My husband is an Internal Medicine physician with a large practice, over 5000 patients. Over 70 % are Medicare recipients. If the cuts take place, he will no longer accept new Medicare patients and he will stop taking Emergency Room call. This will compound the issues of already inadequate access of medical care to senior citizens in our community. In addition the fiscal realties are no small business can sustain a 21% cut in 70% of its income without ramifications. Patient services will be diminished; employees and benefits such as health insurance will either be decreased or cut out altogether. Lastly he will consider closing his practice and looking for other patient care opportunities where Medicare is not integral to business viability.