dr. palomara has been here before. almost every year, congress passes what's come to be known as the "doc fix," a tweaking of the medicare formula that sets payments for physicians. often, the doc fix is done at the very last minute, leaving doctor's worrying about how they will pay their bills. >> i have to tell you, though, perhaps like somebody who has chronic pain, you kind of learn how to live with it and you just push it into the recesses of your memory. >> reporter: this problem began when congress changed the way doctors are paid for treating patients on medicare. a new formula based pay on the growth in medical inflation and the number of seniors seeking care. on paper, the savings were huge; in practice, the new formula was a disaster. >> as it turns out, the formula was well off, and we keep having these across-the-board cuts that it indicates. and the congress says, "no, no, no, we can't use the formula," and they fix the doc's reimbursement. >> reporter: the new formula also targeted only one part of a com