One of my docs closed down a practice because of the payment structure for medicare/medicaid patients. Let's say a procedure costs a doc $100 to perform, considering supplies, staff, overhead, etc, and then Medicare/Medicaid send you a check for $75, or less. How long, working on that kind of math will you eat through your cash?

Much better to be an ER doc for someone else, make the big bucks, and not have the headache of employees, building overhead, etc.