Thanks for the info on IMP. I always learn so much from this board. Although I'm more traditional in practice structure and size (multiple plans, 3.66 employees and about 2000 patients)I yearn to run leaner and perhaps one day come "off the grid" completely, going back to old fashioned fee for service with maybe a modest annual fee to cover misc services such as refills. I don't like the concept of a high priced concierge practice (I didn't become a doctor to just treat rich people). I'm only in my second year of solo practice(11 years total internal medicine practice however)so I'm still evolving my practice. We do have an extra employee to handle referrals, prior auths and so on. While I hate the concept, I have a wonderful person in that position and would not let her go without a fight. Besides, my philosophy includes running a business for the benefit of all the employees and not just for the owner. I wish I could pay them more, yet that is nearly impossible with the current overhead and low reimburesements (we provide a health plan and 401k retirement). A question I always ponder is "How much is a primary care physician truly worth?" I feel 130-150k is a decent salary, yet I do get envious when I see procedural and hospital based colleagues make 2-3 times that much, especially since my wife and I essentially live off my earnings (she is my part time office manager). I'd love to hear other people's thoughts.

For HockeyRef Paul: AC has really helped organize messaging within the office yet I do find it has slowed me down considerably on notating. I can still dictate faster on my Palm Pilot than with Dragon yet I'm sure if I learned/programmed some macros I'd be faster. I continue to plug away with Dragon since I know the more I use it the "smarter" the program becomes and the faster I will be. Encourage your wife to try it for some of her notes each week. I use the $200 version of Dragon and NOT the medical version. The medical vocabulary in the professional version is pretty good. The secret to Dragon working well is the power of your hardware. Faster processors and especially more memory are very crucial. Good luck.