My professional life has changed radically over the past several months. I have left academic medicine and have started a private practice. Living in the professional cocoon of the university, I had absolutely no idea of the complexities, pressures, anxieties and great joy associated with this enterprise. I never dreamed that I would be paying a practice management consultant, a phone installation consultant, an employee health insurance agent, a computer consultant, an office security consultant, a janitorial consultant and the credit card processing company sales associate to provide advice.