The details of the plan, first announced last week by Senate Majority Leader Harry Reid, D-Nevada, as part of a compromise to win over senators opposed to a "public option" - a federal health insurance plan to compete with private insurers - are shrouded in secrecy.

Reid is waiting for the Congressional Budget Office to complete a cost analysis of the measure before providing specifics. Even the No. 2 Democrat in the Senate, Richard J. Durbin of Illinois, said he was "in the dark" about aspects of the plan.

West Virginia family physician Stephen Sebert, MD, is waiting for vaccine that may not arrive.

In early October, his multispecialty practice received influenza A(H1N1) vaccine for about 100 employees who interact with patients. But that was it. His patients still need to be immunized, and Dr. Sebert wonders if he will get another shipment of vaccine.

"We were telling patients, 'Get [the vaccine] any place you can.' But now I don't think anyone has it," he said.

Similar scenarios of vaccine shortages and distribution woes have played out from New England to the West Coast as the H1N1 virus spread nationwide. Even as the epidemic begins to wane and states prepare to lift restrictions on H1N1 vaccinations, some physicians lack supplies of vaccine.

Would you like a golf club membership with your medical office lease? How about a few months of free rent? Fresh paint for the walls? How about just lower rent?

"Everybody is renegotiating their leases," said Tom Dalcolma, a partner in Street Sotheby's Medical Realty Advisors in Columbus, Ohio. "It's clearly a tenants' market."

The real estate slump, combined with tighter credit, means that fewer medical office buildings are being built. But after a previous construction boom, there is still more supply than demand.

So rents are creeping downward, and vacancy rates are going up. These are the conclusions of the Medical Office Research Report published by the real estate investment company Marcus & Millichap. The report looked at the second half of 2009.

"It is unlikely that individual primary care physicians annually see a sufficient number of eligible patients to produce statistically reliable performance measurements on common quality and cost measures, calling into question whether their performance can be differentiated with respect to national benchmarks," write David J. Nyweide, PhD, from the Centers for Medicare and Medicaid Services, Baltimore, Maryland, and colleagues. "This limitation might be overcome by measuring the collective performance of primary care physicians at the practice in which they work."

The aim of this study was to determine whether primary care physicians working in a group practice collectively see enough Medicare patients annually to detect meaningful differences between practices in ambulatory quality and cost measures.