In 2017, perhaps more than any other year, significant change is likely to lie ahead for physician practices.

Here are some of the top challenges that doctors will face this year:

MACRA. There’s no surprise there, as the new physician reimbursement system kicks in this year. Physicians will have to adapt to changes brought by the Medicare Access and Chip Reauthorization Act of 2015.

“MACRA is the biggest thing that’s hit healthcare payments in a generation. This is going to be transformative,” John Goodson, M.D., an internist at Massachusetts General Hospital and an associate professor of medicine at Harvard Medical School, told Medical Economics.

Many physicians are still trying to figure out the complex reimbursement system described in a 2,400-page rule, and they need to educate themselves and choose one of two reimbursement paths: advanced alternative payment models or the Merit-based Incentive Payment System.

An uncertain political future. No one is sure what will change for both doctors and patients with a new Republican Congress and Donald J. Trump in the Oval Office, although both are committed to overturn the Affordable Care Act..

"The uncertainty looming with the ACA's future is a front-burner issue for primary care physicians because of the significant impact of repealing and replacing it,” Timothy Hoff, Ph.D., a professor at Northeastern University in Boston, told Physicians Practice. Groups that represent hundreds of thousands of physicians are urging Congress not to increase the number of uninsured individuals as it moves ahead with plans to repeal the ACA. Physician practices could see patients coming and going if their insurance changes, and if Americans lose their coverage provided by the ACA, practices may see less patient demand.

Changing patient attitudes. Gone are the days when patients were willing to tolerate long waits, confusing bills and inconvenient appointment times to see a doctor, according to Diagnostic Imaging.

Patients have greater expectations for service from their physicians' offices and are increasingly demanding immediate access, convenient hours and multiple ways to communicate with their doctors. At the same time, physician practices face greater competition from retail clinics and are faced with making the patient experience a high priority.

Deciding their personal future. Many physicians will have to decide whether to stay independent or seek employment with a hospital or healthcare system. “The number of small independent practices—which used to be the core of the practice of medicine in the United States—is at its lowest number ever,” Ralph Nobo, M.D., an obstetrician/gynecologist in Bartow, Florida, told Physicians Practice.

One study found 1 in 4 medical practices is now hospital-owned, a trend that is expected to continue in 2017.

Surviving the daily struggle. Running a private practice isn’t easy, and many physicians are finding it harder to enjoy their work. “Physicians feel they’re spending their days doing the wrong work, and that leads to burnout,” Christine Sinsky, M.D., an internist and vice president of professional satisfaction for the American Medical Association, told Medical Economics.

To combat burnout, doctors can make changes in their work environment to create time for themselves, embrace outside interests such as art and music, and focus on wellness with good nutrition, meditation and other stress reducers.