1.      Inflation: most notable is that compensation gains have not kept up with one of the most severe inflationary growth decades.

2.       Salary Surveys: use dated information that does not reflect real-time numbers and often is 1-2 years behind what's happening in the market.

3.       Malpractice Insurance Premiums: most insurance companies are passing along their increased staffing costs, inflation in operational expenses, increased benefit costs for their workforce, etc.

4.       Costs of Living:  the cost of housing has skyrocketed in some areas of the county.

5.       Reimbursement: Regulatory Changes, like the No Surprises Act, have caught physicians off guard and in many cases, they are being reimbursed considerably less than in the past.  Also it's been sometime since most physicians have seen any meaningful increases in reimbursement from government payors and in some cases commercial carriers too.