----and the rate wa still capped at $135.  If HMSA had kept up with inflatiion, the rate would be $207.  Meanwhile our labor costs, electricity, etc. have certainly not been frozen.  Recall that Sen Josh Green, MD, forced the revelation of HMSA's annual income a few yeas back:  500K plus a bonus of 600K for a total of 1.1 MILLION!  Guess on whose backs that money came from?  Keep up the columns; I lke tem almost as much as your radio shows....when I'm on it! ;