The problem is: Doctor Revenue = Number of Hours Worked / Yr / Duration of Average Visit * reimbursement for average visit That's capped, and everyone is sque

The problem is: Doctor Revenue = Number of Hours Worked / Yr / Duration of Average Visit * reimbursement for average visit That's capped, and everyone is squeezing down on it constantly. Every bit of healthcare reform in the last couple decades has been unfunded mandates (aka, increased overhead) coupled to ongoing reductions in reimbursement rates. For that matter, as is usually the case when price ceilings are implemented, demand > supply, and docs are booked to capacity in most places. This creates a problem when it comes to hiring staff. Better staff comes directly out of your pocket, and it doesn't translate into higher revenue: it's just a cost. Er... most businesses don't throw money out of the window if they can avoid it. The exception is billing staff (some of whom are better than others at maximizing your revenue from insurers), and if you plan on moving into a luxury all-cash niche, in which you can demand market rates for better service.