Temple, Texas, is a town of approximately 60,000 people about two hours away from Dallas—and too far for Dallas residents to drive for their care, no matter how much they trust their doctor.

But that’s where long-established Dallas family-practice physician Dr. Bill Walton is moving soon, much to the chagrin of his longtime patients.

Every day he has had to break the news.

After examining a 77-year-old white male Medicare patient with a recent heart condition, Walton breaks the news: “I’m leaving Dallas.”

“Oh, no,” the patient and patient’s wife say in near unison, looking a little more lost than when they came in.

“You see, I’m tired of the business of medicine, and I can’t keep up this pace. I’m 60 years old,” Walton explains.

And after more than 30 years running his own practice, he’s moving to Temple to work as a salaried doctor on staff for an integrated clinic and hospital system, Scott & White. There, he explains, he’ll be paid a salary and will be able to spend more time caring for patients rather than living the life of a solo practitioner and keeping up with the free-market pressures in the dog-eat-dog medical marketplace of Dallas.

In Dallas, it can be especially tough to make ends meet as a family-practice doctor, the lowest paid in the physician-compensation hierarchy, he says.

Dallas is, by many standards, a microcosm of the country at large: “We have one of the biggest free-market-driven systems in the world, and we have the highest cost,” Walton says. No one is organizing health care, he said. “It’s a free-for-all system.”

And in Dallas it tends to be a very demanding population; the pressure is on to offer the latest and greatest in technology, procedures, and tests, which can ratchet up the cost of care for Medicare patients, he said. The city also is a “specialist-heavy” city, Walton said.

Generally specialists tend to be quicker to order tests and procedures. And that attitude can translate into higher medical costs: Dallas is one of the most expensive cities for health care. It costs $10,103 to treat Medicare patients, nearly a couple of thousand dollars more per patient than similar big cities.

That higher price tag is a reflection of the culture: “The entrepreneurial spirit in this city is strong,” Walton says. And that can lead sometimes to excess in a system where physicians get rewarded for the quantity of medical procedures they do, rather than more low-cost services such as visiting with patients and offering advice on preventive care.

But that’s not for him anymore—and that’s why he’s leaving Dallas: “I hate being a businessman, but I love being a doctor,” he said.