In years past, Congress was able with little fanfare to pass legislation forestalling the physician payments cuts under the Medicare Physician Fee Schedule Sustainable Growth rate (SGR) formula. 2009 was a far different story. In fact, the SGR and the "doc fix" was a regular news headline for much of the first half of the year as the public was fixated on health care costs. Now, according a recently prepared letter from the Congressional Budget Office, it would appear that any long-term fix for the SGR is likely to continue to be elusive. According to the CBO, the temporary doc fix passed by Congress for the second half of 2009, together with inflationary adjustments to the Fee schedule, will over, the next 10 years, cost an estimated $330 Billion. In an era of fiscal-belt tightening, this is not comforting news to the physician community and likely means more fee schedule uncertainty next year.