Billing insurance and patients costs me money directly.  Financially, every doctor would be better off if patients paid for services at the time of the visit.  My employees have to be certified and trained.  They need a good income and benefits without actually making any more revenue.  The billing program or billing service is costly.  The claims clearinghouse charges their fees.  When the insurance companies are running short of funds (common with Medicare and Medicaid), they "lose" the claims or say that they were filled out wrong.  Of course our computer program can't fill it out wrong and the clearinghouse verified that it was correctly filed out.  Now the billing employee spends hours on the phone.  When we resubmit the claim, it is on paper and has to be mailed (postage).  The insurance can now postpone for months before assessing the claim.  If they "lose" the second one, it is easy to get on the wrong side of the billing deadline where they don't have to pay at all.

The landlord wants more for rent again this year.  Many patients were shocked to see me reduce my floor space by 40%, just to get rent back to what it was when I first moved in 4 years ago.

Malpractice insurance keeps increasing.  This year TMLT wants a capital investment fee, again.

The cost of medical supplies keeps increasing.  Did anyone notice the price of gas?

Unfortunately, there is no way for me to increase my income to compensate for the increasing overhead.  The difference between reimbursement and overhead is the take home profit for the doctor.  With reimbursement going down every year and the overhead going up every year, a doctor's income goes down.  Once overhead goes higher than reimbursement or reimbursement from insurance companies goes less than overhead, bankruptcy occurs.

For me personally, I was hit with some severe overhead issues.  I left the Covenant Medical Group when it was being dissolved and I had to start from scratch with a completely new office.  At 6 months, I had a final, complete computer crash that lost $178,000 in accounts receivable.  The insurance companies and patients loved the loss of their bills.  While I was still paying the bank for the first computer contract, I had to hire a new computer company and service contract for $30,000.  The lawyer cost $30,000 to find out that I would not get any money from the first computer company since he had been a patient and most of our contract was by handshake (never trust a business person).  Then I found that my expensive billing employee wasn't working and allowed $40,000 of claims to get older than the filing deadline.  Then I get to deal with an embezzling employee.  The bank felt that these disasters were unrecoverable, but I lived on my retirement accounts and we survived as an office and a business.  However, there is no light at the end of the tunnel.  Paying $50,000 per year on loans whose interest has increased will take 7 years to pay off.  By that time, reimbursement from insurances will be lower and overhead will be higher.  I realized that I will never be able to pay my employees what they deserve or afford a retirement 401k for them.  

Overall, my office makes a good income compared to other family practice physicians, but the bank loans reduce my income to $30,000 per year for the past two years.  I do not feel that this is reasonable for my education, hours, and liability.  By moonlighting, I make up most of the difference, but I am working 77-90 hours per week.  I heard that this is "a little" more than most professional's work hours.