A growing trend? Malpractice is an obvious issue, and they are finding out what physicians already know – malpractice insurance is cutting into the business model:

Building the practice has presented challenges. The biggest, said Bryson, was mastering the billing process and getting insurance companies to reimburse her for her services. She’s gotten much more adept at dealing with insurers and now gets much better reimbursement than she did when she started.

Bryson uses a billing assistant who gets paid 5% of what Bryson collects from insurance companies. That’s just one of several expenses that cuts into profits. One of the biggest is malpractice insurance, which last year cost about $20,000.