[eszed]

You're right, but local independent physician business model is being destroyed by insurance requirements. I have an uncle who ran an office like that for 20+ years. He employed two nurses, a receptionist, and a full-time coder (for those of you who don't know, that job is the translation layer between medical services and insurance companies). I don't know the economic details, but lately he was spending too much of his own time arguing with insurance company medical "experts", and facing hiring a second coder. He closed his practice, and semi-retired. He's bitter, and doesn't think there's any route to physician independence beyond cash-pay / concierge care. (He's not a speciality that lends itself to that model.)