1. There is a lack of independent doctors in the community. In essence, it makes it harder to recruit or replace cases if there are not additional independent doctors in the community.
2. One payor has too great of control of the market. In short, without a contract and decent rates from that payor, the center is in a difficult position.
3. There is no core group at the center. Rather, the center is really made up of whole number of individuals, none of which are too connected to each other.
4. The doctors own too little of the center. Here, if the center does well, the doctors may resent the fact that they own too little. Further, the fact that they own too little often prevents them from being motivated.
5. The center has overhead which is not easy to bring into line. The staff costs or fixed overhead costs are so high and cannot be moved into line and, thus, the center cannot thrive.
