I think it depends on where you practice and how many Medicaid, Medicare patients you have as well. It has certainly gotten much worse the past couple of years with lower reimbursment rates from the government , higher malpractice rates and even more people becoming uninsured. Medicare reimbursment will drop 12% in the next 3 years, you think your insurance carrier, office staff wouldn't mind a 12% pay cut? Another reason why it is so important to be politically active and fight for all physicians, not just your specialty. I mean the CRNAs make more money here than the Family Practice docs and general Internists do and some RN's are getting close. Not that money matters though right. If you look at it from a purely business standpoint, the return on investment is becoming pretty poor. Medical school is becoming more and more expensive and with state budget shortfalls, the Universities are getting less and less money so tuition increases will be inevitable. It wouldn't surprise me at all if the average loan debt in the next 5 years grows closer to the $200,000 mark. It's a problem, but it still is a wonderful profession.