For the 50 percent of U.S. physicians currently running private practices, making payroll each month, let alone keeping their doors open, has become a widespread struggle. As a recent column from CNNMoney pointed out, declining insurance reimbursements, increased regulations, rising overhead and flat pay are among the top reasons doctors cite for going broke.

Although independent doctors in most specialties have suffered lately, cardiologists and oncologists have been especially hard hit. For cardiologists, recent 35 percent to 40 percent cuts in Medicare reimbursements for key services, such as stress tests and echocardiograms, have taken a substantial toll on revenue, private practice physician William Pentz told CNN. "Our total revenue was down about 9% last year compared to 2010," he said of his Philadelphia practice.

In oncology, changing reimbursement structures have caused some physicians to fall into debt, they say, because they continue to treat underinsured patients with cutting-edge therapies only to realize later that much of their care would not be reimbursed.

An overarching problem for almost all private practice physicians, however, is a lack of acumen for running a small business. "On average, there's a 10 percent to 15 percent profit leak in a private practice," Marc Lion, CEO of Lion & Company CPAs, told CNN.

But even though doctors don't go to medical school to learn business skills, they must learn how to stop the leakage if they're going to remain in private practice. As Physicians Practice blogger Ike Devji pointed out, "Just being a good doctor is no longer enough." He wrote that practices that haven't already done so work hard to master the ins and outs of their expenses, cash flow, and projected earnings, and develop a plan to address problems immediately. Furthermore, practices should do all they can to keep more of the dollars they earn by enhancing their risk management and reducing their overhead as much as possible.

To learn more:
- read this article and another article from CNNMoney
- read the post from Physicians Practice

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